1. 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

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
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):
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):
Life Course- complex interplay of biological, behavioral, psychological and social factors (risk and protective) to health outcomes. Life course perspective elaborates the importance of time, context, process, and meaning on human development and family life (Bengtson and Allen 1993).
ACEs- Association between childhood exposure to abuse/neglect + significant household dysfunction and later-life health/well-being (depression, anxiety, sub. abuse, sexual risk behavior, chronic disease, etc.) 1998
Knowing what a patient’s life is like, helps us assess concerns accurately and form meaningful patient-centered treatment plans (e.g. identifying key support people, resource limitations). 5 5

6. 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
Ann Hartman developed ecomap (aka sociogram) to illustrate individual and family relationships to larger system
Hartman, A. (1978, reprinted 1995). “Diagrammatic assessment of family relationships.” Families in Society: the Journal of Contemporary Human Services, 76(2), 6 6

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 7

8. Ecomap Domains Significant Relationships Neighborhood Social Groups
Employment
Education
Community Services
Other
Call attention to Ecomap Worksheet for domain details. Inquiry into these domains result in greater understanding of the patient’s context and facilitate the construction of the ecomap… provides structure/framework to obtain and record information. Includes some social determinents of health
$ Rx 8 8

9. Ecomap Construction Social Groups Other Community Services Education
Patient
Employment
Neighborhood
Practice asking questions… how do you take a social history beyond asking about marital status, alcohol and tobacco and seatbelt use. See domains/worksheet on back of ecomap. Read some sample questions… put key relationships in circles (get their own… not all in one domain) and connect based on strength quality and resource flow.
These are the areas you may touch on… but each relationship gets it’s own circle… hopefully will have many circles.
Significant
Relationships
______ _______ /\/\/\/\/\/\/\/\/\/\
_______
Connected Strong Weak Stressed/Conflict
Arrows should aim in the direction of the flow of energy 9 9

10. 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
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), 10 10

11. Ecomaps: A Resident’s Perspective
Insert Greenblatt1

12. Case Example: Sam 48 yr. old, married male Uncontrolled diabetes
“Guest patient”
Use SpongeBob, Simpsons, Modern Family etc.

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

14. 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

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

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

20. 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”
AR how to teach… AO sim. Ecomap construction/questions 20 20

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

22. 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 22
______ _______ /\/\/\/\/\/\/\/\/\
_______
Connected Strong Weak Stressed/Conflict
Arrows should aim in the direction of the flow of energy 22

23. “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? 23 23

24. “Isn’t it time consuming?”
Insert Greenblatt3

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

26. 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
Process enables provider to better understand what it is like to be the patient Partnership Leverage points