View from the Board
Are Things too Complex to be Simple?
by Leighton Y. Huey, M.D.
Birnbaum/Blum Professor of Psychiatry and
Associate Dean for Community and
Continuing Medical Education
University of Connecticut School of Medicine
I don't know whether it is age or experience (or a combination that leads to creeping senescence?) that makes it seem that things are more complex than ever and spiraling out of control. Things seem unwieldy at all levels, in all spheres, whether it is health care or foreign policy or economics or the environment or how we deal with one another or how we measure success or failure...the list is daunting.. The immediacy of information has added to the complexity as we are deluged with various factoids and concepts that are thrown at us, often by our own doing, compounding the confusion as we attempt to discriminate what is legitimate and valuable from what is trash. And who determines legitimacy and value and what is trash?
At the risk of having this written off simply as a harangue, have we reached a point, where by virtue of complexity and overload, we can no longer distinguish easily what it is that needs doing? When I listen to talk shows and four people are saying something at the same time, interrupting, yelling, not being clear, I switch channels. It's not a debate but an assault. I have the same reaction when listening to spokesmen of different political parties or reading by-laws or tax forms or compliance manuals. What I want is something straightforward and unadulterated, something I can comprehend, understand, make sense of, regard as balanced and reasonable, and determine if that seems correct to me which might lead to some (hopefully) intelligent action on my part.
As we struggle with health care and the efforts at reform, what is it we are trying to do? Are we trying to cover as many people as possible? Are we trying to improve outcomes? Are we trying to get costs down? Should we adopt the Triple Aim as our mantra? Are we trying to get the workforce to function differently? Do we want a private system or a public system or a universal system or a hybrid? How much are we willing to spend? And spend on what? How much are we willing to do? And do to what? Can the existing workforce be retrained to do the right thing? And what is the right thing? And if it can't be retrained, then what? And how out of touch are our training systems? Who will change the incentives and disincentives to make them relevant to the need? Ad nauseum...
Are the challenges and tasks confronting us so complex that we cannot grasp the essence and as a result we do nothing coherent but work in a model of successive approximations? Is this as good as it gets? Is this just reality?
Maybe we need to adopt a new standard for the introduction of new concepts. Before getting to the complexities, how about giving us the Cliff Notes first? So we can size up the field, determine the dimensions, hear the note...before drilling six miles down and an inch wide. And how about for every mile of drilling down, we expect a pause to explain where this is going and how it relates to the original concept? Ever tried to understand what the Medicaid spend-down is all about and why it exists and how it affects individuals unfortunate enough to have to live through it? Or hear the pedant talk about ACOs and PCMHs and HIZs as if this were snappy patter and common parlance readily understood?
A longer proposition but maybe early childhood development can teach us another thing about how to simplify so we have a clearer understanding of what we need to do. Certain important concepts get laid down in critical periods that have a bearing on what happens subsequently. So, for example, if children are exposed to different languages early enough, they can become fluently multilingual, whereas for an adult trying to learn a new language it can be a struggle. What about exposing grade school and middle school kids to certain basic health care concepts just as they are exposed to addition and subtraction? Concepts that are part of the critical period of learning so that the education system takes a bottom-up approach to inculcating basic health care concepts into the developing cognition of kids eventually for a better collective understanding as adults. So in addition to areas such as nutrition, exercise, drug education, areas such as simple health economics and prevention, and maybe something about a few of the major diseases, are taught not so much from the factual aspect of this information but from the conceptual perspective.
So two things to consider: periodically, it seems we need to strip away the concretions in order to comprehend more readily what is happening so we better understand what we need to do; beginning early, teach some basic concepts that might help eventually develop a more knowledgeable populace. Such approaches would be useful now and down the road more than ever.
Annapolis Coalition Updates
CMS Leadership Summit White Paper Published
In September 2010, the Centers for Medicare and Medicaid Services (CMS) held a Leadership Summit on Building Capacity and Coordinating Support for Family Caregivers and the Direct Service Workforce. The summit was designed to bring together leaders across the care-giving field and develop standardized recommendations and goals for issues that cut across more than one area of the field. Family care-giving, direct service workforce development, policy makers and advocates were present at the summit.
The Annapolis Coalition was among the academic and research groups that attended, and it contributed to the creation of 12 common goals. Each of these goals contain specific policy recommendations, and are outlined in the recently published white paper that gives an overview of the summit.
Access the white paper here.
2011 Behavioral Health Pacesetter Award
The remaining case studies for the 2011 Pacesetter Award Winners and Programs of Merit are in the final stages of production. When complete, the studies will be posted on the Annapolis Coalition and Hitachi Foundation websites. In the coming months, we will work with the Award Winners to disseminate their successful strategies to other behavioral health providers.
We would like to offer a special thanks to Dr. Wayne Dailey, our Project Coordinator for the Pacesetter Award Project. He came out of retirement to lead this successful project and, although his work is completed, has agreed to serve as a consultant as needed going forward. His professionalism and perseverance were remarkable throughout, and the Annapolis Coalition is deeply indebted to him. He has earned the right to finally enjoy retirement!
Center for Integrated Health Services (CIHS)
We have been working with the CIHS leadership and the SAMHSA-HRSA leadership to formalize a strategic plan for the workforce elements of CIHS initiatives, and are moving to the implementation stage on a number of fronts. The workforce team meets (by phone) at least monthly to ensure that all its efforts are coordinated, and that all of the partner agencies benefit from the experience and skills of others.
In the Literature
New York Times Article Highlights
Decline in Male Therapists
According to a recent New York Times article ("Need Therapy? A Good Man is Hard to Find," May 21, 2011), men seeking therapy may be hesitant to follow through due to a lack of male counselors providing treatment. The article analyzes why psychology has become a female-dominated field, and the potential effects that this shift has on males trying to find a therapist who fits their needs.
As outlined in the article, the number of males in the psychology and social work fields has been steadily declining for some time now. Men currently earn only one in five of all master's degrees awarded in psychology, down from one-half in the 1970s, and men make up fewer than 10 percent of social workers under the age of 34.
The decline is attributed to both financial and cultural factors. The emergence of managed care led to a decrease in therapists' income in the 1990s and, according to the article, "psychiatry, the most male-dominated corner of therapy, increasingly turned to drug treatments. And as women entered the work force in greater numbers, they proved to be more drawn to the talking cure than men - in giving the treatment as well as in receiving it."
While studies suggest that the gender shift to a female dominated field does not impact the value of therapy, it may impact whether men seek therapy in the first place. Ronald F. Levant, a psychologist at the University of Akron, conducted a study among 266 college men and found that "a man's willingness to seek therapy was directly related to his agreement with traditionally male assumptions, like 'I can usually handle whatever comes my way.'
If a man agreed with assumptions like that one, it showed that he was more likely to try to handle certain issues on his own before seeking therapy. The study also found that if a man is unsure about seeking treatment, he may ultimately be dissuaded by the prospect of talk therapy with a female therapist.
According to Levant, men are simply more comfortable talking to other men when it comes to issues like sex, extra-marital affairs and aggression.
Read the full article here .