Citizen Healthcare:An Evolution in Engaging Families

and Communities in Health

Tai J. Mendenhall, Ph.D., LMFT, CFTAssistant Professor, University of Minnesota, Department of Family Social Science

William J. Doherty, Ph.D., LMFT, LPAssistant Professor, University of Minnesota, Department of Family Social Science

Collaborative Family Healthcare Association 14th Annual ConferenceOctober 4-6, 2012 Austin, Texas U.S.A.

Session # B4bOctober 6, 2012

Faculty DisclosureWe have not had any relevant financial relationships

during the past 12 months.

Objectives• At the conclusion of this presentation, the

participant will be able to:– Describe the core tenets and principles of the Citizen

Healthcare Model– Describe core action strategies for Citizen Healthcare

projects– Describe how Citizen Healthcare has been applied across

diverse community settings and mental health / physical health-related foci

– Outline key differences between Citizen Healthcare and other models of collaborative and community-based work

Introductions

Conventional / “Standard” Care• Hierarchal structure

– Provider/Patient– By Specialty

• Provider-consumer design– Care as “goods/services”– Providers give, patients take

• Expert-driven– Providers’ wisdom valued / Providers active– Patients’ wisdom untapped / Patients passive

• Challenged by contemporary contexts…

Healthcare: The Current Context

• Rapid and constant change

• From acute care to preventive and patient-oriented care

• From provider/consumer services to provider/patient partnership

Trends toward Family & Community-based Interventions

We are moving away from doing care “on” people to doing care “with” them

Tapping into patients’ and families lived-experience and wisdom requires professionals to “unlearn” their expert-roles and work more collaboratively within the context(s) of more flattened professional hierarchies

Citizen Health Care• Citizen Health Care (CHC) is a way to engage

patients, families, and communities as co-producers of health and health care

• CHC encompasses an identity-shift for professionals (from “expert” to “citizen”)

• Core principles and planning strategies permeate projects, but no two projects look wholly alike

Origins of Citizen Health Care

• Family Therapy• Medical Family Therapy• Collaborative Family Health Care• Democratic Political Theory• Contemporary Community Organizing

Strategies• Community Based Participatory Research

Citizen Health Care (CHC):Core Principles

• The greatest untapped resource for improving health care is the knowledge, wisdom, and energy of individuals, families, and communities who face challenging health issues in their everyday lives.

Core Principles, con’t

• People must be engaged as co-producers of health care for themselves and their communities, not just as patients or consumers of services.

Core Principles, con’t

• Professionals can play a catalytic role in fostering citizen initiatives when they develop their public skills as citizen professionals in groups with flattened hierarchies.

Core Principles, con’t

• If you begin with an established program, you will not end up with an initiative that is "owned and operated" by citizens. But a citizen initiative might create or adopt a program as one of its activities.

Core Principles, con’t

• Local communities must retrieve their own historical, cultural, and religious traditions of health and healing, and bring these into dialogue with contemporary medical systems.

Core Principles, con’t

• Citizen health initiatives should have a bold vision (a BHAG – a big, hairy, audacious goal) while working pragmatically on focused, specific projects.

Examples Citizen Health Care Projects

• Partners in Diabetes (Regions Hospital / UMN)• A Neighbor Giving Encouragement, Love and

Support (“ANGELS”) (Wake Forest University)• Family Education / Diabetes Series (“FEDS”)

(St. Paul Department of Indian Work / UMN)• Activated Patient Project (Como Clinic / UMN)• Students Against Nicotine & Tobacco Abuse

(“SANTA”) (HHH Job Corps / UMN)

Examples, con’t• Intimate Partner Violence (IPV) in the Hmong

Community: Tacking an Old Problem in a New Way (Lao Family of Minnesota / UMN)

• Reducing Tobacco Use in Southeast Asian Communities (MPAAT / UMN)

• Hennepin County Citizen Professional Project (Hennepin County / UMN)

• Sisters Together Overachieving in Raising Kids (“STORKS”) (Broadway Clinic / UMN)

Family Diabetes / Education Series(the “FEDS”)

• Members of the Native American community who have lived experience with diabetes (as patients or family members) working in partnership with providers in the provision of education and support in culturally appropriate ways

• Designed and implemented through a democratic and collaborative partnership between patients, family members, and providers

FEDS / Introduction

• Engages low-income, urban-dwelling AIs and their families in an active forum of education, fellowship, and support

• Participants include patients and family members (n = 40-60), medical and behavioral health providers (n = 4-5), and tribal elders (n = 4-6)

FEDS / Meetings

• Meetings start with members conducting foot checks and recording each other’s weight/ BMI, blood pressure, and blood sugar

• Meals consistent with AI culture and traditions are prepared and shared communally, along with discussions about ingredients and indicated portion sizes

FEDS / Education

• Educational forums take place in the contexts of talking circles, small and large group discussions, and a variety of lively activities (e.g., traditional music, dancing and aerobics, impromptu theater/role-plays)

• Forums encompass active collaboration between community leaders and Western providers

FEDS / Educational Topics, con't

● Diabetes in the AI Community● Dietary Guidelines & Portion Sizes● Exercise & Physical Activity ● Obesity & Weight Control● Foot Care & Wound Care● Blood Glucose Monitoring & Control ● Eyes and Teeth: Dental Care / Retinopathy

FEDS / Educational Topics, con't

● Blood Pressure & Cholesterol● Heart Disease & Stroke● Stress Management & Strategies● Medical Services & Supplies● Working with your Doctors● Sticking with it: Staying Motivated

& Family/Social Support● Review: Putting it all Together

Outcome Data (at 3-mo. follow-up)

• Metabolic control (A1c) is significantly improved (6.834 to 6.436; p=.011).

• Weight loss is approximately 14lbs (mean weight change from 216.22 to 202.43).

• Blood pressure is trending down across both systolic (137.55 to 143.08; p = n.s.) and diastolic (89.17 to 79.00; p < .05) measures.

Outcome Data (at 6-mo. follow-up)

• Metabolic control (A1c) change is not significant from 3-month follow-up

• Weight loss is approximately 16lbs (mean weight change from 216.22 to 199.56); p = .023

• Blood pressure change is not significant from 3-month follow-up.

Outcome Data (at 12-mo. follow-up)

• Metabolic control (A1c) change is not significant from 6-month follow-up

• Weight loss is approximately 20lbs (mean weight change from 216.22 to 196.41); p = .020

• Blood pressure change is not significant from 3-month follow-up.

Citizen Patient Project

Comparing ApproachesConventional Approach

• Focus on ameliorating problems

• Begin with a needs assessment by professionals

• Familiarity with process and respective roles of professionals and community members

• Emphasis on bringing government or professional resources to the community

Citizen Professional Approach

• Aspiring to take bold but focused civic action to solve problems

• Begin with identifying community pressure points and interest in working on them

• Learning new roles as professionals and community members work together in novel ways

• Emphasis on communities accessing their own resources

Conventional Approach

• Professionals orient community members to the problem and current services

• Applying current professional knowledge to the problem

• The professional hierarchy is highly influential in decision making

• Expectation of widely representative citizen groups

Citizen Professional Approach

• Citizens in the group already have expertise on the problem and the limitations of current approaches

• Generating new knowledge together, taking into account what is currently known

• Leveled hierarchy; groups only work on decisions they can make collectively and democratically

• Okay to focus on a specific group and then spread to others

Conventional Approach

• Citizens sit on county-created committees

• Representatives from the community help to improve county services

• A balance between professionals and community members around the table

• Professionals seek input from citizens on projects

Citizen Professional Approach

• Citizens and professionals form action groups based on mutual interest

• Citizens engage in collective action with facilitative support from the county

• Always more community members than professionals

• Professionals and citizens co-create projects

Conventional Approach

• Timeframe and deliverables are defined by a professional organization or funder

• Expectation for early wide impact

Citizen Professional Approach

• Timeframe and deliverables are created by the group

• Okay to focus on local impact and then spread to other communities

Discussion

Contact Information

Tai J. Mendenhall, Ph.D.Family Social ScienceUniversity of Minnesota275 McNeal Hall1985 Buford Ave.Saint Paul, MN 55108

mend0009@umn.edu612-624-3138

William J. Doherty, Ph.D.Family Social ScienceUniversity of Minnesota275 McNeal Hall1985 Buford Ave.Saint Paul, MN 55108

bdoherty@umn.edu612-625-4752

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!