Health Partners Teaching Social Determinants via Experimental Learning Helen Hill, OMS IV, A.T. Still University - SOMA Shipra Bansal, MD, North Country HealthCare

Disclosures & Introductions North Country Health Care Founded in 1991 and FQHC in 1996 Houses: Northern Arizona Area Health Education Center One of 11 community health sites for ATSU- SOMA osteopathic students A.T. Still University – SOMA Sister school of Kirksville College of Medicine First graduating class 2011 Non-traditional 1+3 model puts students in community health centers from second year on

Social Determinants of health “Conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risk” Healthy People 2020 HealthyPeople.gov. (2015). Social Determinants of Health. Website. Retrieved on 8/13/15. http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health (Healthypeople.gov, 2015)

Social Determinants & Health Outcomes Responsible for approx. 80% of premature mortality Recent study of 1,000 physicians, a mere 20% felt ‘confident’ or ‘very confident’ in their ability to address unmet social needs If physicians could write prescriptions for social needs, they would represent approximately 15% of ALL prescriptions written Robert Wood Johnson Foundation (2011). Health care’s blind side: The overlooked connection between social needs and good health. Retrieved from: http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71795 Bipartisan Policy Center. (2012). What makes us healthy vs. what we spend on being healthy. Retrieved from: http://bipartisanpolicy.org/library/what-makes-us-healthy-vs-what-we-spend-on-being-healthy/ (Robert Wood Johnson Foundation, December 2011) (Bipartisan Policy Center, 2012: Infographic based on Boston Foundation & New England Healthcare Institute))

the gap - how to bridge Without addressing basic social needs, it is often difficult, if not impossible to improve overall health Gap between what we are putting into healthcare and what we are getting out

What can we do? 1. Recognize that social needs are connected to Americans’ health 2. Equip providers with the resources they need to make patients healthy 3. Rethink the health care system to address unmet social needs We are going to focus on the second action since the providers start picking up their skills in medical school

Example: ATSU-SOMA SDH Curriculum Series of questions taught in medical skills course Have you been without a home at any point in the past year? Has there been a time in the last 6 months when someone in your home skipped at least 1 meal because there wasn’t enough money to buy food? Who prepares the meals in your home? If I gave you a prescription today, how would you fill it? Do you feel safe walking around your neighborhood?

But what if… What do you do if you get a positive answer? Are students prepared to address these issues?

Health partners = engaged training Program started January 2015 Offer patients improved access to services that can improve their overall health Provide an opportunity for future professionals to meaningfully understand different factors impacting patient health and to develop skills around filling that gap Support clinicians in providing whole person healthcare by addressing social determinates of health with patients

Health Partners Operations Desk located at entrance to North Country HealthCare Patient referred through staff member or self-referral Intake performed by Intern Intern connects patient to resources in the community specific to his or her needs Follow up calls weekly Cases closed and sent to primary care physician

Student run Program Students staff the HealthPartners desk in NCHC weekly for one semester Work one-on-one with patients with unmet basic social needs Meet weekly Discuss patient cases Experiential learning activities Discuss weekly readings and videos Returning interns take on mentoring role

Inter-professional education Students from a variety of fields have participated Osteopathic Medicine Pre-health Dental Pre-med Pre-PA Pre-nursing Public health Social work Anthropology 1,622 documented hours worked

Curriculum Weekly assignments focus on different aspects of social determinants of health and put them in context of health outcomes Teaching is based on experiences at the desk as well as field trips. Supplemental activities, videos and readings are used to generate discussion Topics include the impact on health of: - Housing - Historical Trauma - Racial bias - Health Policy - Poverty - Food access - Employment - Community planning

Is it working? Currently reviewing Health Partner Intern experience Patient experience The data on referrals

Evaluation of Patient Experience Initially questioned when case closed 103/310 indicated “Health Partners referral was able to help meet their needs” * Telephone questionnaire in progress Mixed results Significant benefit Not able to get resource but identified personal barriers Already aware of resources, wanted something more Deny connection between met or unmet basic needs and health *not all cases that are closed have the opportunity to ask this question

SURVEY Dilemma Users of the desk have not been identifying accessing resources as having an effect on their health How do you measure this type of program?

Clients 310 unique clients served at the desk 155 Applications (APS electricity equalization, Lion’s Club glasses, housing) 924 Referrals * *Caveat All data relies on end of the day recording by the intern Output only as good as the input

Areas of Need Identified Housing Food Dental Vision Transportation Family Health Advocate (Insurance, food stamps, clinic programs) Employment Legal aid Utility assistance Social work Dental is available in the clinic Affordable denture need sprouted new initiative and partnership

Identified Benefits of Health Partners Increased use of clinic resources and programs Provider Intern

Challenges Continued engagement from Interns Measuring and tracking long range outcomes Financial pressure—currently 100% volunteer

Next steps Quantify the difference for providers of having a resource to address social determinants of health in the clinic Quantify how Health Partners influences interns’ future patient interactions Improve evaluation of patient experience with desk, accessing resources, and change health outcomes Reach out to Coconino Community College and other institutions that have pre-health students for possible partnership Integrate Health Partners into clinical operations Expand to our mobile bus clinic to include “Health Partners on Wheels” Expand into behavioral health integrative clinic Care managers and family health advocates wrap it into PCMH model with staff providing some of the structure

Closing Social determinants have significant health outcomes Current curricula do not adequately prepare students to address social determinants Health Partners is an innovative model that utilizes IPE to teach students about social determinants More work needs to be done to evaluate patient perceptions of connection between basic needs and health

Sources Bipartisan Policy Center. (2012). What makes us healthy vs. what we spend on being healthy. Retrieved from: http://bipartisanpolicy.org/library/what-makes-us-healthy-vs-what-we-spend-on- being-healthy/ HealthyPeople.gov. (2015). Social Determinants of Health. Website. Retrieved on 8/13/15. http://www.healthypeople.gov/2020/topics-objectives/topic/social- determinants-health North Country HealthCare (2015). Mission. Accessed on 8/14/2015. Website: http://www.northcountryhealthcare.org/who/our-mission.php. Robert Wood Johnson Foundation (2011). Health care’s blind side: The overlooked connection between social needs and good health. Retrieved from: http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71 795

Questions and Contact Information Shipra Bansal, MD sbansal@nchcaz.org Helen Hill, OMS IV hshill@atsu.edu Please evaluate this presentation using the conference mobile app! Simply click on the "clipboard" icon on the presentation page.