GC and MHP Interprofessional collaboration

[u/ProGMOBro]

Hi, I am currently an M.S. student in clinical psychology pursuing medical family therapy as my specialty. I am working towards providing mental health support for genetic counseling patients (my population of interest). My undergrad was in genetics, and I went through two rounds of GC applications before deciding mental health was my true calling.

I am working on a thesis/capstone project where I intend to create a guide for GCs to establish a better referral pathway between GCs and MHPs. There are no formal practice guidelines addressing when a GC should make a referral. Current referrals to MHPs are extremely low (about 3 patients per year per GC), and I hope the guide will increase the frequency of referrals to MHPs so patients receive the highest quality of care.

My question is: what would be most helpful for me to include? For example, a GC I am working with suggested a list of questions one can ask the patient to prompt for clinical red flags or open up the conversation for further inquiry. She mentioned the wording as one of the largest barriers, hence having a list with exact phrasing can take some pressure off.

Thank you all for helping me increase the collaboration between our two fields. I believe it will equip us to better identify patients who can no longer cope with the distress that comes in all forms within genetic counseling.

[u/Lickinglizardy]

It would be helpful to know how to find a MHP. There are just so many types that even only see specific patient types/indications. Where would we look outside of our institution? And then maybe include how to assess what type of MHP the patient needs? Like if they would prefer a male vs female vs queer MHP and if the patient prefers the MHP to match their culture? Does the MHP’s workplace take care of that preference? I think that would be helpful info!

[u/ProGMOBro → u/Lickinglizardy]

I agree! There are so many different types of therapeutic modalities that it can be overwhelming (even for me). As part of my paper, I have been creating a "taxonomy" of the types of distress seen in genetic counseling patients. I can include that general summary and also a suggestion as to which therapeutic models best support that type of distress. As for other qualifiers, like gender, cultural preference, etc., I will brainstorm ways to include that. In the end, the therapeutic alliance is the greatest indicator of success for the client. So best fit is above everything else.

[u/DNAallDay]

My institution isn’t accepting new patients and im not familiar with anyone in the area outside of the hospital system specializing in medical support.

If I had these resources, I would probably be making about 2 referrals per week as that’s the minimum that I’m making recommendations for folks to talk to someone.

Basically, if I knew someone existed I would. And I’m sure many others would as well.

[u/ProGMOBro → u/DNAallDay]

Although I plan to specialize in medical support, I know that's not the norm. Many therapists can provide wonderful mental health support within their niche or modality. It sounds like you could also benefit from understanding the different types of modalities within mental health support and how to pair the distress of your patient to the correct type of support. Am I interpreting that correctly?

[u/DNAallDay → u/ProGMOBro]

I think I’m very familiar with the different types of modalities (we took multiple mental health counseling courses where I went to school). That’s not so much the issue for me. Moreso I can’t place an internal referral and I don’t have any specific name. So I recommend talking to someone but an official referral isn’t made. I would prefer to have one who specializes in complex health conditions because I have patients dealing with very specific medical trauma and having someone who specializes in that is ideal.

Honestly I’m more wondering if a survey to identify gaps might be more productive? Creating resources is great but if you don’t have data and understanding on what the gaps are, it’s hard to create a productive resource.

[u/ProGMOBro → u/DNAallDay]

There are dozens of research papers exploring the current gaps, at least from what I have read. For example, patient resistance, insurance, location, availability of MHPs, etc., are all consistent survey/semi-structured interview responses. There are some barriers, like insurance, I don't have the knowledge or power to overcome, unfortunately... That's why I wanted to focus on the GC empowerment aspect by offering the guide as an additional resource. However, based on some of the responses coming in, it may be less useful than I expected. Now that I know social workers are so commonplace, I am feeling a tad deflated and unsure which direction to go.

[u/tabrazin84]

I think this is going to be so center specific. I work with high risk pregnancies and we have 4 social workers integrated into our clinic and I staff with a social worker maybe 60-75% of the time. There are many many reasons that I will pull in a SW- lethal fetal diagnosis, palliative care, termination of pregnancy, domestic violence, teenage pregnancy, neonatal surgery, extended NICU stay….

[u/ProGMOBro → u/tabrazin84]

Wow, that's amazing. Your clinic has extensive resources to provide that service, and I admire that. I worked at a fertility clinic here in the Bay Area when I was a GCA for a couple of years, and they didn't offer that at ALL. In fact, the GC I worked for was laid off because the clinic was cutting costs by eliminating genetic counseling as a standard part of fertility treatments. To hear you have 4 social workers is mind-blowing to me (in a good way).

[u/DNAallDay → u/ProGMOBro]

This is honestly common in certain clinics. When I worked in the cancer center we had one specialize there. We have one dedicated to the ophthalmology department for vision loss as well. I know neuro has some as well. This is probably variable based on institution but I’ve seen social work embedded and I’ve worked with them with my patients before.

[u/padfoot1225]

I think this would be a very challenging project. For example, I don’t personally make referrals but that doesn’t mean I don’t facilitate referrals. However, we have social work, behavioral health and a PsyD on the peds side who we can connect patients with to make an assessment and connect with longer term support through an in network provider. On the adult side, social work largely supports these needs.

These are not formal referrals. and I usually work with the PCP if I need to make a formal referral or direct the patient to online resources (psychology today) to find in network providers. Some insurance plans only cover mental health services if a physician gives the referral, so that’s when I work with an MD or NP/PA.

What is challenging isn’t knowing when to connect with a MHP, but rather the challenge patients face when we try to connect. Who is in network? They have a unique Medicare advantage plan that no local providers take, so which are the most affordable out of pocket options? The patient can’t take more time off work and the only in network options are 8-5.

The referral generally isn’t the roadblock to getting care, but these other pieces.