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Whole Health in Your Life
Welcome to Day 2!
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Whole Health in Your Life
7. The Vision
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Video – Introduction to Whole Health
by Dr. Tracy Gaudet
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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
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How do you define Whole Health?
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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.
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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
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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.
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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.
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Physical Life Story Mind Meaning and Purpose Culture Relationships
Emotions Values Photo credit: Jabi - El de verdad via Foter.com / CC BY-NC
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$ $ $ $ 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
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What’s the matter with you?
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What matters to you?
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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
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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
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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
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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
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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
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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
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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
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Each VISN has one site implementing a Whole Health system model in 2018
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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
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Plans for Whole Health Flagship Sites
Veteran Satisfaction Patient Reported Health Outcomes Clinician & Staff Engagement and Satisfaction Clinical Outcomes Cost/Utilization Outcomes Evaluation Toolkit
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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
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8. Stage III: Planning for Action
Whole Health in Your Life 8. Stage III: Planning for Action
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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
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Goal Setting and Action Steps
After determining focus: What is the goal? What are the action steps to achieve that goal?
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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)
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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?
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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?
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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)
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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.
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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.
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Accountability to Action
How would you like to be accountable? Support person (family member, friend, coworker) Self (journal, tracking tool, visual reminder, mobile app)
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Video – Arthur’s Amazing Transformation
Never, Ever Give Up!!
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Goal Setting, Action, and Barriers
SMART Goals and Action Steps Worksheet
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Faculty Demonstration Stage III
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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
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Mindfulness Awareness Activity:
Mindful Eating
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9. Resources and Referrals
Whole Health in Your Life 9. Resources and Referrals
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Key Elements of Personal Health Planning
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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
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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
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Three Key Whole Health Websites: 1. VA Patient-Centered Care
External – OPCC&CT resources for Veterans & family members)
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VA Patient-Centered Care
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Three Key Whole Health Websites: 2. OPCC&CT SharePoint Hub
Internal – OPCC&CT SharePoint Hub
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OPCC&CT SharePoint Hub
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Education Overview Page
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Three Key Whole Health Websites: 3. Whole Health Library Website
External - Resources for clinicians and Veterans Can also Google “Whole Health Library”
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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
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Passport to Whole Health 19 Chapters of Tips and Resources
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Personal Health Planning in Your Practice: Making It Real
Check it out!
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Educational Overview Educational Overview
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PREVENTION & TREATMENT
CONVENTIONAL & COMPLEMENTARY APPROACHES
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Definitions Holistic Complementary & Alternative Integrative
Present Whole Health
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Complementary and Integrative Health
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Whole Health
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Good Medicine
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An Important Point About Whole Health…
Whole Health is inclusive of: Conventional clinical treatment and prevention Self-care strategies Complementary practices
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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
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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.
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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
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The five most common conditions treated at the VA:
Stress Management Anxiety PTSD Depression Pain
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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
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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
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ECHO Mnemonic Efficacy Co$t Harms Opinions
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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
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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
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Naturopathy Tai Chi & Qigong Homeopathy Acupuncture Yoga Feldenkrais
Reiki Biofeedback Hypnotherapy Guided Imagery Healing Touch Chiropractic Sweat Lodges
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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
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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
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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
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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
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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
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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
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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.
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VA Pulse – Whole Health Community
OPCC&CT in general Integrative Health Acupuncture and BFA Others
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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
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Resources – Summary (cont’d)
Integrative Health Coordinating Center (IHCC) IHCC IHCC SharePoint Page FIT SharePoint Page FIT CIH Specialty Team (FIT CIH engagements available)
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10. Stage IV: Executing the Action
Whole Health in Your Life 10. Stage IV: Executing the Action
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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
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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
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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
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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
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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
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Stage IV – Executing the Action
Step 4 - Take Further Action Continue Explore or refer to other services
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Reminders for Stage IV Solicit affirmations from Partner for what they have accomplished Recognize Strengths Reconnect to Mission, Aspiration or Purpose (MAP)
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Faculty Demonstration Stage IV
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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
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11. Next Steps: Personal and Professional Development
Whole Health in Your Life 11. Next Steps: Personal and Professional Development
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What About Local Resources?
Note that this slide is UNIQUE for each VA site – FIT Partner will provide details
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Success Stories Birmingham Gold Team Boston VA
Central Arkansas – IMPACT DC Integrative Health Program Empower Veterans – Atlanta Others!
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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
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Questions?
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Mindful Awareness Activity: A Compassion Practice
See manual for complete description
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Closing Circle and Evaluations
Whole Health in Your Life Closing Circle and Evaluations
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