5. Community and social accountability
- Date: Friday, September 20, 2019
- Concurrent Session D
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Time: 9:45am 10:30am
- Room: Pier 4
- Style: Presentation (information provided to audience, with opportunity for audience to ask question)
- Focus: Balance between both (e.g. Presentation of a best-practice guideline that combines research evidence, policy issues and practical steps for implementation)
- Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff, Representatives of stakeholder/partner organizations
Learning Objectives
The purpose of this presentation is to share our program model that supports patients to achieve the best of the Social Determinants to maximize their overall health. At the end of this session, the learner will gain knowledge on:
- The program framework to implement to best support patients and their Social Determinants of Health.
- The key partners (community agencies, social service agencies) that are integral to the patient success"
Summary/Abstract
Health care is about the whole person, their individual life’s circumstances which influence their overall health and health outcomes. Known as the Determinants of health, they represent a broad range of personal, social, economic and environmental factors. Within this broader context, are the Social Determinants of health which relate to an individual's place in society, based on social and economic factors such as income, education or employment.
Lived experiences that are positive or negative are an influence to who the individual becomes. Individuals who have low income, low education, food and housing insecurity, experience more health inequities. They are more likely to die prematurely, suffer chronic illnesses, be socially excluded, and experience high levels of physiological and psychological stress. Individuals who do not face these issues usually have choices that enables them to lead a healthy lifestyle, have better mental health, and overall, a better outlook on life.
In recognizing the challenges that some STAR FHT patients experience associated with the Social Determinants and the resultant health inequities, the interest was to develop a program that could help the patient identify issues they were experiencing related to these factors, and have a structured plan to help them resolve their individual issues. It was noted in the Primary Care Practice Report (November, 2018) that 26% of the STAR FHT patients live at the lowest income quintile, not far from the provincial average, which is 37%. Patient stories at Health Links interdisciplinary team meetings, and anecdotal accounts from the nursing staff of patients unable to afford to buy hearing aids, dentures, and even their essential hypertension medication were motivating factors to move forward with offering a program called “Finding Options”
“Finding Options” is described in our team’s promotion of the program to patients, as: “Helping you find the help you need”. It is intended to assist patients with a broad range of concerns related to the social determinants, to provide solutions, and hence increase access to opportunities and conditions conducive to better health outcomes.
These could include issues related to employment, housing, income security to name just a few. It is supporting Individuals on the team, associated with identifiable groups e.g. seniors, families with children, Aboriginals, Social Assistance Recipients, and people living with disabilities to ensure that they are receiving the correct income supplements they are entitled.
The program is structured that the patient meets with a social worker, who conducts a brief intake, determining issues of concern. A focal problem is identified, and a workable plan is discussed between the social worker and the patient on how to resolve the problem. Utilizing the resources of the SouthWesthealthline.ca, similar to 211ontario.ca, a customized list of community support service contacts targeted for the patient’s problem is created. This resource then allows the patient to follow-up with the appropriate service, or if necessary, the social worker will advocate on behalf of the patient to resolve the concern.
Key partnerships between the STAR FHT and several linking social agencies in the area, is an integral part of the program. This allows the ease of connecting the patient to vital community services to assist in resolving the problem. The patient and social worker have a follow-up visit to determine the status of the intervention(s), and discuss next steps.
The framework for this program is based on the Centre for Effective Practice: Poverty: A Clinical Tool for Primary Care Providers. This patient-centered approach, empowers them to resolve many outstanding problems. The patient is able to self-refer, which supports anonymity and a greater comfort level to recognize and take control of their concern. The availability of the program is supporting a greater confidence in the clinical team to discuss the patient’s challenges with social determinants of health, taking a holistic approach in care, to ensure patient’s overall well-being.
The social worker is also effective to help the patient to complete pending forms related to various applications, readying them for the physician’s completion. Anecdotally, the feedback has been very positive from both patients as well as the clinical staff. Some patients are expressing gratitude as they feel their life is turning around for the better, as they are now receiving extra income supplements.
Although this program is in its early phase, it is proving to be a valuable component in the care of patients. Helping the patient to resolve the challenges they face with Social Determinants will encourage patient wellness and provider satisfaction as they strive to provide a holistic approach to the needs of all their patients.
Presenter
- Teresa Barresi, Primary Clinical Team Coordinator BSc RN MHS, STAR FHT
- Annie Lichti, Masters of Social Work, STAR FHT
Authors/Contributors