1. The Patient in Context: Teaching Core Psychosocial Assessment Skills Through the Use of Ecomaps
Amy M. Romain, LMSW, ACSW
Amy J. Odom, DO
Sparrow/Michigan State University FMRP
2015 STFM Annual Conference

2. Today’s Objectives Participants will be able to:
Construct an Ecomap based on pertinent contextual information gathered from a patient
Utilize the Ecomap in teaching psychosocial assessment and intervention skills to residents
Apply the Ecomap to a variety of areas of residency curriculum

3. 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):
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): 3 3

4. What is an Ecomap? 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
Hartman, A. (1978, reprinted 1995). “Diagrammatic assessment of family relationships.” Families in Society: the Journal of Contemporary Human Services, 76(2), 4 4

5. 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 5 5

6. Ecomap Domains Significant Relationships Neighborhood Social Groups
Employment
Education
Community Services
Other
$ Rx 6 6

7. Ecomap Construction Social Groups Other Community Services Education
Patient
Employment
Neighborhood
Significant
Relationships
______ _______ /\/\/\/\/\/\/\/\/\/\
_______
Connected Strong Weak Stressed/Conflict
Arrows should aim in the direction of the flow of energy 7 7

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

9. Sparrow/MSU FMRP Behavioral. Science Team 2014
Ecomap Demonstration
video removed
Sparrow/MSU FMRP Behavioral. Science Team 2014

10. Family Elise 35 Church Diabetes Ben son-7 Sam 48 Truck Driver
cannot drive truck while on insulin
Truck Driver
Katie dtr.-9
need to add bedrooms for kids $
Trying to get
Custody
House

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

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

13. Ecomap Teaching Tips PGY1 Introductory workshop pop-culture example
practice on each other
practice on a case in workshop
Practice on patients
Interview patient, construct Ecomap
Present Ecomap - tell the story and discuss
Ecomap patients during video review
Use SpongeBob, Simpsons, Modern Family etc.

14. Ecomap Teaching Tips (cont.)
PGY2 & 3
Mental Health Clinic (create while listening)
Pre-req for in house mental health consult
PGY1-3
Home visits
Family conferences
Case presentations
BM didactics

15. Worksheets help early learners with “script”… how to ask questions and considering possible interventions

17. When to Use an Ecomap video removed
Multiple problems, complicated, new chronic or life altering diagnosis, mental health, new patient, home visit etc.

18. Teaching Case: Depressed Mother “EMILY”
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” 18 18

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

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

21. “How does your understanding of Emily’s context impact your intervention?”
Discussion: Family history of suicide! Insurance/financial issues with meds… no generic for lamictal. Corroborators for history? Who can help with kids while she is so ill? Does she need medical leave from work or can Mike get FMLA to be around more? Counseling referral? 21 21

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

23. Ecomap Resources on FMDRL
Introductory Powerpoint
Blank Ecomaps
Ecomap Worksheets
Sample Case with Ecomap (Emily)

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