expanding your reach · high-quality scientific evidence of safety and effectiveness. …new...

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1

Opening graphic

Insert photoPsycho-Emotional

Satisfaction

Spiritual

Replenishment

Physical

Vitality

Community

2

Golden Gate University

Wellness Resources Office

Michael Anne Conley, MA, MFT

Clinical Director

[email protected]

AN INTEGRATIVE HEALTH APPROACH TO STUDENT WELLNESS

Expanding Your Reach

3

About GGU

Small:

5000

Part-

Time

83%

Graduat

e 87.5%

Urban:

downtown

San Francisco

+

three satellites

(Los Angeles,

Seattle,

Silicon Valley)

Age:

Avg = 34Female:

55%

• Non-residential

• Mostly working

adults seeking to

upgrade/redirect

professional

futures.

~ ~ ~

More than 80% of classes

taught by practicing

professionals

“non-working”

• Law - 24%

• International - 11%

(represent

60 countries)

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About Wellness Resources

Our Mission

help students incorporate healthy lifestyle choices while they work

toward their academic goals.

assist them in using effective wellness tools to enhance their

academic success and balance their educational demands with other

important areas of life.

~ ~ ~

support them in addressing medical and mental health needs from

integrative perspective.

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1996: Career & Counseling Services

- Training for career students, MA and PsyD counseling students

- Mental Health services for students, alumni, general public

(ongoing, long-term)

1999: Center for Counseling & Psychological Services

- Setting change, space reduction

2003: Counseling Services

- Training program partnerships closed, staffing reduction (.6

FTE)

- Direct services reduced to GGU students (referrals only for

alumni)

- Began developing psycho-education workshops

(stress mgmt, time mgmt, visioning and goal-setting, exam

anxiety)

2006: - Training component for MFT trainees and interns reintroduced

ABOUT WELLNESS RESOURCES

Our Evolution

Initiated idea to develop broader based health & wellness

services

Promo:

Webpage

Brochures

Flyers

+ Workshops

+ Orientation

+ Work/Life

Integration

Month

+ GGUTOPIA

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Banner

2008: Wellness Resources

- Setting, Mission change

Expanded development of health and wellness services6

mailto:[email protected]

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Our Staff

0

0.2

0.4

0.6

0.8

1

1.2

Paid staff 0.5 0.67 0.67 0.93 1.2

Unpaid staff 0.25 0 0.25 0 0.64

2000 2003 2006 2009 2010

Paid staff:

• Clinical DirectorLicensed MFT, 25 hours/wk

• 2010 (budget request)

Counselor, MFT Candidate, 20 hours/wk

Unpaid staff:

• Pre-licensed counselors

MFT trainees, interns,

PsyD students(LCSW, LPCC possible)

• Future: Health educator

?

8

# Sessions

FY 09-10

(thru 4/10 only)

136.5% 08-09

81.1% 07-08

CAVEAT:

WR budget w/in OSA (costs for brochures,

copying, space not differentiated)

Itemized expenses:

Salaries, malpractice, dues, conferences,

some furnishings and some promotional

materials


Other Stats

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Some things

you already

doAdd

another

dimension

Expands

Your Capacity

To Meet

What’s New

EXPANDING YOUR REACH

What Does It Mean?

10

Already do


Taking What You Know

Some things

you already

do

Offer health-related service(s):

Counseling Health Promotion

Medical Care Fitness Center/Programs

√ @ GGU

√ √

Make your service visible

(Marketing is letting

your community know

what you offer)

11

Add

another

dimension

Theoretical Frame

Approach to Care

Ways to Reach Out


Adding New Perspective

12

Expanding Ways to Reach Out:

Developing GGU’s Approach

What we did:

1. Set our intention

2. Identified our allies

3. Developed strategic

alliances

4. Experimented with

collaboration on programsOn campus

&

Off campus

Add

another

dimension

Ways to Reach Out

√ @ GGU

3

13

Integrative Health:

Where are you?

Have Basic Idea

But Little

Experience

With Practice of

Integrative Health

Unfamiliar

With Integrative

Health

Terminology

Practice

Have Expertise

in Practice of

Integrative

Health

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Expanding Theoretical Frame

We are the beneficiaries

of an evolving,

worldwide

conversation

about the

definition of health

and the

etiology and

treatment of disease

Add

another

dimension

Theoretical Frame

15

What are our assumptions

James Lake, MD, Integrative Mental Health Care: A Therapist’s Handbook (2009)

What are our assumptions?

“Disparate healing traditions rest

on different assumptions about the

causes and meanings of illness.”

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What Explains Illness


What Explains Illness?

(emphasis added)

Conventional medicine: “…physical or mental illness can be

completely described in terms of biological causes and current

scientific theories.

In these nonconventional healing traditions, explanations of illness

rest on assumptions about fundamental energetic principles that

cannot be described in the language of contemporary Western

science.”

Other traditions, including Chinese medicine, homeopathy

and various schools of „energy‟ healing, do not share this assumption.

17

Conventional

MedicineTraditional

Medicine

Finding a Middle Path

What’s

New

?

Tribal, folk

Indigenou

s

Allopathic

(allos “opposite,”

pathos“suffering”)

Mainstream

Medical Rationalism

Orthodox

Medical Empiricism

Holistic

Complementary &

Alternative

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Treatment can include…targeted amino acid therapy and high-dose

supplementation …specific amino acids are beneficial for individuals

with depression, anxiety, insomnia and ADD…often used in

combination with conventional drugs…

TERMINOLOGY:

CAM, Functional Medicine

Complementary = used together with conventional treatments

Alternative = used instead of conventional medicine

CAM

Functional Medicine

— National Center for Complementary & Alternative Medicine

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19

They Can Co-Exist

(baking a

cake)(enjoying the cake)

20

Abbott et al, , “Medical Student Attitudes Toward

Complementary, Alternative and Integrative Medicine,”

Evidence-based Complementary and Alternative Medicine (eCAM), 01/20/10

http://ecam.oxfordjournals.org/cgi/content/abstract/nep195v1

(emphasis added)

TERMINOLOGY:

What Do We Call This Path?

Integrative Medicine/Health

…combines conventional “with those of CAM that have

high-quality scientific evidence of safety and

effectiveness.

…new paradigm that incorporates core CAM values….

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(emphasis added)

“…on providing skillful psychotherapy, while also advising clients about

lifestyle changes including exercise and nutrition, stress management

approaches, mind-body practices (such as yoga and meditation) and the

appropriate and safe use of herbals, vitamins, omega-3 essential fatty acids,

amino acids and other natural products.”

— James Lake MD

Adjunct Clinical Assistant Professor

Stanford University Hospital Dept. of Psychiatry

Chair, APA Caucus on CAM

Primary Focus

TERMINOLOGY:

Integrative Mental Health

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Higher levels of

education

Higher incomes

50%

43%40%

25% 24%

Native Caucasian Asian Black Hispanic

Race/

Ethnicity

% of users within each subgroup (2007)

Why we should be attentive

* Some college/no degree

(45%)

National Health Interview Survey

http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm

* 18-29 (36%)

2007 National Health Interview Survey

Some form of complementary or alternative medicine used

by

4 in 10 adults — and 1 in 9 children (latter is conservative

estimate) Women (43%)

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Services they use


Biologically

Based

Therapies

Mind-Body

Therapies

Alternative/

Whole

Medical

Systems

Energy

Healing

Manipulation

Therapies

24


Biologically Based

* Wide or increasing use since 2002 study

Substancesfound in nature

• Vitamins/Minerals

• Non-vitamin, non-mineral products* from

plants & enzymes (ex: Herbal remedies)

• Chelation Therapy

• Diet/food-based therapies

Services they use

5

25


Mind-Body therapies

Focus on interaction

between the body and its

brain.

Conventional examples:

support groups,

CBT

• Biofeedback

• Meditation,* Guided imagery

• Progressive relaxation

• Deep breathing* Hypnosis

• Yoga,* Tai chi

* Wide or increasing use since 2002 study

Services they use

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Mind-Body therapies

• Somatic (Body-Oriented) Psychotherapies —— examples

Hakomi Somatic Experiencing Biodynamics

Bioenergetics Formative Psychology

— Stanley Keleman, director, Center for Energetic Studies, http://centerpress.com

At conception each person is given a biological and emotional

inheritance but it is through voluntary effort and self-

management that this constitutional given fulfills its potential for

a personally formed life.

Services they use

27


Alternative/Whole Medical Systems

Based on complete

systems of theory

and practice, often

from and earlier

than conventional

approach

European: Asian:

Homeopathy Traditional Chinese

Naturopathy Medicine/Acupuncture

(Japanese, Tibetan)

South Asian: Worldwide:

Ayurveda Traditional healers

Services they use

28


Energy Healing

Use of energy fields, either

through physical pressure or

electromagnetic tools

Conventional example:

ECT

• Therapeutic Touch

• Qi Gong

• Reiki

• Magnet therapy

• Shoe inserts, knee wraps for joints and muscles soreness

Services they use

29


Manipulation Therapies

Manipulation and/or movement

of one or more parts of the

body

• Osteopathy *

• Chiropractic

• Massage

• Movement therapies

* Often considered a form of conventional medicine

Services they use

30

Expanding Approach to Care

Integrative

treatment is

oriented toward

using the

expertise

that best fits the

patient and the

medical situation.

Add

another

dimension

Approach to Care

http://centerpress.com

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Gift from CAM

McIntosh, Anna, PhD, ND, “Understanding the Differences Between Conventional, Alternative, Complementary,

Integrative and Natural Medicine,” Townsend Letter (July, 1999)

(emphasis

added)

For Example:

• Naturopathic practitioners are trained “as experts in prevention and gentle

treatment of all common ailments and chronic degenerative diseases which

have a dietary and lifestyle, i.e. multifactorial etiology.”

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Gift from Conventional

McIntosh, Anna, PhD, ND, “Understanding the Differences Between Conventional, Alternative, Complementary,

Integrative and Natural Medicine,” Townsend Letter (July, 1999)

Whereas

• Conventional practitioners “have expert training in high intervention

medicine. When surgery is required, when a potent antibiotic is required,

when a strong, potent drug is required, when life support systems are

required, conventional medicine practitioners have unparalleled expertise.”

33

Expanding Approach to Care

Integrative

treatment is

more than

what we do.

Practitioners are

also committed to

the process of

how we do it.

Add

another

dimension

Approach to Care

34

LEARNING OBJECTIVE #1:

Integrative Health Principles

Center for Integrative Medicine, University of Arizona (established 1994, Andrew Weil, MD)

http://integrativemedicine.arizona.edu

Patient and practitioner

are partners

in the healing process.

35 35

Mind Spirit

Community

Body

All factors that influence

health, wellness, and disease

are taken into consideration.

Center for Integrative Medicine, University of Arizona


Psychosocial satisfaction:

• history and life circumstances

35



Cultural forces:

• race, ethnicity • gender orientation • spiritual inclination or practice

Physical vitality:

• personal and family medical background

36





Appropriate use of both

conventional and alternative methods

facilitates the body's innate healing response.

7

37

“The dominant paradigm of Western psychiatry — biological

psychiatry — posits that the causes of specific symptoms or

disorders are dysregulations of specific neurotransmitters or their

receptors.”

However, in conventional psychiatry:

“Although many are available, formal biological assessment tools

are seldom used in day-to-day clinical practice.”


A Conundrum: IMH Example


38





Effective interventions that are natural

and less invasive should be used whenever

possible.

39



At GGU—

Conservative

:

Start with tx

that have

potential for

support with

least risk of

side effects;

consult

&

collaborate

Conventional

Medicine

Yes

Yes

No

Not

sur

e

In emergency?

Adjunct Referral

PRN

Prefers CAM/Traditional?

No Yes

• Research as necessary

• Consult, Refer & Collaborate to appropriate services

Discuss pro‟s/con‟s of various options

Familiar with CAM?

40





Integrative health neither rejects conventional approaches

nor accepts alternative therapies uncritically.

41





Good health care is based in good science.

It is inquiry-driven and open to new paradigms.

42


Benefits for our students

Build self-care habits with long-term impact (as alumni)

Learn to manage their health in short-term (college)

Non-pharma possibilities for managing stress and anxiety

More options to meet needs

Reduces stigmatization re mental health

8

43


Benefits for staff

Live integrative principles when this is consistent with

our own self-care

Expand the safety net that holds our students

Work with colleagues whose expertise extends our knowledge

base

Attract staff

Increase our understanding of fuller range of options

For student health care

44

Reaching out: what to do

Add

another

dimension

Ways to Reach Out

45

Inform Offer

Experience

Refer Consult &

Collaborate

Coordinate

√@ GGU:

√@ GGU:

√@ GGU:

√@ GGU:

X@ GGU:


Range of Options for IH Model

Some redirection of staff activities/funding)

Intention (actions, not words)

Change in perspective by staff

46


Option 1: Inform

More broadly distribute IH content to students

Continuum of financial impact

Example:

$ — info to more campus allies

and more often

$ — web-based wellness

programs

Handouts

• Workshops

• Signups at events

• Orientation

Email to new faculty, staff

Introduce CAM perspectives in

clinical sessions as appropriate

Future: Cybercampus courses

Some things

you may

already do

√ @ GGU

47

Invite various vendors/services in the community to campus:

Farm Fresh to You (CSA) Circle Community Acupuncture

Satori Yoga Studio Crunch Fitness/24-Hour Fitness

GGUTOPIA (annual student lifestyle fair)

Work/Life Integration Month (October - various dedicated activities)

Wellness Wednesdays (monthly tabling on campus)

Orientations (August, September, January, May)

√ @ GGU


Option 1: Info at Events

48

Write and produce information intended to draw interest

Extend how info is distributed

Law School News (weekly required reading)

Campus Currents (monthly student magazine)

Downtown Stress Relief Flyer

√ @ GGU


Option 1: Info through Media

9

49

Offer students the

opportunity to

personally experience

Some IH approaches

(mind-body are good

place to start)

• Bring some IH-oriented events to campus

• Introduce IH experiences in clinical

sessions and workshops as appropriate

√ @ GGU


Option 2: Offer experience

50

Law School Massage Day

(hosted by SBA, supported by WR)

Lunchtime Stress Break(hosted by WR, led by Brahma Kumaris)


Option 2: Experiential events

50

Special Events (as able)

GGUTOPIA (annually)

Wellness Wednesdays (monthly)

51

Within events & sessions

Instructions Shorthand

Press both feet flat to the floor, just enough that you feel your

leg muscles tense up. Feet Floor

Rest both hands on your thighs, feeling your legs tighten Hands Thighs

Take a slow, deep breath, as far into your belly as you can

without strain.Deep Breath

Exhale, loosen your jaw, then unpress your hands and your

feet.

Release

Take 2-3 regular breaths, and then do another round from the

start.Regular Breath

2006 Michael Anne Conley, MFT, shared with Golden Gate University with permission.

[email protected] 925-274-3311


Option 2: Include experience

51 52

Utilize off-

campus

resources to

extend level

of care

beyond

institutional

ability

Seeking Integrative Resources more routinely

Referral Database (local and national resources)

Networking through off-campus resources

- alternativementalhealth.com/emailpro.htm

- Integrative Mental Health network (international, forming)

- Licensee listserves

Memberships/subscriptions (to research tx)

- worstpills.org (ctr for science in public interest)

- naturalstandard.com (cam tx research aggregator)

√ @ GGU


Option 3: Refer

53

Seek expert

advice and/or

work together

informally with

Integrative

practitioners in

the service of

student needs

On-campus: working more closely with Disability Services

Off-campus: - Osher Center for Integrative Medicine- Kaiser Permanente- Individual practitioners

Case-by-Case (PRN)

or Ongoing collaboration (form a relationship beyond

case)

√ @ GGU


Option 4: Consult & Collaborate

54

Create a formal administrative structure

where IH practitioners work together as a team,

including the communication and sharing of records

(requires greater institutional commitment)

Don‟t foresee:*

• size

• demographics

Coordination

not @ GGU

* Except possibly just within IMH, per + health education


Option 4: Coordinate


10

55

EXPANDING WAYS TO REACH OUT:

Getting from there to here

On campus

&

Off campus

Add

another

dimension

Ways to Reach Out

4. Experimented with

collaboration on programs

3. Developed strategic alliances

2. Identified our allies

1. Set our intention

√ @ GGU

56


1. Set your intention

We will create a more We will create partnershipscomprehensive frame that with off-campus servicesmoves student health from that support anmental health treatment integrative health approachto whole person care. for our students.

√ @ GGU

Name your intention: √ @ YOU

57


2. Identify your allies

Name 2-4 allies (on- & off-campus √ @ YOU

On-campus: Off-campus:

Dean of Student Affairs Nearby Massage School

University Librarian Local Acupuncturist

Dean of Law Student Services Yoga Studio next door

√ @ GGU

58

On-campus: Work/Life Integration Team

We formed an internal support group with a few faculty and staff, and occasionally students)

58

University Library

Bar Exam Services

Undergraduate Programs

Cybercampus

√ @ GGU


3. Develop Strategic Alliances

59

On-campus: Off-campus:

University Library Brahma Kumaris Meditation Center

Law Student Services Farm Fresh to You

Undergraduate Programs Crunch/24-Hour Fitness

Bar Exam Services Circle Community Acupuncture

Student leaders (SGA/SBA, Campus Currents) Satori Yoga Studio

Cybercampus National Holistic Institute


3. Develop Strategic Alliances√ @ GGU

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Who Are Your Potential Strategic Partners?


3. Develop Strategic Alliances

√ @ YOU

11

61

√ @ GGU


4. Collaborate on programs√ @ GGU

9

We are partners who offer each other mutual support

Work/Life Integration Team Work/Life Integration Month

University Library Lifelong Learning SymposiumResearch for the Real World Symposium

Office of Student Affairs GGUTOPIA

Law Bar Exam Services/Law Student Services Bar Exam Support Group

Brahma Kumaris Meditation Center Lunchtime Stress Break &Downtown Stress Release Promo

WLI Team/CyberCampus & Economic Resilience ProjectWeb Design Team

62

On campus: Economic Resilience Project

• Videoclip series for GGU intranet

• Focus on mental health: attitude

• Keys to Economic Resilience


3. Develop Strategic Alliances√ @ GGU

Replace worry with

constructive actionFind your financial

comfort zone

Take a long-term viewKnow what you know

Explore your community.

63


4. Collaborate on programs

Invision one program for starters √ @ YOU

64

Some things

you already

doAdd

another

dimension

Expands

Your Capacity

To Meet

What’s New

AN INTEGRATIVE HEALTH APPROACH TO STUDENT WELLNESS

Expanding Your Reach

65

FOR INFO & REFERRAL:

Resources

65

American Holistic Medical Association

http://www.holisticmedicine.org/displaycommon.cfm?an=1&subarticlenbr=100

Arizona Center for Integrative Medicine — http://integrativemedicine.arizona.edu/alumni.html

Community Supported Agriculture — Find a farm near you:

http://www.nal.usda.gov/afsic/pubs/csa/csa.shtml#find

Consumer Lab — third-party resource for evident of natural product safety by brand:

http://www.ConsumerLab.com

Institute for Functional Medicine

http://www.functionalmedicine.org/findfmphysician/index.asp

Integrative Mental Health listserve, email James Lake, MD

[email protected] (refer to this presentation and ACHA conference)

National Center for Complementary & Alternative Health — http://nccam.nih.gov/

Safe Harbor, Integrative Psychiatry listserve —

http://www.alternativementalhealth.com/emailpro.htm

United States Association for Body Psychotherapy — http://www.usabp.org/

Natural Standard — research aggregator on nonconventional treatments

http://www.naturalstandard.com

66

References

66

Abbott, Ryan B, et al. Medical Student Attitudes Toward Complementary, Alternative and Integrative

Medicine. Evidence-based Complementary and Alternative Medicine (eCAM), 2010: Jan. 20.


American Holistic Medical Association. http://www.holisticmedicine.org

Center for Integrative Medicine, University of Arizona. http://integrativemedicine.arizona.edu

Ausubel, Kenny. When Healing Becomes a Crime: The Amazing Story of the Hoxsey Cancer Clinics

and the Return of Alternative Therapies. Rochester, Vermont: Healing Arts Press; 2000.

Coulter, Harris L., Empiricism vs. Rationalism in Medicine, J. Orthomolecular Medicine. 1994;9(3).

http://orthomolecular.org/library/jom/1994/articles/1994-v09n03-p159.shtml

American Association for Marriage and Family Therapy. Family Therapy magazine. Alternative

Therapies issue,. 2010: January-February.

Keleman, Stanley. Center for Energetic Studies. http://centerpress.com

Lake, James, MD. Integrative Mental Health Care: A Therapist‟s Handbook. New York: W. W. Norton

& Company; 2009.

McIntosh, Anna, PhD, ND. Understanding the Differences Between Conventional, Alternative,

Complementary, Integrative and Natural Medicine. Townsend Letter. 1999; July. http://www.tldp.com/medicine.htm

http://www.holisticmedicine.org/displaycommon.cfm?an=1&subarticlenbr=100

http://integrativemedicine.arizona.edu/alumni.html

http://www.nal.usda.gov/afsic/pubs/csa/csa.shtml

http://www.functionalmedicine.org/findfmphysician/index.asp


http://nccam.nih.gov/

http://www.alternativementalhealth.com/emailpro.htm

http://www.usabp.org/

http://www.naturalstandard.com


http://www.holisticmedicine.org






http://centerpress.com

http://www.tldp.com/medicine.htm

12

67

References

National Center for Complementary and Alternative Medicine (NCCAM). http://nccam.nih.gov/

National Health Interview Survey. National Center for Health Statistics & National.Center for Complementary and Alternative Medicine. 2007.


Stanford Encyclopedia of Philosophy; 2008. http://plato.stanford.edu/

United States Association for Body Psychotherapy. http://www.usabp.org/

World Health Organization

http://www.who.int/mediacentre/factsheets/fs134/en/

67 68

THANK YOU!

http://nccam.nih.gov/


http://plato.stanford.edu/

http://www.usabp.org/

http://www.who.int/mediacentre/factsheets/fs134/en/

expanding your reach · high-quality scientific evidence of safety and effectiveness. …new...

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