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Planning for Tomorrow with a Change in Behavior

February 04, 2020

The concept of consolidated behavioral health, or CBH, has been introduced in preceding articles, and it is best understood as a strategic plan or vision for our field. This article will further elaborate that plan with my colleagues in mind. It is addressed to the many staff clinicians who love their work, want career advancement, and wonder where their field is headed.

Which entity should drive an agenda like CBH? Might a professional association take the lead? Associations tend to focus on more immediate guild concerns, much less on industry strategy. There is no existing organization in our industry to drive its strategic direction, and so the most efficient plan is to engage the people working in the industry who might embrace one.

Any hope to mobilize the energies of people working in this field must be clear about what a message includes and excludes. In fact, people should be able to evaluate the CBH plan much like they would any company they are considering for employment or investment. Let’s start with a vision statement for our industry as conceived in the CBH clinical model.

The concise vision would be to help people change behavior to ensure better health and wellbeing. The more detailed expression of this idea would be to help people change behavior to ensure better health and wellbeing, especially, mental health, safe use of substances, and a healthy lifestyle. This detailed version articulates the three domains that constitute CBH.

Mission statement

While a vision statement is aspirational and points to the future, a mission statement addresses what we are doing now. If a vision statement promotes strategic goals and an ambitious destination, a mission statement answers questions about what we should be doing, whom we service, and how we provide those services. A mission is the tactical plan that supports the loftier strategic plan and vision.

What do we do? A previous article on health behaviors focused on how our core knowledge of behavior change starts with psychotherapy. Resting on that foundation, coaching, digital self-care and other interventions based on therapy models can help people with mental health, substance use and unhealthy behaviors. Psychopharmacology can be adjunctive to these essential activities.

Whom do we service? There is an expanded population being served once you accept the CBH inclusion of health behaviors as central to its mission. Lifestyle behaviors are currently served with insufficient attention and help from several healthcare specialties. CBH recognizes the immense role of health behavior in chronic care, and it provides a strong therapeutic platform for developing skills in this area.

How do we provide services? Peer coaches and digital interventions are critical supplements to the work of professionals. Services today by text and phone can buttress those in person, and behavioral healthcare will always be at the forefront of new technologies since the communication of ideas is the essence of behavioral health solutions. Technology has transformed communication first and foremost.

A tactical plan

Ambitious goals cannot rely on a handful of leaders. Should our field agree on a strategic direction like CBH, we would then need the engagement of staff working in our industry. This is akin to social activism insofar as people must become engaged to push for change. Can we turn to the research literature for guidance in such efforts to engage staff to become a driving force for CBH?

Fortunately, there is an illuminating body of research on how organizations have succeeded in getting people involved in civic activism. Hahrie Han is a leading researcher on what makes certain associations more effective at keeping people motivated and engaged. Her analysis identifies two key features of high engagement organizations1.

They combine what she calls transformational organizing with transactional mobilizing. The organizers drive engagement around the mission. They shape leaders who drive activism with inspiring communication. Mobilizers focus on maximizing the number of people involved. They focus less on developing people’s skills for civic action. Successful organization have both types of people.

The main point of this research is that you need people with passion to bring about change rather than just position papers or mass marketing. There are people who motivate others and become leaders, while others specialize in enlarging the group. Some organize and lead; others mobilize new support. This presupposes a plan like CBH can inspire people and galvanize these dual efforts.

Why behavior change?

Professionals may ask how their training in mental health and SUD treatment can be condensed under the heading of behavior change. We have been trained that thoughts and feelings are every bit as important as behaviors, and yet only one gets top billing. This is more about scientific paradigms than science. We need to brand our psychosocial work, and the behavioral health category is already known.

Social groups coalesce around a concise message, a phrase everyone understands. The CBH vision is that we want to own all things behavioral. This establishes turf. It connects with the actual work we do to some extent, but it communicates in simple language with those outside the field. People often ask if behavioral healthcare is about behavior. The answer should be absolutely!

An unstated implication of the CBH clinical model is that it is largely an outpatient treatment model. There are linkages with other levels of care, and yet a focus on emergency care and crisis stabilization is complementary. Similarly, treatment with medication is vital, but exists as a complement to the core mission of behavior change.

One might ask why we need another clinical model, or an alternative to the medical model which confers great legitimacy on problems and solutions. This requires an extended discussion, and it will be the focus of the next and final article outlining CBH. Let it be said for now that the medical model seeks cures for diagnostic entities. Behavior change is more about living than curing, and about living well.

Many people wonder why our field is called behavioral health. It was originally an insurance term for two treatment domains, mental health and substance abuse (i.e., MHSA benefits). The CBH model now embraces a third domain of treatment, confronting the most pervasive sources of illness and suffering, and led by professionals with extraordinary potential to improve health and wellbeing.

The CBH clinical model is energized by two forces, one driving expansion to include all areas where behavior change is essential to health, and the other seeking integration of the domains for changing behavior so that each informs and potentiates the other. This might be described as noble and heroic work, but it is not curing diseases.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

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Reference

Han, H., How organizations develop activists: civic associations & leadership in the 21st century. Oxford University Press, 2014.

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