Session # B4b
October 6, 2012
Citizen Healthcare:
An Evolution in Engaging Families
and Communities in Health
Tai J. Mendenhall, Ph.D., LMFT, CFT
Assistant Professor, University of Minnesota, Department of Family Social Science
William J. Doherty, Ph.D., LMFT, LP
Assistant Professor, University of Minnesota, Department of Family Social Science
Collaborative Family Healthcare Association 14th Annual Conference
October 4-6, 2012 Austin, Texas U.S.A.
Faculty Disclosure
We have not had any relevant financial relationships
during the past 12 months.
Objectives
• At the conclusion of this presentation, the
participant will be able to:
– Describe the core tenets and principles of the Citizen
Healthcare Model
– Describe core action strategies for Citizen Healthcare
projects
– Describe how Citizen Healthcare has been applied across
diverse community settings and mental health / physical
health-related foci
– Outline key differences between Citizen Healthcare and
other models of collaborative and community-based
work
Introductions
Conventional / “Standard” Care
• Hierarchal structure
– Provider/Patient
– By Specialty
• Provider-consumer design
– Care as “goods/services”
– Providers give, patients take
• Expert-driven
– Providers’ wisdom valued / Providers active
– Patients’ wisdom untapped / Patients passive
• Challenged by contemporary contexts…
Healthcare: The Current Context
• Rapid and constant change
• From acute care to preventive and patientoriented care
• From provider/consumer services to
provider/patient partnership
Trends toward Family &
Community-based Interventions
We are moving away from doing care “on”
people to doing care “with” them
Tapping into patients’ and families livedexperience and wisdom requires professionals
to “unlearn” their expert-roles and work more
collaboratively within the context(s) of more
flattened professional hierarchies
Citizen Health Care
• Citizen Health Care (CHC) is a way to engage
patients, families, and communities as coproducers of health and health care
• CHC encompasses an identity-shift for
professionals (from “expert” to “citizen”)
• Core principles and planning strategies
permeate projects, but no two projects look
wholly alike
Origins of Citizen Health Care
•
•
•
•
•
Family Therapy
Medical Family Therapy
Collaborative Family Health Care
Democratic Political Theory
Contemporary Community Organizing
Strategies
• Community Based Participatory Research
Citizen Health Care (CHC):
Core Principles
• The greatest untapped resource for improving
health care is the knowledge, wisdom, and
energy of individuals, families, and communities
who face challenging health issues in their
everyday lives.
Core Principles, con’t
• People must be engaged as co-producers of
health care for themselves and their
communities, not just as patients or
consumers of services.
Core Principles, con’t
• Professionals can play a catalytic role in fostering
citizen initiatives when they develop their public
skills as citizen professionals in groups with
flattened hierarchies.
Core Principles, con’t
• If you begin with an established program, you
will not end up with an initiative that is
"owned and operated" by citizens. But a
citizen initiative might create or adopt a
program as one of its activities.
Core Principles, con’t
• Local communities must retrieve their own
historical, cultural, and religious traditions of
health and healing, and bring these into dialogue
with contemporary medical systems.
Core Principles, con’t
• Citizen health initiatives should have a bold
vision (a BHAG – a big, hairy, audacious
goal) while working pragmatically on focused,
specific projects.
Examples Citizen Health Care Projects
• Partners in Diabetes (Regions Hospital / UMN)
• A Neighbor Giving Encouragement, Love and
Support (“ANGELS”) (Wake Forest University)
• Family Education / Diabetes Series (“FEDS”)
(St. Paul Department of Indian Work / UMN)
• Activated Patient Project (Como Clinic / UMN)
• Students Against Nicotine & Tobacco Abuse
(“SANTA”) (HHH Job Corps / UMN)
Examples, con’t
• Intimate Partner Violence (IPV) in the Hmong
Community: Tacking an Old Problem in a New
Way (Lao Family of Minnesota / UMN)
• Reducing Tobacco Use in Southeast Asian
Communities (MPAAT / UMN)
• Hennepin County Citizen Professional Project
(Hennepin County / UMN)
• Sisters Together Overachieving in Raising
Kids (“STORKS”) (Broadway Clinic / UMN)
Family Diabetes / Education Series
(the “FEDS”)
• Members of the Native American community
who have lived experience with diabetes (as
patients or family members) working in
partnership with providers in the provision of
education and support in culturally
appropriate ways
• Designed and implemented through a
democratic and collaborative partnership
between patients, family members, and
providers
FEDS / Introduction
• Engages low-income, urban-dwelling AIs
and their families in an active forum of
education, fellowship, and support
• Participants include patients and family
members (n = 40-60), medical and
behavioral health providers (n = 4-5), and
tribal elders (n = 4-6)
FEDS / Meetings
• Meetings start with members conducting foot
checks and recording each other’s weight/
BMI, blood pressure, and blood sugar
• Meals consistent with AI culture and
traditions are prepared and shared
communally, along with discussions about
ingredients and indicated portion sizes
FEDS / Education
• Educational forums take place in the
contexts of talking circles, small and large
group discussions, and a variety of lively
activities (e.g., traditional music, dancing
and aerobics, impromptu theater/roleplays)
• Forums encompass active collaboration
between community leaders and Western
providers
FEDS / Educational Topics, con't
● Diabetes in the AI Community
● Dietary Guidelines & Portion Sizes
● Exercise & Physical Activity
● Obesity & Weight Control
● Foot Care & Wound Care
● Blood Glucose Monitoring & Control
● Eyes and Teeth: Dental Care / Retinopathy
FEDS / Educational Topics, con't
● Blood Pressure & Cholesterol
● Heart Disease & Stroke
● Stress Management & Strategies
● Medical Services & Supplies
● Working with your Doctors
● Sticking with it: Staying Motivated
& Family/Social Support
● Review: Putting it all Together
Outcome Data (at 3-mo. follow-up)
• Metabolic control (A1c) is significantly
improved (6.834 to 6.436; p=.011).
• Weight loss is approximately 14lbs (mean
weight change from 216.22 to 202.43).
• Blood pressure is trending down across
both systolic (137.55 to 143.08; p = n.s.)
and diastolic (89.17 to 79.00; p < .05)
measures.
Outcome Data (at 6-mo. follow-up)
• Metabolic control (A1c) change is not
significant from 3-month follow-up
• Weight loss is approximately 16lbs (mean
weight change from 216.22 to 199.56); p =
.023
• Blood pressure change is not significant
from 3-month follow-up.
Outcome Data (at 12-mo. follow-up)
• Metabolic control (A1c) change is not
significant from 6-month follow-up
• Weight loss is approximately 20lbs (mean
weight change from 216.22 to 196.41); p =
.020
• Blood pressure change is not significant
from 3-month follow-up.
Citizen Patient Project
Comparing Approaches
Conventional Approach
Citizen Professional Approach
• Focus on ameliorating
problems
• Begin with a needs
assessment by professionals
• Familiarity with process and
respective roles of
professionals and
community members
• Emphasis on bringing
government or professional
resources to the community
• Aspiring to take bold but
focused civic action to solve
problems
• Begin with identifying
community pressure points and
interest in working on them
• Learning new roles as
professionals and community
members work together in
novel ways
• Emphasis on communities
accessing their own resources
Conventional Approach
Citizen Professional Approach
• Citizens in the group already
• Professionals orient
have expertise on the problem
community members to the
and the limitations of current
problem and current services
approaches
• Applying current professional
• Generating new knowledge
knowledge to the problem
together, taking into account
• The professional hierarchy is
what is currently known
highly influential in decision
• Leveled hierarchy; groups only
making
work on decisions they can
• Expectation of widely
make collectively and
representative citizen groups
democratically
• Okay to focus on a specific
group and then spread to
others
Conventional Approach
Citizen Professional Approach
• Citizens sit on county-created
committees
• Representatives from the
community help to improve
county services
• A balance between
professionals and community
members around the table
• Professionals seek input from
citizens on projects
• Citizens and professionals form
action groups based on mutual
interest
• Citizens engage in collective
action with facilitative support
from the county
• Always more community
members than professionals
• Professionals and citizens cocreate projects
Conventional Approach
Citizen Professional Approach
• Timeframe and deliverables
are defined by a professional
organization or funder
• Expectation for early wide
impact
• Timeframe and deliverables are
created by the group
• Okay to focus on local impact
and then spread to other
communities
Discussion
Contact Information
Tai J. Mendenhall, Ph.D.
Family Social Science
University of Minnesota
275 McNeal Hall
1985 Buford Ave.
Saint Paul, MN 55108
William J. Doherty, Ph.D.
Family Social Science
University of Minnesota
275 McNeal Hall
1985 Buford Ave.
Saint Paul, MN 55108
mend0009@umn.edu
612-624-3138
bdoherty@umn.edu
612-625-4752
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!