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Who Says You Can’t Choose Your Family?!

Posted By Helen Royal , Thursday, August 25, 2011
So 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…

One 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 traditional lifestyle.

These 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...
Ask 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."

Ty 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?

The 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?

If 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.

This 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
Workforce Center
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

As 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 destination.

What a great symbol of paying forward that caring, compassionate connection that always seems to puzzle him from his "extended family".

Helen 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
Project leader for an integrated care grant working on integrated primary care. She is passionate about equine assisted psychotherapy!

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Comments on this post...

Randall Reitz says...
Posted Saturday, August 27, 2011
Helen, Thanks for catching me up to speed on life at Care Clinic. It sounds like the frenetic pace continues since my departure. In my mind the clinic (and your blog post) embodies the heart of what it means to be a patient-centered medical home. This is most apparent in the warm welcome, the one-stop availability of medical, mental health, and dental services, and in the commitment to serve all. I'm happy to hear this spirit lives on.
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Ajantha Jayabarathan says...
Posted Sunday, September 11, 2011
I found your raw reflections on the plight of what it takes to humanise care within your 'medical home" enlightening. In my professional life as a family doctor, I too face this challenge, however, am physically and psychologically "shielded" to some extent since the system of "community services" in the Canadian Health care system offers to share the role of "family" with me.....but it is hit and miss....with many misses at the systems level even in our more "socialised" approach to healthcare.
I agree that the "community" that one lives in geographically, its identity as dictated by the various subgroups within and its willingness to embrace or keep at bay "new members" ( not unlike a school yard) helps individuals take root and develop meaning, purpose and self-reflection....
Ty is working to become part of the very community in which he has found a link to the little boy he gave company to as they walked to his mother's place of work......nurturing these tendrils of forming purposeful meaning in a,I believe what groups like yours and ours are now being called upon to help co-create with community partners....and citizens.
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