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An ACP Perspective on Integrated Care in Oklahoma: Help and hope for a dive into precarious waters. Debra K. Greenwood-Clark, MSW Candidate Anne & Henry.

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Presentation on theme: "An ACP Perspective on Integrated Care in Oklahoma: Help and hope for a dive into precarious waters. Debra K. Greenwood-Clark, MSW Candidate Anne & Henry."— Presentation transcript:

1 An ACP Perspective on Integrated Care in Oklahoma: Help and hope for a dive into precarious waters. Debra K. Greenwood-Clark, MSW Candidate Anne & Henry Zarrow School of Social Work University of Oklahoma – Tulsa: March 13, Image Adapted from: Diving into Water (2015) & Bird (2013) rch?q=mr+bean+high+dive&FO RM=VIRE1#view=detail&mid=4 4BEC271E34EEDCED60444BEC 271E34EEDCED604

2 Using a Diving Analogy Five Elements of Diving (Franklin, 2015):  Starting position  Approach  Take off  Flight  Entry Key equipment:  Platform  A Tank of Water

3 “ Progress Being Made on the Integrated Tank Alternative to Medicaid Expansion” - Image Adapted from Wohlers Ranch, 2011 Treatment-tank: A cow tank used in Oklahoma’s tight economy as a community resource for integration of cattle watering, after-school recreation programs, faith-based baptisms, health & wellness immersions, and training of ACP MSW health social workers.

4 Diving Element #1: Starting Position - Why Social Work? … Diver is standing straight, head erect (Franklin, 2015): She is clothed with strength and dignity; she can laugh at the days to come. - Proverbs “The ‘personal is professional’ and embedded in this statement are political points of view.” – Arrendondo (2010) From Merging Personal & Professional Goals – Rothman (1999) People who are suffering want help All of humanity is interdependent My own experiences will help me to help others

5 Diving Element #1: Starting Position - Why ACP in Integrated Care? … with both arms in a straight and steady position (Franklin, 2015): “Many social work students graduate into clinical practice…  …if they can get some extra information about participation in the advocacy area, they will be better social workers and they will be able to help more people…” - Deborah Weinstein, Coalition on Human Needs (Pace, 2015) "The medical social service movement recognized that there should be…  someone definitely assigned to represent the patient's point of view...  work … with the physician  medical treatment in the light of the patient's social condition (Ms. Cannon, 1930)." - Ms. Cannon was the first hospital Social Worker (Miller-Cribbs, 2014)

6 Diving Element #2 “Social workers bring to public health practice skills, such as community assessment … cultural competence … sensitivity to race and ethnic issues.” - Gehlert & Browne (2012) - The Approach - - smooth motion, showing good form (Franklin, 2015) The ACP focus: condition of the tank in which we swim and the climate affecting it and us!

7 The Macro Approach: Assessing our National Healthcare Treatment Tank  Financing of care  Substandard care  Violations of our ethical rights  Culturally competency  Need for prevention services  Need for mental health care  Healthcare linkage to our communities - Adapted from Jansson (2011) Seven Problems Commonly Encountered by Healthcare Consumers

8 Mezzo Approach: Assessing OK’s MH & SA Treatment Tanks Overview from State of Oklahoma - December 5, 2006: Oklahomans needing treatment …  repeated relapses - crisis situations  symptoms of trauma not recognized  inadequate service  system inadequacies lead to ineffective treatment  heavy spending in the criminal justice, primary health care, homeless shelter, and systems. We’re talking about us – our families – our local communities - OK Department of Mental Health & Substance Abuse Services (2006)

9 Micro Approach: Assessing My ACP Place in the Social Work Profession in Oklahoma “[Oklahoma’s state] agencies purport a workforce crisis and indicate social work shortages… “ – Kinzie (2015) Aging workforce Increasing demand My research findings from Future is Now symposium in December 2014 indicate that social work respondents embrace the future of integrated care. Tisdale Clinic Community Engagement Project - Image by Nate Fakes

10 - Balance, Control, & Safety in the Hurdle (*Franklin, 2015) Diving Element #3: The Take Off *The diver must leave the springboard from both feet. - Image by Randy Walton (2010) I hope I’ve had enough Training, Supervision, Self-Care & Wheaties for this!

11 The Need for Balance in Oklahoma’s Services “The fragmented or siloed delivery of services to clients ‘because the connections between services are either absent or problematic, or needed services are missing all together’ resulting in patients falling through system cracks.” - Bunger (2010) (us – or our families - whole communities)

12 If facilities are “drying up” in the “resource-rich” areas of Oklahoma – i.e., closure of OSU child & adolescent psych unit in Tulsa (KTUL, 2015) - then … what is happening in my rural community?

13 Element #4: The Flight - Aiming the Dive ….at no time should the dive move to the left or the right of the springboard or platform (Franklin, 2015) - Graphic adapted from Ramirez, 2010

14 - Institute for Healthcare Improvement, 2007 The Wonky Spot Analyzing the Pentaho & EMR data to inform administrative decision-making OK Policy Institute Budget Summit Tisdale Clinic – the change agent

15 Center for Health Innovation & Effectiveness (2015) Vision: Leveraging Health Systems to Improve Population Health Mission: To collaboratively align resources to meet health systems needs and improve population health. - OK Department of Health (2015) The Macro Aim: Integrated Care in Oklahoma The Wonky Spot “The research … indicates that a nonprofit organization’s mission can facilitate innovation, which has been shown to be a key mediating step in achieving superior organizational performance. - McDonald (2007)

16 The Mezzo Aim: MH & SA Integration Transforming Ok’s Behavioral Health System: Every (ODMHSAS) operated and contracted program shall provide and/or make available MH/SA services that are - integrated, -trauma informed The Wonky Spot Assisting NGO’s with research-based outcomes measurements needed for requests for funding proposals - OKDMHSAS (2006)

17 The Mezzo Aim: OK Medical Healthcare National Association of Community Health Centers (2013)

18 Micro Aim: The Primary Care Clinic Institute of Medicine: Principles of Quality Improvement  QI work as systems and processes  Focus on patients  Focus on being part of the team  Focus on use of the data - Health Resources and Services Administration (2011) Problem Statement: Duke University School of Medicine Physicians need training in community engagement, leadership, and population health work with partners within the community - Sheline, Tran, Jackson, Peyser, Rogers, Engle (2014)

19 The Micro Aim - An Issue: Suicide Prevention Smoothed, Age-adjusted Suicide Rates* per 100,000 population, by County, United States, 2000–2006 From 2000–2006, the western US counties, including Alaska, had predominantly high suicide rates. Suicide rates were also high in certain Appalachian counties of Kentucky and West Virginia, southern Oklahoma and northern Florida. - Center for Disease Control and Prevention (2014)

20 Element #5: The Entry – Use *Brief, Functional Interventions “The cleaner the entry, the higher the score” (Franklin, 2015) - *Kotria, (2006)

21 ? - Oklahoma State Board of Health (2014) Macro: Collaborative Efforts to Improve Outcomes

22 A Mezzo Example: The role of faith-based organizations. - Thomas & Netting, (2008).

23 Micro: Finding or Creating Administrative Positions within Medical Cultures of Empowerment The empowerment culture… Is consciously consumer oriented and driven Implements participatory management practices Is based on working in partnership with others. The barriers to an empowerment-based practice: funding sources social environment intrapersonal issues interpersonal issues - Gutiérrez, Glenmaye, & Delois, (1995) - Image: Curse of Mr. Bean (1990)

24 Reasons to H O P E Macro Social Work’ s projected employment increase of 19% from 2012 to 2022 due to health care reform - Bureau of Labor Statistics (2014) #WayForward – Suicide Attempt Survivors Taskforce: using insights from lived experience (qualitative research) - National Action Alliance for Suicide Prevention (2014) Mezzo Primary care – where individuals with depression are showing up - Robinson & Reiter (2007) Dr. Quinnett – QPR: using technology to empower a gateway culture - Lancaster, et al. (2014) Micro Freebirds of SE OK – Out of the Darkness Walk – Tulsa,, (October, 2014) - Action Alliance for Suicide Prevention

25 H O PE – I’m not diving in alone … “If you’re beating death then take your dive, but shut-up if you’re not” - Adapted from Difference Maker, Source: Need To Breath - Dana Kunze: World Record High Dive Source: Share Amazing Vidz… (2012) - Image: Dupre (2015)

26 Andrews, C., Darnell, J., McBride, T., & Gehlert, S. (2013). Social Work and Implementation of the Affordable Care Act. Health & Social Work, 38(2), Bird, E., (2013). In pictures: An aerial view of the drought Curse of Mr. Bean, Act 1, (1990). +diving&FORM=HDRSC2#view=detail&id=EA7AEEAD79568D8C0C884E E72362D5CBB8814E13&selectedIndex=13 Bureau of Labor Statistics, (2014). U.S. Department of Labor, Occupational Outlook Handbook, Edition, Social Workers, workers.htm (visited March 08, 2015) Dupre, K. (visited 2015). High Dive. Zgallerie.com high-dive.aspx Diving Into Water, (visited 2015). References

27 Gehlert, S., & Browne, Teri Arthur. (2012). Handbook of health social work (2 nd ed.). Hoboken, N.J.: John Wiley & Sons. Franklin, W. (visited 2015). Judging and scoring a diving meet: The five basic elements of a dive. About.com. meetscompetitions/a/judgingBasics.htm Fakes, N. Institute for Healthcare Improvement, (2015). Kotria, K., (2005). Social work practice in health care: The need to use brief interventions. Health and Social Work, 30(2) Jansson, B., (2010). Improving Healthcare Through Advocacy: A Guide for the Health and Helping Professions. Hoboken: Wiley. Greenwood-Clark, D.K., (2015). Embracing the future: Social workers attitudes about integrated physical and behavioral healthcare. [student abstract accepted for presentation at the OU-Tulsa Research Forum, 2015]. Gutiérrez, L., Glenmaye, L., & Delois, K. (1995). The Organizational Context of Empowerment Practice: Implications for Social Work Administration. Social Work, 40(2),

28 McDonald, R. (2007). An Investigation of Innovation in Nonprofit Organizations: The Role of Organizational Mission. Nonprofit and Voluntary Sector Quarterly, 36(2), Miller-Cribbs, J. (2014). Social work profession as a catalyst of change. [presentation] The Future is Now Symposium. University of Oklahoma - Tulsa. Mullolu, B., (February 20, 2015). Mental Health Unit For Kids To Close. KTUL Lancaster, Paige G., Moore, J. Taylor, Putter, Stefanie E., Chen, Peter Y., Cigularov, Konstantin P., Baker, Aaron, & Quinnett, Paul. (2014). Feasibility of a web-based gatekeeper training: Implications for suicide prevention. Suicide and Life-Threatening Behavior, 44(5), 510. Kinzie, M.J., (2015). Ruth Fizdale grant application. NASW OK. [cc’d correspondence from Julie Miller-Cribbs, February 28, 2015]. National Action Alliance for Suicide Prevention: Suicide Attempt Survivors Task Force. (2014). The Way Forward: Pathways to hope, recovery, and wellness with insights from lived experience. Washington, DC: Author. prevention.org/files/The-Way-Forward-Final pdf

29 OK State Department of Health, (2015). Center for Health Innovation & Effectiveness: vision & mission statements. nd_Effectiveness/ Oklahoma State Department of Mental Health and Substance Abuse Services, (2006). Consensus document: Integrated services initiative consensus system implementation plan for provision of integrated services for individuals and families with or at risk for co-occurring mental health and substance use (and other addictive) disorders, (rev.). Oklahoma Proposal for State Demonstrations to Integrate Care for Dual Eligible Individuals Financial Models to Support State Efforts to Coordinate Care for Medicare, (2011). https://www.cms.gov/Medicare-Medicaid-https://www.cms.gov/Medicare-Medicaid- Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid- Coordination-Office/Downloads/OKProposal.pdf Nicholson, B., Blanson,K., & Fair, A., (2012). Fracking's Alleged Links to Water Contamination and Earthquakes frackings-alleged-links-water-contamination-earthquakes.html

30 Sheline, B., Tran, A., Jackson, J., Peyser, B., Rogers, S., & Engle, D. (2014). The Primary Care Leadership Track at the Duke University School of Medicine: Creating change agents to improve population health. Academic Medicine : Journal of the Association of American Medical Colleges, 89(10), Share Amazing Vidz…, (2012) Dana Kunze: World record for highest dive. dive.html Pace, P.R. (2015). Program links social work policy practitioners, students. NASW News, Volume 60, Number 2. Washington, D.C. Rothman, J.C.,(1999). The self-awareness workbook for social workers. Boston: Allyn and Bacon. Robert Graham Center, (2014). Profiles of the medically disenfranchised: Communities experiencing shortages of primary care providers in Oklahoma. National Association of Community Health Centers. Robinson, P., & Reiter, Jeff., (2007). Behavioral Consultation and Primary Care A Guide to Integrating Services. Dordrecht: Springer.

31 Thomas, M., & Netting, F. (2008). Faith-based Organizations and Legislative Advocacy: A Qualitative Inquiry, ProQuest Dissertations and Theses. Walton, R., (2010). Faith and Diving Boards. and-diving-boards/ Wholers Ranch, (2011). our-3rd-24-livestock-water.html

32 Extra Slides for Clinical-ACP Collaboration Hope in precarious water: An ACP social work student’s dive into integrated care in a frackin’-drought-- stricken (s)State Original Proposed Title of This Presentation

33 Establishing the Lexicon: Possibly Useful Definitions ACP: Administrative & Community Practice MSW Focus Five Elements of Diving (Franklin, 2015):  Starting position  Approach  Take off  Flight  Entry Treatment-tank: A cow tank used in Oklahoma’s tight economy as an integrated community resource for watering cattle, after-school recreation programs, faith-based baptisms, health & wellness immersions, and training of ACP MSW divers

34 More Possibly Useful Definitions F.D.S.D: Acronym for “frackin’-distressed-states- disorder”. Not found in the DSM. May be related to diving into allegedly contaminated and earthquake prone treatment tanks. Drought-Lander: A person with a predisposition to dive into – or land in – less than favorable conditions. Wonky Spot: According to ACP drought-landers affected by F.D.S.D., the “sweet spot” for entering social work. The place where geeky wonks hang out; possibly equivalent to a OK redneck honky-tonk

35 The need for Collaborative Clinical and ACP Skillsets: Case Study & Logic Model Example of ACP student with F.D.S.D. presenting in the Integrated Care dive setting Student describes feeling distressed. Uses slang expletive “frackin’” often. Describes textbooks as liquid theory and asserts that it is being forced into her brain matter. Attributes the escape of gaseous assumptions in class to this processing of theory. Describes having frequent thoughts of escaping deadlines, *hallucinations of social work peers in their underwear while she is presenting, and irrational fear of death from not following APA citing requirements. May be indications that student is: addicted to wonky substances, and, [older student] has aversion to modern, “smart-alec” technology Organi zation al Theory Behavi oral Theory Leader ship Theory brain farts *I have these scary thoughts every Friday the 13th - Image Adapted from GoGraff (2015)

36 Clinical and ACP Orientations to how “frackin” might present in an ACP student The Clinical Question: What functional, brief intervention to use? The ACP Question: What do I report as the outcomes measurement to funders?

37 H O PE for Recovery for F.D.S.D. ACP Students: Assess Student Support Network:  Does student have access to policy blogs, budget summits, webinars, healthcare symposiums, and other geeky-wonky supports?  Does student have plenty of coffee? Psycho-education:  Regular use of peer-reviewed articles for gray matter formulation  Regular intake of coffee CBT:  Emphasis on program and community planning that includes reasoned evaluation, measurable outcomes, and thoughts, feelings, and behaviors focused on sustainability of the triple aim  Offer student free coffee samples supplied by partner industry Psychotherapy:  For older students only: participation in a tech-for-dummies support group;  Make sure coffee is available at group sessions to promote participation MI: Ask student about willingness to change caffeine habits!


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