A Focused Ethnography: Mental Health Therapists in Pediatric Integrated Care

The scope of practice for Licensed Professional Counselors (LPCs) and counseling residents (LPC-R) in integrated behavioral health (IBH) settings is grounded in accredited, theory-informed education and training. The benefits of IBH models are well-documented, however there is limited research that addresses how counselors develop professionally and clinically function, while navigating within pediatric inpatient environments. This qualitative dissertation used a focused ethnographic design to explore the lived experiences of ten purposively sampled counselors (n = 10) through demographic surveys, field observation, and semi-structured interviews. Reflexive journaling bracketed researcher bias, and thematic analysis, supported by NVivo and new member checking, guided interpretation. Participants described navigating systemic and relational complexities, including fragmented supervision, shifting leadership, and marginalization within medical hierarchies. Simultaneously, they found meaning through peer consultation, collaborative teams, and witnessing patient and family system progress. Eight themes emerged: notable events, professional identity, conflict dynamics, collaboration, team cohesion, power imbalance, cultural relations, and continuous improvement. Findings highlight how cultural dynamics, interdisciplinary relationships, and counselor voice shape clinical identity, therapeutic practice and ethical decision-making. This study emphasizes the need for experiential training, context-specific supervision, and mentorship within high-acuity counseling. Implications extend to counselor education, quality clinical supervision, and interdisciplinary workforce development to support the advancement of integrated care for vulnerable child and adolescent populations.