I’m running around, doing whatever it is that I do at a fast pace all
day long; seeing patients, supervising behavioral health providers,
consulting with medical providers, reviewing unanticipated outcomes,
trying to incorporate our behavioral health work into the new electronic
health record and uh-oh, my blog is due. As I start preparing to write
about the parallel process of change for patients and staff as we
transition to an electronic health record and an increasingly complex
world, I keep getting interrupted by some kind of patient need. I get
pulled away from writing about life in integrated care, to the reality
of patient care. That darn patient who relies on us for so many
unusual services keeps stopping by. He needs his pill boxes filled,
and can we check on his dental appointment time? He’s feeling stressed
and suicidal, can we talk to him? He’s got medication questions, and he
needs help in figuring out the letter he just got from unemployment.
Do we have anything to feed him because he missed breakfast in order to
catch the bus… and just in general, can we make time for him when
there often just isn’t time? It struck me that this is what you do with
family; shift your priorities and make time to focus on what’s
important. Of course we’ve got time. My blog theme just morphed…
of the values of the Collaborative Family Healthcare Association is
involving family members in patient healthcare. However, in many areas,
and in the life of many patients, their families aren't available, or
aren't even a great source of support if they are available. In the
rural resort region where my non-profit clinic for un/underinsured, low
income patients are served, we rarely see patients who've grown up here
or who really have any strong family ties. Often they "escape" to the
area due to unhealthy family situations or an inability to fit into a
patients, perhaps more than those with traditional families, need
providers to expand their definition of family to provide comprehensive
healthcare. Care providers need to challenge our notion of family. What
is family? People connected by duty, blood, history, values? Is there a
way to engage community members in this same manner? What does a
supportive family provide? Companionship, understanding, compassion,
honest opinions, help with life's day to day and big time struggles.
Communities can do that...
Ty! He is that darn needy patient who says: "I can't figure it out,
but everywhere I go people know me and say hello and are nice to me."
is a middle aged male who is currently involved in many services in our
community. He's suspected of having cognitive impairment his whole life
as evidenced by his employment history, law enforcement involvement and
overall poor decision making. Prior to his biological family's passing,
he had a "safety net" to help him redirect his actions, face the
consequences for the poor decisions and keep on track financially. After
his parents passed, the pattern of substance use escalated and he
suffered a series of medical complications. From that point on the road
got steeper. Have you ever tried to find a job, apply for food stamps,
keep stable housing, keep your beloved pet, stay sober, keep track of
medication and manage the daily stressors of life without transportation
and without family?
concept of medical home is, in a nutshell, a hub of compassionate,
comprehensive care. We are the core family. We are the ones who don't
give up, no matter how annoyed, busy, frustrated or confused we may
become. We may be charged with continuing to manage and encourage
patient engagement and access to services. Sometimes we too need
"family" help. Our colleagues and network of providers can fulfill that
for us if we remember to look for it; to challenge that notion of
"family". Can we bring others into the medical home web? Find out who
has your patient connected to? Maybe an employer or a child's daycare
provider. Food stamp administrator? Bring them into the web! Find who
can help you model those healthy connections?
we get stuck with the traditional view of "family" in collaborative
family healthcare we miss the rich opportunity to engage communities in
helping its members feel that sense of belonging and connectedness that
we strive for with our patients. We need to challenge ourselves to
engage with our patients and help them create families who can be active members in their healing process.
means really listening to what's important to them. Yes, Ty, you want
to live independently, yes you want to keep your dog, yes, you want to
have some power over how the little money you have is used/spent. No,
you don't want to live in assisted living with a bunch of people waiting
to die. You don't want to be pushed into decisions, you want to be
heard. And you want the darn sore on your arm to go away! Well OK then.
When do you do well? When do you struggle? How can your "family" help
with this? Who do you consider part of your family around here? I
asked Ty that very question today and here's what he offered up:
Social Services caseworkers
Medical Clinic: MD, clinic assistants, front desk and Behavioral Health providers
Billing person at the hospital
Security Guard at the hospital
Peer Support at Mental Health Center
Therapist at Mental Health Center
Bus drivers on free bus
Regular bus riders
I was still letting the concept of extended "family" roll around in my
mind, I was driving around doing errands and saw Ty and a young child,
who I later learned was a neighbor child. They were walking down the
side of a busy road, Ty on the outside, so the kid stayed on the safe
sidewalk. I watched them walk together for quite a while and then Ty
took him into a store where his mom was working. Off to his next
a great symbol of paying forward that caring, compassionate connection
that always seems to puzzle him from his "extended family".
Royal is a Colorado State Licensed Professional Counselor and Director
of Behavioral Health at Summit Community Care Clinic in Frisco Colorado.
She has worked in community mental health for 20 years as a clinician
and quality improvement manager and is currently |
leader for an integrated care grant working on integrated primary care.
She is passionate about equine assisted psychotherapy!