mpc - case studies in pro bono care

8/8/2019 MPC - Case Studies in Pro Bono Care

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Case Studies in Pro Bono Behavioral Healthcare

Note: This feature on the Michigan Pain Consultants behavioral healthcare internship was originally published asa three-part series on the organization's blog,www.michiganpainblog.com. Michelle L. Davis, MA, LLPC, aformer MPC intern and founder of the behavioral healthcare internship, and current interns Lyndsay McGarryand Hillari Madison shared their experiences and thoughts regarding behavioral healthcare with the blog'scontent managers.

For more details about MPC, visit its web site,www.michiganpain.com.

Behavioral healthcare is an intimidating, medical-sounding phrase that few people, including those who need it,could probably define. However, its meaning isn't all that complex -- and after working with a program thatcontributed more than 1,500 hours of pro bono care during the past two years, MPC's interns are quite familiarwith defining it.

To me, it means care that addresses the interaction between the mind and the body, said Davis.

She explained: That intersection is not a one-way street. Things happen physiologically, to the body that candirectly impact how a person feels, and vice versa. Stress, for instance, can impact the body in a variety of ways.So behavioral healthcare can be simply explained as the science that addresses the physiological, social, andemotional well-being of a person in an holistic way.

In other words, behavioral healthcare involves both physical care and mental care, treating the body and themind as a single unit.

MPC's behavioral healthcare offerings can be a boon for a community, Davis said, for a couple different reasons.

First, there is a relative lack of mental healthcare for a majority of the overall population. And also because someof the social and economic demographics of Michigan make getting behavioral care for chronic pain particularlydifficult.

There is such a huge disparity between mental health coverage and policies that cover physical health. Mentalhealth, generally, is awfully underinsured, she said. The uninsured have no real coverage to speak of formental health treatment, and the underinsured are many times not adequately insured for mental healthcoverage either. In fact, behavioral health needs are much less addressed even among those people who areinsured through policies that seem very adequate, such as Medicare or Medicaid.

Those alarming trends are national in scope. But what about the specific needs of Michigan residents?

In Michigan, we're really feeling the effects of the economic difficulties that the country and the world are facing,Davis said.

Dire economic situations lead to more uninsured and underinsured patients. According to the Ann Arbor-basedCenter for Healthcare Research and Transformation, 11 percent of Michigan residents were uninsured thissummer. Since then, the employment situation facing the state has hardly improved, going from 13.2 percent thissummer to 13 percent in October, according to the Bureau of Labor Statistics. This is concerning because theprimary way to procure the health insurance that provides good, reliable care is through employment.

Location, too, matters. Pain care is a highly specialized area of healthcare, she said, and community healthcenters that frequently provide low-cost or subsidized care for the underinsured sometimes are not trained togive chronic pain care that requires a multidisciplinary, mind-as-well-as-body approach.
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So there is socioeconomic discrimination that comes into play, she said. Imagine being the patient who, wheninsured patients walk two doors down to get their behavioral healthcare, gets told you have to go to a communitymental health facility that is in another county.

Filling that void, she said, is one primary goal of the MPC internship program.

MPCs current interns agreed that a big part of behavioral healthcare is preventive care, or focusing on healthyliving by preventing afflictions from surfacing rather than scrambling to treat them when they do transpire.

Pro Bono: Temporary Volunteerism, Lasting Impact

Without pro bono care, Davis said, a lot of MPC patients may have been left without options for behavioral care.This demand is what led to the creation of a formal internship program to fill the void between care that wasneeded and care that was accessible to the community.

There was a group of patients who were just falling through the cracks. They'd get these referrals and it'd gonowhere, she explained. I suggested starting an internship program to address that challenge.

There had been interns at MPC before, but there hadn't been an organized program that allowed future internsto start where previous ones had left off.

The MPC behavioral health internship program will turn two years old in January of 2011, and the program'srecordkeeping has progressed to include procedural manuals and Wikipedia-like databases of program detailsthat incoming interns can learn from and ultimately add to.

Regarding pro bono care giving in general, Davis said that performing volunteer healthcare aligns with themedical community's professional code of ethics. She also pointed out some challenges those interested inproviding pro bono care grapple with: In order to legally donate their services for pro bono purposes, sheexplained, mental health providers have to work outside the context of their practice. If not, they risk committinginsurance fraud.

It's interesting how managed care limits this type of pro bono work for mental health professionals unless theyvolunteer at a nonprofit that isn't associated with their practice, she said. Because of [insurance] regulation,mental healthcare providers are actually discouraged from performing that type of work.

Davis, McGarry, and Madison all agreed that behavioral care that includes group settings, or a combination ofphone support and in-person group education, is one direction the internship program may look to progresstowards.

This would be particularly appropriate for the MPC program because, oftentimes, chronic pain patients lackadequate social support to complement their care.

We think adding a group element could be a big plus for the patients, and is something interns would beparticularly well-suited for, Davis said.

Grasping Experience From Pro Bono Care

The Michigan Pain Consultants' behavioral healthcare internship has a dual purpose. It provides pro bono

behavioral healthcare to those in and around Western Michigan who need it most. In addition, it guides medicalprofessionals through an intense period of training meant to complement their education.

In other words, it gives interns practical, real-world experience they would not receive in the confines of aclassroom.

Because MPC is a private practice, it has been really good for me to see the nuts and bolts of how it's run as awhole, said Madison. Getting hands-on experience with patients in classes is somewhat of a static process. Butwhen you're actually speaking and interacting with the patients, you get a more dynamic experience, and youstart to see all the intangibles that happen as a result of those encounters.


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This feedback makes adjusting the therapy to fit the patient easier.

McGarry recounted similar sentiments.

I wasn't expecting to have such a diverse internship, she said. A lot of my classmates, for example, hadinternships where they're doing all one-on-one contact with clients, or all organizational tasks, or spending all oftheir time on one specific task or process. From this internship, I got a diverse perspective that ranged widely: itincluded one-on-ones with clients but also program development, organizational-type work, honing other skills

that are important to counselors, and even public speaking.

She added, I never thought I'd have the opportunity, at an internship, to learn both the organizational skillsrequired to excel in a private practice as well as the clinical skills for providing clients helpful behavioral care.

Davis explained the specifics of the internship program. Interns are typically in rotation for two semesters of part-time work, she said, as opposed to one semester of full-time work.

To have them in for one semester doesn't give adequate time to get completely up to speed with the specificnature of the work. We want to give interns enough time to form relationships with not only our staff, but with thepatients as well, she explained.

She summarized the two-semester experience thusly: What the interns do for our practice is a bit above-and-

beyond what you're trained to do in your classes and coursework. She also said she has noticed that the staffregularly ends up treating the interns as full-time colleagues at the practice.

Both Madison and McGarry recounted specific experiences from their internships that stick out in their minds.

Madison said the human connection she forged with patients was a lasting memory. It's good to see when thelight goes on. Some of these pain patients have really put their lives on hold and have been held captive by theirafflictions. Our focus on a multidisciplinary approach to pain management improves life quality, and it's gratifyingto provide.

McGarry said one challenging experience is a highlight for her. She presented at the MPC clinical educationsymposium with a colleague during her internship, which required her to address the entire organization publiclywith a presentation about her areas of responsibility.

For me, that was a big challenge to overcome because public speaking has not been my forte, she explained.It was something I was challenged to do and I did it, and I learned a lot and grew professionally from thatexperience.

mpc - case studies in pro bono care

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