Could a light bulb, a day planner, a bus pass, or a bike ride impact a person’s health?
Since its inception, Hennepin Health has been hearing from providers that small-dollar items and services could make a difference for patients — potentially improving their health care use, lowering their health care costs, and increasing their level of satisfaction and engagement — but that there isn’t a funding mechanism in place to buy them.
So, in 2015 Hennepin Health is using money from its administrative budget to pilot a “Flexible Member Fund” project. In January, care coordinators were invited to submit proposals for up to $1,000 worth of small-dollar items or services. Awardees will be required to track their expenditures and patients served, and to share anecdotes.
As the year progresses, Hennepin Health will share our findings. One of the inspirations for this project was Jeremiah, a Hennepin Health patient profiled below.
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For 29 years, Jeremiah was largely oblivious to healthy eating.
His grandmother’s fried chicken, corn bread, and mashed potatoes were mainstays of his diet. He didn’t understand portion size or how to interpret nutritional labels on food packages.
“I didn’t know what sodium or carbohydrates were,” he admitted. “And I thought you could eat as much of a ‘good’ food as you wanted.” Jeremiah also ate to counteract boredom and other emotions. “Everything led back to the refrigerator,” he said.
Eventually, he weighed 400 pounds.
In June 2009, Jeremiah began experiencing flu-like symptoms. Four months later, he grew dizzy while descending a staircase and almost collapsed. An ambulance brought him to Hennepin County Medical Center, where he was diagnosed with Type 2 diabetes.
Doctors prescribed insulin and other medications; at one point, Jeremiah was on 12 medications. Learning to take them consistently was, for him, the hardest adjustment to diabetic life.
At Hennepin County Medical Center’s Medicine Clinic, Jeremiah began working with physicians, a nutritionist, an R.N. clinical care coordinator, and others. After ensuring that he was stabilized and taking his medication consistently, staff helped him with nutrition.
Then they suggested exercise.
For years, Jeremiah was more inclined to stay home, near his grandmother, mother, and younger sister, than to leave the house and work out. “I considered myself their protector,” he said. “But I knew I had to do something for myself.”
In 2014, he joined Anytime Fitness, but found it difficult to get to the gym without a car. Because he didn’t have four or more medical appointments per month, he wasn’t eligible for a 31-day Metro Transit bus pass. Jeremiah’s R.N. clinical care coordinator, Eugene Galybrek, contacted Hennepin Health. We agreed to pay for Jeremiah’s bus pass out of Hennepin Health administrative funds; now we have the Flexible Member Fund for such requests.
Eugene Galybrek (third from left), RN clinical care coordinator
Jeremiah now goes to the gym five times a week. He walks, bikes and lifts weights, and has shed 21 pounds. “I need to get new clothes, because my old clothes don’t fit anymore,” he said. Another outcome has been a lessening of his insomnia and sleep apnea. He’s now off insulin and three of his 12 medications.
Jeremiah revealed his new goals: be medication-free, lose at least 100 more pounds, run a marathon, and get a truck driver’s license.
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A male child who has experienced six or more types of childhood trauma is 4,600 percent more likely to become an intravenous drug user.
This is just one of the shocking findings from the Adverse Childhood Experiences (ACE) Study.
Adapted from Capture Queen / CC
The ACE study — a collaboration between Kaiser Permanente and the Centers for Disease Control and Prevention — is the largest study to examine the impact of childhood trauma on health care use and cause of death. And it's still ongoing.
From 1995 to 1997, the initial phase of the study, researchers administered a standardized physical examination to over 17,000 study participants. Then the participants took a survey to gauge their exposure to ACEs. The survey measured 10 types — physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Exposure to each ACE counted as one point.
The survey found that adverse childhood experiences are common; two-thirds of study participants had experienced one or more, one-quarter had experienced two or more, and one-sixteenth had experienced four or more.
Over the next decade, Kaiser Permanente and the Centers for Disease Control and Prevention tracked study participants’ health care use and cause of death. Since 1998, more than 50 research papers have been published. The results are staggering. For instance, compared to those with an ACE score of zero, adults who’ve experienced four or more ACEs were:
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460 percent more likely to have chronic depression
- 1,220 percent more likely to have attempted suicide
- 240 percent more likely to have hepatitis
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390 percent more likely to have chronic pulmonary lung disease
Hennepin Health’s response is Trauma Informed Care (TIC), which is the belief that a quality healthcare, human services and/or social safety net organization needs to address the impact of trauma on every person in that organization.
Staff training on TIC
Hennepin Health supports Trauma Informed Care and has committed to working with its clinics and providers to implement TIC principles. One of the first places where TIC is being rolled out is at Health Care for the Homeless.
“TIC represents a cultural and paradigm shift within an organization. It supports staff and providers to move from asking ‘What’s wrong with you?’ to ‘What happened to you?’ or ‘How did you get here?’” said Julie Bluhm, Hennepin Health clinical program manager. “This simple change helps providers to interpret patients’ behaviors and actions more empathetically and ultimately to provide more effective interventions.
“TIC doesn’t have to entail a huge overhaul of the system,” she added. “It can be gradually introduced and even seemingly small changes can make a huge difference.”
Julie Bluhm, Hennepin Health clinical program manager
TIC has seven domains:
- Community outreach and partnerships
- Screening and assessment
- Consumer-driven care and involvement
- Nurturing a trauma-informed and responsive workforce
- Evidence-based and emerging best practices
- Creating safe environments
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Ongoing improvements and evaluation
For the next few months, each issue of this newsletter will feature a TIC domain. We’ll share practical ways to implement that domain and showcase examples of current work that supports it.
If you’re interested in learning more about TIC, the blog www.acestoohigh.com is an excellent resource. Additionally, the Camden Coalition produced this 3-minute video that uses ACE study findings to explain why some patients over-use the emergency department.
Would you like a TIC poster for your clinic? Contact lori.imsdahl@hennepin.us
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The Hennepin-University Partnership (HUP) is a strategic alignment between Hennepin County and the University of Minnesota. HUP is designed to be beneficial for both organizations. It involves research on local government policies and practices, community-based research, sharing of academic and practitioner expertise, and opportunities for students to apply their academic learning to a real-world setting.
At a recent HUP event, Ross Owen, Hennepin Health director, gave a presentation on Hennepin Health.
We encourage you to check out HUP's upcoming events page. This page includes not only HUP events, but events at the University of Minnesota that may be of interest to Hennepin County staff.
And in case you missed an event, this page includes videos and handout materials from past events.
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Touchstone Mental Health is now contracted to provide in-network health and wellness services to Hennepin Health members.
Services include:
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Health and wellness nurse practitioner assessment (a unique service focusing on a wellness plan of care that integrates mind, body, and spirit)
- Dietician services
- Fitness assessment and membership at Touchstone’s fitness center
- Acupuncture for pain management
Touchstone’s integrative team offers individuals a comprehensive and holistic approach to care that is designed to empower people on their path to healing.
To make an appointment, call 612-314-1020.
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Hennepin Health’s Social Service Navigation Team helps Hennepin Health members link to social services, including housing. The team has updated their contact information for staff referrals:
Michelle Soplata (left) and Deanna Hayden are staff on Hennepin Health's Social Service Navigation Team
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