The Patient in Context Teaching Core Psychosocial Assessment

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

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

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. " ilbank M Quarterly 80. 3 (2002): 433 -479. 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 Medicine 14. 4 (1998): 245 -258. 3

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), 111 -122. 4

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

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

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

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

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

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

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

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

Ecomap Teaching Tips PGY 1 q Introductory workshop üpop-culture example üpractice on each other üpractice on a case in workshop q Practice on patients üInterview patient, construct Ecomap üPresent Ecomap - tell the story and discuss q Ecomap patients during video review

Ecomap Teaching Tips (cont. ) PGY 2 & 3 q Mental Health Clinic (create while listening) q Pre-req for in house mental health consult PGY 1 -3 q Home visits q Family conferences q Case presentations q BM didactics

When to Use an Ecomap video removed

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

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

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

“How does your understanding of Emily’s context impact your intervention? ” 21

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

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

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