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Laurie Lockert, MS, LPC Health Resilience Program Manager Rebecca Ramsay, BSN, MPH

A Non-Traditional Workforce for High Risk Patients: Health Resilience Specialists. Laurie Lockert, MS, LPC Health Resilience Program Manager Rebecca Ramsay, BSN, MPH Community Care Director. Who is Jake?. 30 yr old male on HSO since April At time of engagement: Homeless (July 2013)

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Laurie Lockert, MS, LPC Health Resilience Program Manager Rebecca Ramsay, BSN, MPH

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  1. A Non-Traditional Workforce for High Risk Patients: Health Resilience Specialists Laurie Lockert, MS, LPC Health Resilience Program Manager Rebecca Ramsay, BSN, MPH Community Care Director

  2. Who is Jake? • 30 yr old male • on HSO since April • At time of engagement: • Homeless (July 2013) • 19 ER visits since April 1 • EMR Note stating “Aggressive Behavior”

  3. Jake’s “Problem List” Alcohol dependence in remission Renal calculi Cannabis abuse Vaccine refused by patient GAD (generalized anxiety disorder) Bipolar disease, manic PTSD (post-traumatic stress disorder) Self-injurious behavior Hand Pain Antisocial personality disorder ICH Benzodiazepine abuse, continuous Noncompliance with medication treatment due to overuse of medication Acute bronchitis Drug-seeking behavior Hand fracture Panic disorder Hx of suicidal ideation

  4. What Lisa learned from Jake… …outside of Jake’s Medical Record Passions and Interests Life Experiences Joined white supremacy group which provided a place where he could belong DX of borderline intellectual functioning in elementary school Acknowledged substance abuse to address mental health symptoms He and his mother were physically & verbally abused by an alcoholic father – he requested a female provider due to this abuse (“it is hard not to freak out when guys touch me”) Easily overwhelmed by loud voices, large numbers of people and language that is “over my head” • He loves dogs and likes to help elderly people • He is meticulous in grooming and keeping his surroundings clean • He enjoys landscaping and yard work • He would ask to walk on the street side of Lisa so she would not be splashed • He insisted on opening doors for her “my mom taught me to be respectful”

  5. Red flags Jake presented with ‘red flag’ trauma behaviors: • Drug use/multiple psych meds • Multiple MH diagnoses /behaviors: • PTSD • Antisocial • Panic Disorder • Self injurious • Easily overwhelmed by loud noises

  6. How does a Health Resilience Specialist Engage Clients Like Jake How Lisa developed trust with Jake • Listened..Often to the same stories, reflecting back the content with emotions that he expressed • Asked for permission to help • Preparation for appointments • Slow things down—allow lots of time to express concerns, ask questions or sit and think. • Provide an environment of openness vs judgment

  7. What Makes a Successful Health Resilience Specialist? This has been our experience: • Comfort and experience with mental health conditions, addiction and substance abuse, poverty, and trauma • In specialty clinics, clinical expertise • Excellent interpersonal skills, professional boundaries, and enough confidence and experience to communicate/ advocate with medical professionals • Compassion, non-judgmental attitude, cultural agility, and commitment to social justice principles • Experience doing home visits – often will visit shelters, group homes, and SNF/Assisted Living sites as well • Understanding of our community and its resources

  8. Health Resilience Specialists:A New Workforce That Enhances Primary (and a few specialty) Care Teams • Even the best patient-centered primary care homes still require the patient to enter the clinic to receive care and assistance • Poverty alone places huge burdens on patients to adjust to our schedule, our geography, and our rules (transportation barriers, planning barriers, time barriers) • The experience of trauma adds many more layers of challenge – trust and rapport are difficult to attain, and sometimes impossible within the structure of a medical office building • But we know they need healthcare… • ???How do we draw them in??? • ???How do we serve them respectfully?? • ???What do they need first? The most??? Needed: Trauma-Informed Primary Care

  9. Why is it important to understand TIC? Our Delivery System is struggling to reach this population. Examples of trauma in a clinic setting: • No shows • Not following through with treatment plans • Emotional Reactivity • Re-traumatizing people FQHC’s serve a high proportion of these clients There are tools available to be more effective

  10. Non-Traditional Engagement Strategies

  11. Client-Centered Agendas

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