Navigating Family Health: A Biopsychosocial Team Approach to Disease and Wellness

1. FAMILY MEDICINE MODULE Navigating disease and wellness with families thru integration/collaboration using biopsychosocial team-based approach Helen S. Sigua, MD, MHA, BFEF, FPAFP

2. Criteria for selecting family • Willing to give written ethical consent for longitudinal nurturing • Convenient and safe for visitation, near LEC project site • Residing on a permanent status by way of ownership or evidence of long –term lease • With member with chronic ilnesstrajectory • No member who is alcoholic or physical abuse/violence problem

3. Family practice interprofessional collaborative practice model

4. Drivers for integration

5. Shades of continuity to achieve

6. Players in the envisioned system of care

7. LEARNING COMPETENCY 1 • Given a family in the community, At end of the year, the student must demonstrate an understanding of the micro and macro psychosocial, behavioral, contextual (home & community) factors which influence the family’s manner of navigating disease and wellness. The student is expected to use that understanding to collect and incorporate relevant data into an appropriate care/intervention project addressing the following specific issues:

8. Specific issues to address: • Forces that affect health-seeking behavior • Effect of family relationships & dynamics on health and illness and vice versa • Complex behavioral change towards health improvement • Age(developmental & normative)-related behaviors • Role of education, economics, school/ workplace environ, social institutions, & leisure on their health • Community resources and public health programs & resources

9. Learning Competency 2 • Given a family with a sick member in the hospital setting, the student is expected to demonstrate an understanding of the micro and macro biomedical and psychosocial, behavioral, and contextual (hospital/health systems) factors influencing the family’s manner of navigating disease. The student is expected to gather and incorporate data into an appropriate care/intervention plan that addresses the same specific issues as enumerated earlier.

10. Strategies for family health & wellness intervention • System diagnosis • Community action • Self-efficacy • Patient education • Supportive environments and healthy public policy • Decision-making support

11. LEARNING TARGETS • Disease in its undifferentiated presentations, and 2 kinds of trajectory acute, chronic • Wellness: promotive

12. 3 E’s • Engaging • Evaluating • Equipping

13. family engagement process • To apply patient-centered communication skills/techniques and models in establishing rapport and partnership with the families • To get relevant information about both biomedical and psychosocial state of health and all influencing factors using both micro (person & family) and macro (beyond family) lens • To get a glimpse of the family’s structure & function in terms of dynamics, roles, resources, using family systems theory • To integrate professionalism and ethical during encounters • To set and align health & wellness goals with the family

14. Process & outcome outputs for family engagement process (July 2013) • Documentations of this journey in terms of KII, family conferencing, home visits, oculars, direct observation • Identification of the skills/techniques/models applied on patient-centered communication, facilitation skills, family skills • Accomplished home visit form, pre-FC worksheet, FC process checklist, FC outcome form, family satisfaction survey • Self-reflection

15. Family evaluation process (September, 2013) • Biomedical---longitudinal care plan with trajectory • Psychosocial • Family assessment tools applied and their outcomes • Meanings derived from the tools • Coming up with a cohesive interpretation of the family in terms of structure & functionality • Sharing and validating with family

16. Family equipping process (Dec, 2013) • Carrying out your family nurture plan • Outcomes and significant progress of the intervention/care/nurturing process • Measures: qualitative, but not necessarily purely narrative • Conclusions, lessons learned, insights, inspirations

17. accessibility

18. Structure : logical model worksheet

19. For more in-depth consumption • Insel & Roth. 2012. Wellness Worksheets • Coleman & Newton. 2005. Supporting Self-management in Patients with Chronic Illness • Dilorio, et al. 2002. Motivational Interviewing as Health Promotion. • Arnold, R. 2010 . (Hospital) Critical Care Communication Fundamental Skills. • Kissane et al. 2007. Conducting a Family Meeting. • A BDI Logic Model for working with young Families: a resource kit. http://www.healthyteennetwork.org/index.

20. Adviser assignments & their contact numbers/emails • Group 1 Sigua 09086429944 , 861-37-11hsigua@gmail.com • Group 2 Dionisio • Group 3 Lazaro • Group 4 Pascual • Group 5 Abrogena • Group 6 Madrigal • Group 7 Josef

21. toolkit • Sigua’s electronic tool inventory (2012-13), family consent from, logic model worksheet • Sigua’spowerpoint, demo video, family conferencing skills card (2013) • All lectures from yl5 to yl7 • www.fmdrl • other benchmarks & standards we can google along the way that can help us reach our goals & targets

22. Community Pediatrics rotation • In-vivo processing thru demo return demo of family conference and home visit using 2 families referred to Family Medicine • Pre-FC worksheet after toolwork • Informal but structured and prepared for • Documentations • Tuesdays 1-5 PM

23. Patient-centered care plan (March, 2014) • Select a case from any hospital , handled by consultants with family-leveraging skills training (list will be provided at that time) • Apply the 3’s as much and as far it can allow you in the short time • Usual case presentation with a patient-centered tweak

24. Grade Computation Individual Final exam - 20% • 50 mcq • 60 passing Individual Attendance/Punctuality- 10% Group Clinical Performance-70& (360 degree) • Adviser’s grade (40) • Peer grade (20) • Family satisfaction (10)