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The Patient in Context: Teaching Core Psychosocial Assessment Skills Through the Use of Ecomaps

Amy J. Odom, DO Sparrow/Michigan State University FMRP Katy Kropf , DO Ohio University Heritage College of Osteopathic Medicine. The Patient in Context: Teaching Core Psychosocial Assessment Skills Through the Use of Ecomaps. Taking a closer look…. … changes perspective!.

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The Patient in Context: Teaching Core Psychosocial Assessment Skills Through the Use of Ecomaps

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  1. Amy J. Odom, DO Sparrow/Michigan State University FMRP Katy Kropf, DO Ohio University Heritage College of Osteopathic Medicine The Patient in Context: Teaching Core Psychosocial Assessment Skills Through the Use of Ecomaps

  2. Taking a closer look…

  3. … changes perspective!

  4. Today’s Objectives 1. Identify the patient-centered benefits gained by understanding the complex components of a patient’s life. 2. Learn the components of an Ecomap 3. Construct an Ecomap based on pertinent psychosocial information gathered from a patient 4. Consider applications of Ecomaps in practice to help both patients and providers to see potential strengths and intervention opportunities, and to enhance the doctor-patient relationship

  5. Why is context important? • Life Course Theory • Risk & protective factors contribute to health outcomes • ACE’s • Relationship between childhood maltreatment and later-life health &well-being • Social Determinants of Health • Enable patient-centered assessment & treatment planning through greater understanding of whole person Halfon, Neal, and Miles Hochstein. "Life course health development: an integrated framework for developing health, policy, and research." Milbank Quarterly 80.3 (2002): 433-479. Felitti, Vincent J., et al. "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study." American Journal of Preventive Medicine14.4 (1998): 245-258. 5

  6. What is an Ecomap? Hartman, A. (1978, reprinted 1995). “Diagrammatic assessment of family relationships.” Families in Society: the Journal of Contemporary Human Services, 76(2), 111-122. 6 • Developed by Dr. Ann Hartman in 1970’s • Ecosystem theory applied to human communities and relationships • Illustration of psychosocial status based on key domains in patient’s life • Strength and quality of relationships • Flow of energy or resources

  7. Why use an Ecomap to elicit context? • Provides structure for discovering patient’s context • Gives a window to person’s environment that goes beyond just family • Includes social determinants of health • Efficient • Easy to read (retrievable) • Strengthens provider-patient relationship 7

  8. Ecomap Domains $ Rx 8 Significant Relationships Neighborhood Social Groups Employment Education Community Services Other

  9. Ecomap Construction Social Groups Other Education Community Services Patient Employment Neighborhood Significant Relationships ______ _______ - - - - - - - /\/\/\/\/\/\/\/\/\/\ _______ Connected Strong Weak Stressed/Conflict Arrows should aim in the direction of the flow of energy 9

  10. What is an Ecomap? Hartman, A. (1978, reprinted 1995). Diagrammatic assessment of family relationships. Families in Society: the Journal of Contemporary Human Services, 76(2), 111-122 10

  11. Ecomaps: A Resident’s Perspective

  12. Case Example: Sam • 48 yr. old, married male • Uncontrolled diabetes • “Guest patient”

  13. Ecomap Demonstration Sparrow/MSU FMRP Behavioral. Science Team 2014

  14. Family Elise35 Church Diabetes Benson-7 Sam48 cannot drive truck while on insulin Truck Driver Katiedtr.-9 need to add bedrooms for kids $ Trying to get Custody House

  15. Context Informs Assessment & Intervention • Understand stressors & potential barriers • Identify supports • Reinforce strengths • Patient education (health literacy, family health beliefs) • Readjust goals • Opportunities

  16. Practice Exercise • Divide into pairs • Interview your partner & construct their Ecomap • Switch roles • Discussion

  17. When to Use an Ecomap

  18. Teaching Case:Depressed Mother “EMILY” 20 35 yr. old, married with two young children Hx. of depression Employed Here with her mother Episodes include “ignoring her children to get things done”

  19. “Using the Ecomap Worksheet, What additional questions do you have about Emily?”

  20. Health Insurance church Little Lambs Preschool Mike 38 Finances Sarah 4 Emily 35 Depression Charlie 2 Part-time biller Orthodontist office Dad Bipolar Suicide 1980 Mom Texas Julie Kate Grandma Dementia 22 ______ _______ - - - - - - - /\/\/\/\/\/\/\/\/\ _______ Connected Strong Weak Stressed/Conflict Arrows should aim in the direction of the flow of energy

  21. “How does your understanding of Emily’s context impact your intervention?” 23

  22. “Isn’t it time consuming?”

  23. Other Applications of Ecomaps • Intern Wellness or “get to know you exercise” • Systems-based Practice • Health System Management

  24. Summary • Ecomap provides structure to explore the patient’s context • At a glance, patient and provider can see strengths& intervention opportunities • Enhances doctor-patient relationship • Understanding patient’s context is central to providing appropriate, patient-centered care

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