In July 2004, a subset of members of the NED planning team met at Georgetown University to draft a vision statement and set a work plan. The retreat team immediately realized that, while initial efforts would focus on a large gathering of educators a year later, NED's vision required a multi-year process. Work would include convening meetings, but NED would also engage in projects which could have stand-alone value. Those projects are described below.
NED Planning Retreat Team, July 2004: Back row: David O'Bryon JD, Ben Kligler, MD, MPH, Sheila Quinn, Adi Haramati, PhD, Pamela Snider, ND, Paul Mittman, ND, Adam Perlman, MD, MPH. Second row: Joan Leach, Pali Delevitt, PhD (cand.), Janet Kahn, PhD, LMT. Kneeling: John Weeks, Linnea Larson, MSW, MFT, Carla Mariano, RN, EdD, AHN-C, Reed Phillips, DC, PhD.
Phase 1: A Historic Meeting to Create Common Ground
The central NED project in Phase 1 was convening 70 educators at Georgetown University, May 31-June 3, 2005. Educators from the following professions were represented at the onsite meeting.
- acupuncture and Oriental medicine
- behavioral medicine
- chiropractic
- direct-entry midwifery
- holistic medicine
- holistic nursing
- integrative medicine
- massage therapy
- naturopathic medicine
- occupational medicine
- public health
- whole foods dietetics
- yoga therapy
Conventional medicine was represented by 23 of the 70 participants; each of the licensed CAM professions was represented by 3-10 educators; and the remaining participants represented other disciplines healthcare. Over the three days, participants met in small groups, interactive sessions, and as a Committee of the Whole. They listened to expert panels and responded to outcomes of initial NED projects. Most important, the group helped set an agenda for the next phase of NED and ACCAHC work. The priorities, published in the January 2006 issue of Explore, are noted below. A Progress Report on NED Phase 1 activity was published in October 2005. (click here for PDF)
Participants in the NED Onsite Meeting, May 31-June 3, 2005: Back row: Bill Benda, Bryn Clark, Karen Lawson, Lauri Grossman, Don Warren, Guy McCormack, Dan Seitz, Cathy McInturff-Ayers, Marcia Pengruber, Dawn Schmidt, Les Sweeney, Stephen Myers, Ira Zunin, Michael Traub, Rich Barrett, Joseph Brimhall, Mary Jo Kreitzer, Roberta Kaneko, Sue Fleischman, Adam Perlman, Tony Lu, Todd Rowe. Middle row: David O'Bryon, Gerald Monk, Jim Berg, Ivan Zador, Richard (Muz) Ansano, Mary Ann DiRoberts, Barbara Dossey, Mike Dyer, Joseph Kaczmarczyck, Sonia Ochoa, Jim Giordano, Joanne Myers-Ciecko, Anne Nedrow, Suzzanne Myer, David Peterson, Michael Goldstein, Catherine Niemiec, Sheila Quinn, Janet KAHN, Peter Wayne3, Dale Lick, Elaine Zablocki, Adi Haramati, Joan Leach. Seated row: Frank Zolli, Kory Ward-Cook, Veronica Zador, Sherman Cohn, Marc Diener, Jan Schwartz, Cynthia Ribeiro, Mary Guerra, Vic Sierpina, Chuck Sawyer, Carla Mariano. In front: Melanie Edwards, John Weeks, Whitney Lowe, Pamela Snider. Photographer/participant: John Pan.
White House Commission on CAM Policy (2001) Recommendation: The White House Commission on Complementary and Alternative Medicine Policy Report (2002) recommended:
"...agencies should convene conferences of the leaders of CAM, conventional health, public health, evolving health professions, and the public; of educational institutions; and of appropriate organizations to facilitate the establishment of CAM education and training guidelines. Subsequently, the guidelines should be made available to the states and professions for their consideration."
Outcomes of Phase 1
Status of Inter-Institutional and Inter-Disciplinary Relationships
What is the current status of relationships among educational institutions that train professionals for practice in the diverse CAM and conventional medicine disciplines? Where are there best practices? In early 2005, Benjamin Kligler, MD, MPH, and Michael Goldstein, PhD, led an eight member team conducting an internet-based survey of all 130 accredited programs from the five CAM disciplines with a federally-recognized accrediting body and the 30 members of the conventional academic consortium. The findings (presented at the North American Research Conference on Complementary and Integrative Medicine in May 2006) are available in PDF.
Values Working Group
Do the diverse disciplines involved with NED have shared values? If so, what are these? And what are the competencies involved in expressing these values? Carla Mariano, RN, EdD, AHN-C, led a team of professionals from nine disciplines in drafting a shared values document. The statement was utilized as part of the NED onsite meeting. Beginning in 2006, the Values Working Group is deepening their exploration of the "shadow issues" and strengths that may shape the integration process, studying, for example, issues of power and economics and of perceived inferiority and superiority. The Working Group anticipates developing educational resources and strategies. The work is partially supported by a grant from the American Holistic Nurses Association.
Educational Resources and Curriculum Task Force
Education in any of the healthcare disciplines is an intensive process that typically includes very little information about the many other kinds of healthcare practitioners. A joint ACCAHC/NED team is seeking to change this model. "We started out our work in developing educational resources with a very simple premise: If you wish to collaborate with someone, the more you know about the person and the field with which you wish to collaborate, the more effective and useful to the patient that collaboration is going to be." (Dan Seitz, JD, Co-Chair) What do we need to know about each other's disciplines to best work together? Who determines the content? Who presents the content? How do we manage hot-spots and overlapping content?
The optimal practice of collaborative, patient centered healthcare requires new knowledge and skills for conventional and CAM practitioners alike. Some are interpersonal, some clinical, some technical. In Phase 1 of this work, an ACCAHC-led team created a model template for collaboratively developing educational resources and curriculum models. It is included in the NED Progress Report as Appendix 5, page 36: A Model Outline for Educational Resources to Enhance Delivery of Collaborative Health Care (PDF)
Glossary and Terms
One of the differences among the diverse fields involved in integrated healthcare is that they use different language to describe or refer to the same thing. NED planners set as a goal the creation of a glossary to support the use of common language. The goal is to help participants in integrated health care work from common understanding of terms in their education, practice and subsequent communication. We have learned through surveys that clarity and agreement on definitions is important. Continued work on the Glossary is being carried forward as part of the Educational Resources work in Phase 2.
Shaping a More Inclusive Definition of Integrative Medicine
A definitive outcome of NED work in the first year was facilitation of a dialogue between the CAM educators in ACCAHC and the conventional educators in CAHCIM around the latter's definition of "integrative medicine." CAHCIM members had endorsed a definition of "integrative medicine" which referred to making use of "all appropriate therapeutic approaches to achieve optimal health and healing." The definition had no reference to practitioners from other disciplines. At ACCAHC's initiative, the NED team endorsed a request to the CAHCIM steering committee to amend their definition. As a result of constructive dialogue, the definition now ends: " ...all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing." With the change, any conventional academic who begins exploring integrative medicine will see that working with other providers and disciplines is of central importance.
Phase 2: October 2005-September 2007
PRIORITIES
(All priority projects depend on our ability to secure funding. If you are an interested supporter, or know of potential funding sources, please contact us at ihpc@ihpc.info .)
- Facilitate development of geographically based inter-institutional relationships among conventional and CAM institutions and disciplines. Promote student and faculty exchanges, create new clinical opportunities, facilitate integrated post-graduate and residency programs, and provide opportunities for students to audit classes and share library privileges.
- Create resource modules on teaching about distinct CAM, conventional and emerging disciplines (approved by those disciplines) that can be used in a variety of formats.
- Develop a website to foster exchange of educational and faculty resources.
- Continue multidisciplinary work to create a concise statement of core values with resonance across the disciplines to guide efforts to create quality integrated healthcare education.
Other Planned Projects
- Develop and sponsor continuing education initiatives designed to draw participants from diverse disciplines.
- Develop educational resources to prepare students and practitioners to practice in integrated clinical settings.
- Develop an outline of skills and attitudes appropriate for those involved in collaborative integrated health care.
- Provide support for leadership in change creation.
- Explore third-party clinical sites that serve the underserved, such as community health centers, as locations for developing clinical education in integrated healthcare practices.
Regional Collaborations: National Impact
The core NED strategy to fulfill this agenda is to directly support model regional collaborations that demonstrate best practices and create resources that can be made available for use by others. While still in the early stages, NED has begun work with educators from multiple institutions in four geographic regions. In the anticipated model:
Step 1: Regional leaders identify types of inter-institutional collaboration they are interested in exploring and the kinds of educational resources thatwould be useful in creating these relationships.
Step 2: NED-ACCAHC networks are used to find examples of existing "best practices" in the identified areas of interests.
Step 3: Regional leaders use the NED-ACCAHC resources to inform the developments of their own, regional models and educational programs and resources.
Step 4: Programs and agreements developed regionally are then made available nationally, via the NED-ACCAHC website.
This project has initial (but limited) funding from the ArKay Foundation. Additional funding is actively being sought.
NED-ACCAHC Partnerships with Interested Institutions/Organizations
While many healthcare leaders acknowledge that inter-institutional and cross-disciplinary action will be an increased part of their future, few have set a plan for exploring the opportunities and responding proactively to the perceived risks in this evolving world. NED and ACCAHC are in dialogue with a number of organizations on "partnership" strategies in which the organizations' integration-related objectives can be met, and a national benefit can also be realized. NED-ACCAHC is currently involved in partnerships with the American Holistic Nurses Association, and the National Certification Commission on Acupuncture and Oriental Medicine.
Contact: Direct queries on projects, reports, and partnership explorations to John Weeks, NED Project Director at johnweeks@theintegratorblog.com. Funding information or inquiries should be sent to Janet Kahn, PhD, IHPC Executive Director, at ihpc@ihpc.info.