1. Whole Health in Your Life
Welcome to Day 2!

2. Whole Health in Your Life
7. The Vision

3. Video – Introduction to Whole Health
by Dr. Tracy Gaudet

4. Personalized, Proactive, Patient-Driven
PERSONALIZED A dynamic adaptation or customization of recommended education, prevention and treatment that is specifically relevant to the individual user, based on the user’s history, clinical presentation, lifestyle, behavior and preferences. PROACTIVE Acting in advance of a likely future situation, rather than just reacting; taking initiative to make things happen rather than just adjusting to a situation or waiting for something to happen. Using strategies that strengthen the person’s capacity for health and healing, such as mind-body approaches prior to surgery. PATIENT-DRIVEN An engagement between a patient and a health care system where the patient is the source of control such that their health care is based in their needs, values, and how the patient wants to live. This requires that we change the conversation and start from a different place.
Tailor my care
to me as a person
Help me prevent future problems and prepare for any health problem that comes up
Support me with what matters most to me
Mentalhealth.va.gov

5. How do you define Whole Health?

6. Definition of Whole Health
Whole Health, also known as “Personalized, Proactive, Patient-driven Care,” is an approach to health care that empowers and equips people to take charge of their health and well-being and to live their life to the fullest. The Whole Health System includes conventional treatment, but also focuses on self-empowerment, self-healing, and self-care.

7. Core Concepts for Transforming to Whole Health
All aspects of my life are interconnected and impact my health
Holism: People are more than a broken body part or a list of medical problems
Self Healing: People possess the innate capacity to heal, and mobilizing that is an important priority
Mindful Awareness: Self-awareness leads to better health, and there are ways to enhance it
There are approaches that can strengthen – or weaken – my capacity to heal and stay well
Paying more attention helps me make better decisions in my self care
Explore.va.gov

8. Purpose in Life = Longer Life
7,108 Americans
Ages 25-75
Followed for 14 years
Answered three questions:
I don’t wander through life
I think about the future
I feel there is still more to do in life
Hill, Psychol Sci, 2014; 25(7):1482–6.

9. Purpose in Life = Longer Life
Regardless of
Age
Retirement Status
Relationships
Depression
There was a survival benefit for those with a sense of purpose
Hill, Psychol Sci, 2014; 25(7):1482–6.

10. Physical Life Story Mind Meaning and Purpose Culture Relationships
Emotions
Values
Photo credit: Jabi - El de verdad via Foter.com / CC BY-NC

11. $ $ $ $ Triptan HA LBP SSRI Statin DM HTN Insulin ACE PPI Obesity GERD
Appetite Suppressant
Triptan
Opioids
Obesity HA
LBP
SSRI
Statin
Disease Focused Care
Depression
Dyslipidemia DM
HTN
GERD
Insulin $
ACE $
PPI

13. What’s the matter
with you?

14. What matters
to you?

15. Whole Health: An Element of Suicide Prevention
Whole Health begins with Mission, Aspiration, and Purpose.
Lack of these can be important in identifying at-risk Veterans.
Focus on these can heal and decrease risk
Mindful awareness and other problem-solving strategies enhance stress management skills
Enhancing self-care fosters resilience and buffers against events that contribute to suicide risk

16. Whole Health: An Element of Suicide Prevention
Trusting your professional care team members makes you more comfortable with disclosure of deep-seated concerns
Awareness of and access to community resources makes interventions more accessible
Reaches those who may not seek help otherwise
Facility, local, and national resources
The Whole Health approach is well-suited to exploring complex comorbidities that predispose to suicide
E.g., chronic pain, insomnia, PTSD, depression, substance misuse

17. Suicide Prevention Resources
National Suicide Prevention Lifeline & Veterans Crisis Line: , Press 1
Veterans Crisis Line
Suicide Prevention Lifeline
Spread the Word:
VA Office of Suicide Prevention
U.S. Air Force photo illustration/Airman 1st Class Corey Hook

18. Telling Others About Whole Health: The Elevator Speech Exercise
Draft out a 30- second elevator speech using the manual for suggestions
Can use suggested elements or add your own
Give your speech to a partner, and listen to your partner’s speech
Offer constructive feedback
We will invite volunteers to share
claybanksstudio.com

19. WHOLE HEALTH CLINICAL CARE
Whole Health System
Community
THE PATHWAY
(Empower)
Partners with Veterans to discover their mission, aspiration, and purpose and begins to create an overarching personal health plan
Personal Health Plan
WELL-BEING PROGRAMS
(Equip)
WHOLE HEALTH CLINICAL CARE
(Treat)
Healing Environments
Healing Relationships
Self-Care/Skill Building and Support
Complementary & Integrative Health (CIH)
Health Coaching & Health Partner Support
Outpatient & Inpatient
Health & Disease Management within a Whole Health Paradigm (i.e., Personal Health Planning, CIH, Health Coaching)
Community

20. Whole Health 2016-17 = FY16 Whole Health Facilities
Greater Los Angeles
San Francisco
Portland
North Texas - Plano
St. Louis
Columbia
Minneapolis
Tomah
Central Arkansas
Jesse Brown
Salisbury
Washington DC
Baltimore
Boston
Biloxi
Durham
Iowa City
Hudson Valley
= FY16 Whole Health Facilities
= FY17 Whole Health Facilities

21. Whole Health Design Sites, 2018
Fresno
Syracuse
Kansas City
Fargo
Madison
Cincinnati
Manchester
Mountain Home, TN
Bedford
Birmingham
West Palm Beach
Sioux Falls
Detroit
FY18 Design Sites

22. Each VISN has one site implementing a Whole Health system model in 2018

23. Whole Health Flagship Sites
20-Portland
2-NJ
1-Boston
23-Omaha
4-Erie
21-Palo Alto
10-Saginaw
19-SLC
12-Tomah
5-Beckley
9-Tenn Valley
15-St Louis
22-Tucson
6-Salisbury
16-Little Rock
7-Atlanta
17-San Antonio
8-Tampa
Key
FY16 Original Design Sites
FY17 Additional Design Sites

24. Plans for Whole Health Flagship Sites
Veteran Satisfaction
Patient Reported Health Outcomes
Clinician & Staff Engagement and Satisfaction
Clinical Outcomes
Cost/Utilization Outcomes
Evaluation Toolkit

25. How Will You Identify Success?
This ultimate goal is to bring the Whole Health model into all VA facilities. This is your chance to try it out yourself!
How Will You Identify Success?
When you achieve outcomes you never even imagined.
VETERANS HEALTH ADMINISTRATION

26. 8. Stage III: Planning for Action
Whole Health in Your Life
8. Stage III: Planning for Action

27. WHOLE HEALTH PROCESS MODEL Conduct PHI assessment.
Stage I
Explore
Mission
Aspiration
Purpose
Stage IV
Execute
the
Action
Take further action.
Re-plan.
Learn lessons.
Assess action.
Create vision.
Explore values and
value conflicts.
Goals & Actions.
Explore barriers.
Training & Support. Accountability.
Conduct PHI assessment.
Define focus.
Assess readiness.
Stage II
Reflect,
Assess & Focus
Stage III
Plan for
Action

28. Goal Setting and Action Steps
After determining focus:
What is the goal?
What are the action steps to achieve that goal?

29. Definition of Goal and Action Steps
What the partner plans/intends to achieve in a 2-6 month period
Action
Steps
Specific short-term actions (in the next week)

30. SMART Criteria
SPECIFIC – What do you want to accomplish? Is it clear and concise?
MEASURABLE – How much? How many?
ACTION-ORIENTED – What are you “doing?”
REALISTIC – Able to reach? Do you have skills, resources needed, or can obtain them easily?
TIMED – Timeframe?

31. Considerations with SMART goals
Goal Setting
Considerations with SMART goals
Is the goal really SMART?
How does the goal align with vision, mission, and values?
Are importance and confidence reasonably high?

32. Determining Action Steps
The goal is set – now what?
Start with a manageable (small) action step
Ensure it is small enough to be done soon (usually within a week)

33. Goal Setting and Action Steps - Examples
SMART these goals and provide one SMART action step
I want to lose weight.
I want to exercise more.
I want to find a new job.
I want to reduce my stress.

34. Barriers/Challenges
Anticipate what barriers or challenges you may encounter when attempting action steps.
Assist partner in designing at least one contingency plan/back-up plan.

35. Accountability to Action
How would you like to be accountable?
Support person (family member, friend, coworker)
Self (journal, tracking tool, visual reminder, mobile app)

36. Video – Arthur’s Amazing Transformation
Never, Ever Give Up!!

37. Goal Setting, Action, and Barriers
SMART Goals and Action Steps Worksheet

38. Faculty
Demonstration
Stage III

39. Triad Exercise, Stage III
Listener
Use suggested questions (stick to the script!)
Practice WH communication skills (reflections, open- ended questions, no problem-solving or advice)
Pause frequently. This is your opportunity to practice. Take your time!
Speaker
Reflect carefully, answer honestly and authentically

40. Mindfulness Awareness Activity:
Mindful Eating

41. 9. Resources and Referrals
Whole Health in Your Life
9. Resources and Referrals

42. Key Elements of Personal Health Planning

43. Health Plan Writing Tips
Plans take many forms
Use all the info you have
The better you know a person, the better the plan
Co-authored
Always set up follow up
Consider context
Foter.com

44. Health Plan Writing Tips
Consider culture
Use a template
Have tools and materials on hand
Note the positive
Do a PHP for yourself
Compare notes with colleagues

45. Three Key Whole Health Websites: 1. VA Patient-Centered Care
External – OPCC&CT resources for Veterans & family members)

46. VA Patient-Centered Care

47. Three Key Whole Health Websites: 2. OPCC&CT SharePoint Hub
Internal – OPCC&CT SharePoint Hub

48. OPCC&CT SharePoint Hub

49. Education Overview Page

50. Three Key Whole Health Websites: 3. Whole Health Library Website
External - Resources for clinicians and Veterans
Can also Google “Whole Health Library”

51. More on the Whole Health Library
Whole Health Library Website
Has resources for clinicians and Veterans
Will be changing this fiscal year – more web-friendly
Over 200 different topics
Materials from all the OPCC&CT clinical courses

53. Passport to Whole Health 19 Chapters of Tips and Resources

56. Personal Health Planning in Your Practice: Making It Real
Check it out!

57. Educational Overview
Educational Overview

59. PREVENTION & TREATMENT
CONVENTIONAL & COMPLEMENTARY APPROACHES

60. Definitions Holistic Complementary & Alternative Integrative
Present
Whole Health

61. Complementary and Integrative Health

62. Whole Health

63. Good Medicine

64. An Important Point About Whole Health…
Whole Health is inclusive of:
Conventional clinical treatment and prevention
Self-care strategies
Complementary practices

65. 2015 HAIG Report – Complementary and Integrative Health
Healthcare Analysis & Information Group (HAIG)
A Field Unit of the Office of Strategic Planning & Analysis
within the Office of the ADUSH for Policy and Planning

66. CIH and Veterans?
76% of veterans report they would use CAM modalities if offered at their VA facility. CAM services in high demand, high rates of satisfaction with care, and improvements in physical and mental health symptoms.
BMC Complement Altern Med. 2006;6:34. J Rehabil Res Dev. 2006;43:99–110. Global Adv Health Med. 2014;3:27–31. Complementary and Alternative Medicine. Healthcare Analysis and Information Group. Washington DC: Department of Veterans Affairs; 2011.

67. What CIH Approach is Most Commonly Used in VA?
Mind-Body Medicine
Biologically Based Practices
Manipulative Body-Based Practices
Energy Medicine
Other Systems of Healing

68. The five most common conditions treated at the VA:
Stress Management
Anxiety
PTSD
Depression
Pain

69. 2015 Data – HAIG Report Anxiety Depression PTSD Stress Management Pain
Mindfulness
SMRT
Acupuncture
Chiropractic
Guided Imagery
PMRT
Art Therapy
Yoga
SMRT = Stress Management Relaxation Training PMRT = Progressive Muscle Relaxation Therapy

70. What About CIH at the VA? 2015 HAIG Report
Top 10 Integrative Health Services :
1. Stress Management Relaxation Therapy (SMRT)
2. Mindfulness
3. Guided Imagery
4. Yoga
5. Progressive Muscle Relaxation Therapy (PMRT)
6. Art Therapy
7. Acupuncture
8. Music Therapy
9. Biofeedback
10. Animal Assisted Therapy

71. ECHO Mnemonic
Efficacy
Co$t
Harms
Opinions

72. How do you know what you know?
Facts - measurements, numbers, statistics
Observation
Empirical thought
(scientific method)
Experience - phenomenology
Anecdotes
Hands-on (heuristics)
Taught by others
Experts
Books, education
Media (“Ask your doc about…”)
Propaganda
Social affiliations
Culture-Specific Syndromes
Tradition
Narratives
A story, a myth
Instinct
Collective consciousness
Serendipity
Intuition, inspiration
Contemplation
Faith

73. How Do You Know?
Think of a CIH approach you have tried (or want to try)
Apply the ECHO approach
Efficacy
Costs
Harms
Opinions
What made you decide this was a therapy you want to try?
Share at your table

74. Naturopathy Tai Chi & Qigong Homeopathy Acupuncture Yoga Feldenkrais
Reiki
Biofeedback
Hypnotherapy
Guided Imagery
Healing Touch
Chiropractic
Sweat Lodges

75. VA Integrative Health Coordinating Center (IHCC)
Created in 2013
Led by Ben Kligler, MD
Multiple clinical champions
Charged with implementing strategies across the system
Education
Research
Clinical Care
Two major functions:
Identify and address barriers to offering CIH in the VA
Provide resources, clinical expertise, and education for Veterans, clinicians, and leadership

76. CIH and Standard Medical Benefits Package
3 Steps to provide guidance and regulatory change
CIH Memo
Supported CIH implementation
Initiated vetting process for CIH services through the VEC and Integrative Health Coordinating Center (IHCC)
CIH Directive – Signed by USH May 2017
Evidence-based review to create 2 lists of CIH services

77. Approved CIH Approaches Step 3: Regulatory Change
LIST I
Promising/Potential Benefit*
Acupuncture
Meditation
Tai Chi
Yoga
Massage for treatment
Guided imagery
Biofeedback
Clinical hypnosis
LIST II
Generally Considered Safe
Healing Touch
Acupressure
Alexander Technique
Reflexology
Reiki
Therapeutic Touch
Emotional Freedom Technique
Animal-assisted Therapy (under recreational therapy)
*As of October 2018, these sites will need to make List 1 options available

78. VERA and Whole Health
As of October 2017, new CIH VERA Class 14 (Price Group 4)
In order to qualify for this CIH Class , a Veteran needs 10 CIH visits
Per ARC: Qualifying CPT and HCPCS codes for this Fiscal Year
Peer facilitated Whole Health Coaching Visits
CIH modalities

79. Business Infrastructure
Two CIH/Wellbeing Stop Codes
159 – Either position
CIH treatment
139 – Either position
Wellbeing approaches
Co-pay exemption regulatory change underway; Timeline 1-2 years
CHAR 4 codes
National Note Title – Integrative Health Note

80. Ongoing Efforts Office of Community Care Telehealth Volunteer Services
Position Descriptions
Whole Health Partners
Whole Health Partner Supervisor
Yoga Instructor
Tai Chi Instructor
Health Coach developmental PD pending

81. Whole Health Community of Practice Call
First Thursday, 2 pm ET ContinueTheConversation/SitePages/Home.aspx
For other COP call info, see link on OPCC&CT SharePoint Hub.

82. VA Pulse – Whole Health Community
OPCC&CT in general
Integrative Health
Acupuncture and BFA
Others

84. Resources—Summary
VA Patient Centered Care (External–OPCC&CT resources for Veterans & family members)
OPCC&CT SharePoint Hub (Internal–OPCC&CT SharePoint)
Education Hub:
Whole Health Library

85. Resources – Summary (cont’d)
Integrative Health Coordinating Center (IHCC)
IHCC
IHCC SharePoint Page
FIT SharePoint Page
FIT CIH Specialty Team (FIT CIH engagements available)

86. 10. Stage IV: Executing the Action
Whole Health in Your Life
10. Stage IV: Executing the Action

87. Conduct PHI assessment. WHOLE HEALTH PROCESS MODEL
Create vision.
Explore values and
value conflicts.
Conduct PHI assessment.
Define focus.
Assess readiness.
Goals & Actions.
Explore barriers.
Training & Support. Accountability.
Take further action.
Re-plan.
Learn lessons.
Assess action.
Stage I
Explore
Mission
Aspirations
Purpose
Stage II
Reflect,
Assess & Focus
Stage III
Plan for
Action
Stage IV
Execute
the
WHOLE HEALTH PROCESS MODEL

88. Stage IV – Executing the Action
Step 1 - Have Partner self-assess how they have progressed since last session
Fully took action
Partially took action
No action taken

89. Stage IV – Executing the Action
Step 2 - Assist Partner in assessing what they learned about themselves and the situation. These ‘learnings’ may include:
Barriers/challenges encountered
Contingency plans
Strengths and successes
Personal insights

90. Stage IV – Executing the Action
Step 3 - Assist the Partner in modifying or adding to their plan.
Continue with the same plan
Add additional action steps
Modify existing action steps
Revisit earlier stages: MAP, values, area of focus, or goal

91. Conduct PHI assessment. WHOLE HEALTH PROCESS MODEL
Create vision.
Explore values and
value conflicts.
Conduct PHI assessment.
Define focus.
Assess readiness.
Goals & Actions.
Explore barriers.
Training & Support. Accountability.
Take further action.
Re-plan.
Learn lessons.
Assess action.
Stage I
Explore
Mission
Aspirations
Purpose
Stage II
Reflect,
Assess & Focus
Stage III
Plan for
Action
Stage IV
Execute
the
WHOLE HEALTH PROCESS MODEL

92. Stage IV – Executing the Action
Step 4 - Take Further Action
Continue
Explore or refer to other services

93. Reminders for Stage IV
Solicit affirmations from Partner for what they have accomplished
Recognize Strengths
Reconnect to Mission, Aspiration or Purpose (MAP)

94. Faculty
Demonstration
Stage IV

95. Triad Exercise, Stage IV
Listener
Use suggested questions (stick to the script!)
Practice WH communication skills (reflections, open- ended questions, no problem-solving or advice)
Pause frequently. This is your opportunity to practice. Take your time!
Speaker
Discuss your self-care assignment from last night

96. 11. Next Steps: Personal and Professional Development
Whole Health in Your Life
11. Next Steps: Personal and Professional Development

97. What About Local Resources?
Note that this slide is UNIQUE for each VA site – FIT Partner will provide details

98. Success Stories Birmingham Gold Team Boston VA
Central Arkansas – IMPACT
DC Integrative Health Program
Empower Veterans – Atlanta
Others!

99. Small Group Discussion: Relating This to Our Work
Discuss with your small group
How can you bring the Whole Health approach into your work?
With team members?
With Veterans?
Examples:
Mindful awareness moments with team huddles
Using the PHI with Veterans
Weekly self care courses
Integrative Health clinics
EMR template changes

100. Questions?

101. Mindful Awareness Activity: A Compassion Practice
See manual for complete description

102. Closing Circle and Evaluations
Whole Health in Your Life
Closing Circle and Evaluations