Whole Health 102 F Flagships Whole Health for

Whole Health 102 F (Flagships): Whole Health for You and Me

The Vision of Whole Health

Talk to Someone New (or New-ish) 3

Talk to Someone New (or New-ish) What brings you joy? Riding my unicycle with my parrot. Thank you. 4

Objectives • Consider what health is and how health is created • Learn about Whole Health in VHA and what it means to be a Flagship facility • Reflect on your own health and well-being • Strengthen skills for supporting health and well-being for both you and those around you 5

How healthy are you feeling in this moment? • • What is health? What does it mean to “feel healthy”? How are these created? How are these supported? 6

A Whirlwind Tour Through our Health Care System Relentless Skeptic Wise Senior Colleague This Photo by Unknown Author is licensed under CC BY-NC-ND This Photo by Unknown Author is licensed under CC BY-NC-SA Choose your avatar. Curious Neutral Observer

Introductions for the Journey Together • • Your Name Your Role in VA What brings you joy? In 30 seconds or less! This Photo by Unknown Author is licensed under CC BY-NC-SA 8

Community Agreements for getting on the Rocket Ship üBe Present üBe Healthy üBe Curious üBe Honest üBe Respectful üCulture

Other important matters for getting on the Rocket Ship üSign in for CEUs üRest Rooms üSchedule

This Photo by Unknown Author is licensed under CC BY-SA

The Economics and the Outcomes UC Project for Global Inequality Crow, B and Lodha, S. (2011) Atlas of Global Inequalities. Oakland, CA. University of CA Press.

Healthcare and Financial Crisis Facing our Nation • Poor outcomes • 18% of our GNP (Gross National Product) • Chronic conditions – 75% of health care costs – Health behaviors VETERANS HEALTH ADMINISTRATION 14

“Fixing” the problem is no longer so easy. Leading cause of death. Not infection anymore. Chronic conditions drive this now. This Photo by Unknown Author is licensed under CC BY-NC-ND These are largely driven by health behaviors.

More diagnoses More “work” More pay for the system System Rewards Disease This Photo by Unknown Author is licensed under CC BY

t n i a mpl o C f ie Ch Problem List Deficit Model What ? r e t t a ’s the m ? g n o r w s ’ t a Wh s l e Lab

? d e e n u o y What do What can I do f or you? make o t s d e e n P C P r u o Y the referral… “We have the solutions. ” “You don’t have the solutions…” “You need permission. ”

How do we spend our time and energy? Social Determinants of Health: Developing Healthy People 2020. CDC Health Disparities and Inequalities Report- US, 2011. MMWR Jan 14, 2011, Vol 60. 19

Below the Surface Physical Meaning and Purpose Life Story Mind Culture Relationships Emotions Values Photo credit: Jabi - El de verdad via Foter. com / CC BY-NC

Race, Anyone? This Photo by Unknown Author is licensed under CC BY-SA

Simple Solution for a Complex Problem https: //www. nih. gov/news-events/opioids-digital-press-kit#images. Accessed 3. 31. 18

Power

Fatigue

In a year, how much time do you spend with your health care team? How much time do you spend with yourself? With your family, friends and community?

How many of us have made a choice in the past 24 hours that was inconsistent with our own personal health values?

What if…?

Put on Your Own Mask First 29

Paying Attention to Different Things • What’s going right? • What are strengths? • What really matters?

This Photo by Unknown Author is licensed under CC BY-SA

Strength This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY

Knowledge, Skills and Confidence This Photo by Unknown Author is licensed under CC BY-NC-SA

Resilience This Photo by Unknown Author is licensed under CC BY-NC-SA

IHI: New Rules for Healthcare Redesign Change the balance of power: Co-produce health and well being in partnership with patients, families, and communities. Customize to the individual: Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of what matters to the person Promote well being: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require healthcare. Create joy in work: Cultivate and mobilize the pride and joy of the healthcare workforce. http: //www. ihi. org/Engage/collaboratives/Leadership. Alliance/Documents/IHILeadership. Alliance_New. Rules. Radical. Redesign. pdf 1/9/2022

Physical Meaning and Purpose Life Story Mind Culture Relationships Emotions Values Photo credit: Jabi - El de verdad via Foter. com / CC BY-NC

What is it that we do, REALLY? 39

Veterans Health Administration • Largest integrated healthcare system in the world • Over 65% of all US-trained physicians trained in VA’s – Large numbers of other health professions trainees also • Innovation, Pilots and Research • Infrastructure – Office of Patient Centered Care & Cultural Transformation (OPCC&CT) – Coding/Documentation – Reimbursement

Whole Health System Flagship Sites Key FY 16 Original Design Sites FY 17 Additional Design Sites 20 -Portland 2 -NJ 23 -Omaha 21 -Palo Alto 19 -SLC 22 -Tucson 12 -Tomah 15 -St Louis 1 -Boston 10 -Saginaw 4 -Erie 5 -Beckley 9 -Tenn Valley 6 -Salisbury 16 -Little Rock 7 -Atlanta 17 -San Antonio 8 -Tampa 41

Whole Health: A Partnership Whole Health is an approach to health care that empowers and equips people to take charge of their health and well-being, and live their life to the fullest.

What’s the matter with you?

What matters to you?

Dream Rangers video 45

Reflection: Living Life to the Fullest • Share with a partner – What is something you would do if you had more time for yourself? – What really matters to you in your life? How can you live your life to the fullest? How can we help our patients do this? 46

The Whole Health System

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Pathway • Peers Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend. -Albert Camus

Well-Being Programs • Skill-Building Classes • Health Coaching • Complementary/ Integrative Health therapies

Whole Health Clinical Care • Linking to What Matters Most, Empowering & Equipping • Integration with other parts of system This Photo by Unknown Author is licensed under CC BY-SA

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The Promise of Whole Health in VHA • • • VHA National Strategic Goal Chronic conditions Opioid crisis Mental Health care Employee Health and Well-being 53

What Veterans Are Saying “Whole Health is the difference between managing your health and getting better. The biggest things for me have been pain management without medication, increased flexibility, and mindfulness. ” 57

What Veterans Are Saying “Overall, I really think the biggest change I’ve seen in the VA that really allowed me to heal was them switching over to the Whole Health model. ” 58

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Veterans committed their lives, health, and well-being to Mission Success in defense of our country. VETERANS HEALTH ADMINISTRATION

BREAK 61

Movement and Connection Exercise This Photo by Unknown Author is licensed under CC BY-SA 62

Debrief • • How did it feel to be greeted in different ways? How do your interactions with others impact you? What does it mean to feel connected? What do you notice about how your mind and body relate to one another? 63

Walking the Circle of Health 64

Circle of Health Components of Proactive Health and Well-being 65

Walking the Circle • Look around the room at the different areas on the wall signs • Move to an area you feel is a strength for you.

Noticing

Walking the Circle • Look around the room at the different areas on the wall signs • Move to an area for growth that you would like to learn more about or set a goal around.

Noticing

Mindful Awareness

Mindful Awareness A way of being… in the present moment…. on purpose…. nonjudgmentally Jon Kabat-Zinn, Ph. D

When are you most… • • • Aware Present Centered Focused Calm

Mindful Awareness and Meditation – formal and informal practices • • Breath Awareness Seated Meditation Moving and Walking Meditation Mindful Eating Compassion Practice Contemplative Prayer Mantra Repetition

Resources for Mindfulness • Mindfulness Videos: Downloadable video products • VA CALM Intro to Mindfulness Video Toolkit: A toolkit on how to develop Mindfulness Program • Mindfulness Audio Podcasts: Audio files which can be used to plug and play mindfulness sessions. 74

Mindfulness for Chronic Low Back Pain 75

Mindfulness Everywhere Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study. Ann Fam Med. 11(5); 412 -420. 2013

Suggestions for practicing Listen with your whole body Deep breath before each interaction Threshold exercise Exam room/office centering – The moment you sit in your chair… • Supportive group • Daily practice • Others? • • http: //www. virtualtoolbox. ca/

Personal Health Inventory (PHI)

Reflection: Your Own Health and Well-Being • In your small group, discuss – How is it to consider your own health and well-being? – How would being healthier yourself support your patients? • Large group discussion – What came up in your groups? 80

BREAK 81

Professional Care: Complementary And Integrative Health (CIH)

Prevention & Treatment Conventional & Complementary Approaches

CIH and Veterans • 40% of active duty personnel and Veterans • 76% of veterans would use if offered • High demand – High rates of satisfaction with care – Improved physical and mental health symptoms • • BMC Complement Altern Med. 2006; 6: 34. J Rehabil Res Dev. 2006; 43: 99– 110. Global Adv Health Med. 2014; 3: 27– 31. Complementary and Alternative Medicine. HAIG. Washington DC: Department of Veterans Affairs; 2011.

An Important Reminder Whole Health is inclusive of conventional clinical treatment and prevention, self-care strategies, and complementary practices.

“Find it, Fix it” and CIH therapies

Approved CIH Approaches- List 1 Promising/Potential benefit, Standard Benefits Package • • Acupuncture Meditation Tai Chi Yoga • • Massage for treatment Guided imagery Biofeedback Clinical hypnosis Note: Chiropractic care considered conventional in VA http: //vaww. infoshare. va. gov/sites/OPCC/Site. Pages/IHCC-Approved-CIH. aspx

New Processes • Ongoing Questions – Finite resources – Harder in more rural areas – For which conditions? – How much, how often? Supply Demand

VERA and Whole Health • Potential money for the facility • Whole Health will be a new price category in VERA (category 4) – In order to qualify for that category, a Veteran needs 10 Whole Health/CIH visits* (occurring on different days)

The Passport has a chapter on each group of therapies. • Chapter 14 – Intro to CIH • 12, Power of the Mind (covers mind-body therapies) • 15 – Biologically Based • 16 – Manipulative and Body. Based • 17 – Energy Medicine • 18 – Whole Systems of Medicine https: //wholehealth. wisc. edu/

Mindful Movement 91

Whole Health for You and Me

This Photo by Unknown Author is licensed under CC BY

Long-Range Planning 94

Personal Health Planning • Partnering • Process of exploration – Health and well-being – Values and ideals – Insight and hope • Shared goals and collaborative action planning

Shared Goals Health Care Team Goals Shared Whole Health Patient Goals

Supporting Our Whole Health • What matters most • Vitality signs • Vision of their best possible health • Area of strength • What they’d like to work on • How they’d like to work on it 97

Supporting Our Whole Health • Share with your partner (choose 2) – What matters most – Vitality signs – Vision of your best possible health • Partner will listen generously. – Silent appreciation – “Thank you for sharing that with me. ” – Reflect back what you’ve heard (“…sounds like your family is really important to you…”) Generous listening Thank your partner and switch roles. 98

Where would you like to grow? • Share 1 -2 areas you might want to explore more – Where are you now? • What are the reasons you chose this number? – Where would you like to be? • What changes could you make to help you get there? • Why is this important? – How does this relate to what matters most to you or what brings you joy? 99

Large Group Discussion • What was that like? – As the person sharing – As the person listening 102

Success Stories • In small groups – Share about a positive change you made in some aspect of your life. • Can be very big or very small. • Temporary change also good. • Listeners – Acknowledge intention, efforts and success – As a group, ask one follow-up question: • What helped them be successful • What they learned about themselves • What they were able to control This Photo by Unknown Author is licensed under CC BY 103

Success Stories • What came up in your groups? – What is helpful in supporting change? – What are people able to control? – What did people learn about themselves? 104

This Photo by Unknown Author is licensed under CC BY-NC-ND 105

This Photo by Unknown Author is licensed under CC BY-NC-ND 106

e v i t c e Goal Setting f f e In • I’m just going to eat healthier. It’s important. I’ve got to do it. • I need to lose weight soon. I know my weight is making my pain worse. This Photo by Unknown Author is licensed under CC BY-NC-SA 107

e v i t c Goal Setting e f f Ine • I want to lose 35 pounds by next month. This Photo by Unknown Author is licensed under CC BY-ND 108

v i t c e Goal Setting: Make it SMART f f E e I need to lose weight soon. I know my weight is making my pain worse. q Specific q Measurable q Action-oriented q Realistic q Time-bound • I want to lose 2 pounds this month. • To do this, I will limit dessert to 1 x/wk and will not have seconds at dinner. 109

Setting a Goal • Ask your partner to think about a SMART goal for themselves • Gently help them consider q. Specific q. Measurable q. Action-oriented q. Realistic q. Time-bound This Photo by Unknown Author is licensed under CC BY-SA-NC 110

Troubleshooting Reality This Photo by Unknown Author is licensed under CC BY-NC-SA This Photo by Unknown Author is licensed under CC BY-SA 111

Getting Real • Ask your partner what possible barriers might come up • Ask for potential advance solutions – What might you do to prevent/overcome these? • Who will they be accountable to? – When? How? Life is what happens to you while you’re busy making other plans. -John Lennon This Photo by Unknown Author is licensed under CC BY-SA-NC 112

Effective and Meaningful Goals • Ask your partner how this SMART goal ties back to what matters most/what brings them joy This Photo by Unknown Author is licensed under CC BY-NC-ND 113

Thank your partner. This Photo by Unknown Author is licensed under CC BY-NC-ND 114

Local Offerings and Resources For Veterans For Staff 115

Arthur’s Amazing Transformation

We may not always have total control over everything… But what might we have some control over? 118

Put on Your Own Mask First 119

Paying Attention to Different Things • What’s going right? • What are strengths? • What really matters?

How healthy are you feeling in this moment? • What is health? • What does it mean to “feel healthy”? • How is this created? 121

The Path Forward 122

This Photo by Unknown Author is licensed under CC BY-ND 123

What if…?

This Photo by Unknown Author is licensed under CC BY-NC-SA 125

To Learn More About Whole Health VA Patient Centered Care (External–OPCC&CT resources for Veterans & family members) http: //www. va. gov/patientcenteredcare/ OPCC&CT Share. Point Hub (Internal–OPCC&CT Share. Point) https: //vaww. infoshare. va. gov/sites/OPCC/Pages/Default. aspx Whole Health Education Website https: //wholehealth. wisc. edu/ (Your facility) VA Flagship Education Champions (Your email here)

Whole Health Education Website http: //wholehealth. wisc. edu

Gratitude This Photo by Unknown Author is licensed under CC BY-NC-SA 12 8