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

2. 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

3. 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.
(Healthypeople.gov, 2015)

4. 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:
Bipartisan Policy Center. (2012). What makes us healthy vs. what we spend on being healthy. Retrieved from:
(Robert Wood Johnson Foundation, December 2011)
(Bipartisan Policy Center, 2012: Infographic based on Boston Foundation & New England Healthcare Institute))

5. 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

6. 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

7. 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?

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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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?

17. 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

18. 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

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

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

21. 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

22. 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

23. Sources
Bipartisan Policy Center. (2012). What makes us healthy vs. what we spend on being healthy. Retrieved from: being-healthy/ HealthyPeople.gov. (2015). Social Determinants of Health. Website. Retrieved on 8/13/15. determinants-health North Country HealthCare (2015). Mission. Accessed on 8/14/2015. Website: Robert Wood Johnson Foundation (2011). Health care’s blind side: The overlooked connection between social needs and good health. Retrieved from: 795

24. Questions and Contact Information
Shipra Bansal, MD Helen Hill, OMS IV
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