By Mark Humowiecki, Senior Director, Camden Coalition’s National Center for Complex Health and Social Needs
Chair of the complex care core competencies working group

“To do complex care, you need to be tenacious.” — Jonathan Weedman, CareOregon

The practice of complex care is radically different from traditional healthcare. It relies on integrated teams and cross-sector collaborations to provide whole-person care to individuals facing multiple, confounding physical health, behavioral health, and social challenges — a population that our healthcare system has historically failed. As described in the Blueprint for Complex Care: “Complex care involves … a heightened emphasis on relationship formation, team-based care, [] treatment of mental health and substance use disorders, and trauma-informed care, that was not part of training for prior generations of providers.” 

Success in complex care requires creativity and a commitment to do whatever it takes to support people facing the most challenging circumstances. This is particularly evident as we reckon with the disproportionate impact of both the COVID-19 pandemic and police violence on communities and individuals of color, whose complex health and social needs are often a direct result of structural racism.

For the last eight months, I have had the privilege of chairing a diverse group of experienced, passionate complex care experts charged with developing core competencies. Chartered by the Complex Care Field Coordinating Committee and chosen by open nomination, this group reflects the best of complex care – social workers, physicians, community health workers, nurses, lawyers, peer recovery specialists, and consumer leaders. They work in large academic health centers, health plans, rural hospitals, community based organizations, behavioral health agencies and healthcare for the homeless. They have lived experience providing and receiving care. 

The working group’s two vice chairs reflect the diversity and commitment of our field. Sara Reid is a peer leader in the Boston Healthcare for the Homeless program and in trans communities. Anna Doubeni is a family practice physician and teacher at Penn Medicine who works with homebound patients with complex needs.

Defining and developing the complex care workforce
Our work seeks to define the practice of complex care and the shared identity of a field still in its formative stages. Complex care practices have emerged organically out of experimentation and adoption of insights and practices from different professions and sectors about how to effectively serve those with significant health and social needs. We do not seek to define a new profession, but rather to identify competencies that are complementary to those already defined for the constituent members. 

Through this project, we are creating a framework for teaching, training, and evaluating current and future complex care practitioners. Beyond the competencies, we expect to establish standards and milestones and create model curricula that will enable individuals to learn about and work to attain the complex care core competencies through formative and continuing education. 

We imagine a future where nurses and social workers can obtain a specialization in complex care, where community health workers and peer counselors are certified in complex care, and where physicians and pharmacists can do a complex care fellowship. Moreover, we seek to introduce complex care principles and competencies in interprofessional experiences like our Interprofessional Student Hotspotting Learning Collaborative that have proliferated in health science programs throughout the country. 

Building consensus around the essence of complex care practice

In the course of our time together, the core competencies working group has discussed and debated the core elements of complex care.

• What is the essence of complex care practice? 
• What must every member of the front-line complex care team — whether physician or community health worker — know, believe, and do to work effectively with people with complex needs? 
• What are the unique knowledge, skills, values and attitudes that make complex care different from traditional healthcare, and what makes it work? 

Some ideas were obvious and had immediate consensus: we must be accepting of individual differences and able to form trusting relationships; we must understand all the determinants of health — biological, psychological, social and structural; we must communicate and collaborate in integrated teams that include the individual and their support structures. 

Other priorities required extensive debate. What are the respective roles of the individual, family, and care team in identifying care goals and achieving behavior change? What is the role of a front-line complex care practitioner in advocacy and helping create system change? What is their role in building the evidence base and adapting practice for people whose needs are extremely complex?

After surveying the field and extensive discussion, we arrived at six major domains encompassing nearly thirty competences:

• Human complexity and context
• Professional and personal commitment and ethics
• Person-centered relationship powered care
• Integrated team collaboration
• Diverse information management
• Systems complexity and context

How you can get involved

We are looking forward to sharing the final report and set of competencies with you at our virtual convening in October. As we continue to develop the competencies, we want to hear your thoughts. Do these draft competencies reflect what is essential in your practice? Are they the knowledge and skills you want your next care manager or complex care provider to learn in school? Are they applicable to all members of the care team? 

Let us know what you like, what needs work, and what is missing. We will be holding a webinar on June 12, 2020 at 1 pm ET to review the competencies and solicit feedback. Please also provide feedback about the individual competencies through our survey. You can also send more general comments to Rebecca Koppel, Program Manager for Field Building and Resources, at [email protected].

We know that this is just the beginning. A working group alone cannot achieve our vision of a complex care workforce that is prepared and supported to fulfill the principles and promise of complex care. It requires the commitment and contributions of our entire community, and we hope that you will contribute to this critical field-building work.

Learn more about core competencies for complex care