Debra K. Greenwood-Clark, MSW Candidate
Anne & Henry Zarrow School of Social Work
University of Oklahoma – Tulsa: March 13, 2015
An ACP Perspective on Integrated Care in
Oklahoma: Help and hope for a dive into
precarious waters.
- Image Adapted from: Diving into Water (2015) & Bird (2013)
Using a Diving Analogy
 Five Elements of Diving (Franklin, 2015):
 Starting
position
 Approach
 Take off
 Flight
 Entry
 Key equipment:


Platform
A Tank of Water
“Progress Being Made on the Integrated Tank
Alternative to Medicaid Expansion”
Treatment-tank: A cow tank used in
Oklahoma’s tight economy as a
community resource for integration of
cattle watering, after-school recreation
programs, faith-based baptisms, health
& wellness immersions, and training of
ACP MSW health social workers.
- Image Adapted from Wohlers Ranch, 2011
Diving Element #1: Starting Position
- Why Social Work?
… Diver is standing straight, head erect (Franklin, 2015):
She is clothed with strength and dignity; she can laugh at the days to come.
- Proverbs
 “The ‘personal is professional’ and embedded in this
statement are political points of view.” – Arrendondo (2010)
 From Merging Personal & Professional Goals – Rothman (1999)
All of humanity is interdependent
People who are suffering want help
My own experiences will help me to help others
Diving Element #1: Starting Position
- Why ACP in Integrated Care?
… with both arms in a straight and steady position (Franklin, 2015):
 “Many social work students graduate into clinical practice…

…if they can get some extra information about participation in the
advocacy area, they will be better social workers and they will be
able to help more people…”
- Deborah Weinstein, Coalition on Human Needs (Pace, 2015)
 "The medical social service movement recognized that there should be…



someone definitely assigned to represent the patient's point of view...
work … with the physician
medical treatment in the light of the patient's social condition (Ms. Cannon,
1930)."
- Ms. Cannon was the first hospital Social Worker (Miller-Cribbs, 2014)
Diving
Element #2
-
The Approach
-
- smooth motion,
showing good
form (Franklin,
2015)
“Social workers bring to public health practice
skills, such as
 community assessment …
 cultural competence …
 sensitivity to race and ethnic issues.”
- Gehlert & Browne (2012)
The ACP focus:
condition of the tank
in which
we swim
and the
climate affecting it
and us!
The Macro Approach: Assessing our National
Healthcare Treatment Tank
 Financing of care
 Substandard care
 Violations of our ethical rights
 Culturally competency
 Need for prevention services
 Need for mental health care
 Healthcare linkage to our communities
Seven Problems Commonly Encountered by Healthcare Consumers
- Adapted from Jansson (2011)
Mezzo Approach: Assessing OK’s MH & SA
Treatment Tanks
Overview from State of Oklahoma - December 5, 2006:
Oklahomans needing treatment …
We’re talking about us – our
families – our local communities





repeated relapses - crisis situations
symptoms of trauma not recognized
inadequate service
system inadequacies lead to ineffective treatment
heavy spending in the criminal justice, primary health care,
homeless shelter, and systems.
- OK Department of Mental Health & Substance Abuse Services (2006)
Micro Approach: Assessing My ACP Place in
the Social Work Profession in Oklahoma
• “[Oklahoma’s
state]
agencies
purport a workforce crisis and
indicate social work shortages… “
– Kinzie (2015)
• Aging workforce
• Increasing demand
• My research findings from Future
is Now symposium in December
2014 indicate that social work
respondents embrace the future of
integrated care.
• Tisdale Clinic Community
Engagement Project
- Image by Nate Fakes
Diving
Element #3:
The Take Off
I hope I’ve had
enough
Training,
Supervision,
Self-Care &
Wheaties for
this!
*The diver
must leave
the
springboard
from both
feet.
- Balance, Control, & Safety in the
Hurdle (*Franklin, 2015)
- Image by Randy Walton (2010)
The Need for Balance in Oklahoma’s Services
“The fragmented or siloed delivery of
services to clients ‘because the
connections between services
are either absent or problematic, or needed
services are missing all together’
resulting in patients
(us – or our families
- whole communities)
falling through system cracks.”
- Bunger (2010)
If facilities are “drying up” in the “resource-rich” areas of
Oklahoma –
i.e., closure of OSU child & adolescent psych unit in Tulsa
(KTUL, 2015) then
… what is happening in my rural community?
Element #4: The Flight
- Aiming the Dive
….at no time should the dive move to the left or the right of the springboard
or platform (Franklin, 2015)
- Graphic adapted from Ramirez, 2010
Analyzing the Pentaho & EMR data to inform administrative decision-making
The
Wonky
Spot
Tisdale Clinic – the change agent
OK Policy Institute Budget Summit
- Institute for Healthcare Improvement, 2007
The Macro Aim:
Integrated Care in Oklahoma
Center for Health Innovation
& Effectiveness (2015)
Vision:
Leveraging
Health
Systems to Improve Population
Health
Mission: To collaboratively
align resources to meet health
systems needs and improve
population health.
- OK Department of Health (2015)
The
Wonky
Spot
“The
research …
indicates that a
nonprofit
organization’s
mission can
facilitate innovation,
which has been shown
to be a key mediating
step in
achieving superior
organizational
performance.
- McDonald (2007)
The Mezzo Aim: MH & SA Integration
Transforming Ok’s Behavioral Health System:
• Every (ODMHSAS) operated and contracted program shall provide and/or make
available MH/SA services that are
- integrated,
-trauma informed
The
Wonky
Spot
- OKDMHSAS (2006)
Assisting NGO’s with research-based outcomes
measurements needed for requests for funding
proposals
The Mezzo Aim: OK Medical Healthcare
National Association of Community Health Centers (2013)
Micro Aim: The Primary Care Clinic
Institute of Medicine: Principles of Quality Improvement




QI work as systems and processes
Focus on patients
Focus on being part of the team
Focus on use of the data
- Health Resources and Services Administration (2011)
Problem Statement: Duke University School of Medicine
Physicians need training in
• community engagement,
• leadership, and
• population health
• work with partners within the community
- Sheline, Tran, Jackson, Peyser, Rogers, Engle (2014)
The Micro Aim An Issue: Suicide Prevention
Smoothed, Age-adjusted Suicide Rates* per 100,000 population, by
County, United States, 2000–2006
From 2000–2006, the
western US counties,
including Alaska, had
predominantly
high
suicide rates. Suicide
rates were also high in
certain
Appalachian
counties of Kentucky and
West Virginia, southern
Oklahoma and northern
Florida.
- Center for Disease Control and Prevention (2014)
Element #5: The Entry – Use *Brief, Functional Interventions
“The cleaner the entry, the higher the score” (Franklin, 2015)
- *Kotria, (2006)
Macro: Collaborative Efforts to Improve Outcomes
?
- Oklahoma State Board of Health (2014)
A Mezzo Example:
The role of faith-based organizations.
- Thomas & Netting, (2008).
Micro: Finding or Creating Administrative Positions within
Medical Cultures of Empowerment
The empowerment culture…
• Is consciously consumer oriented and driven
• Implements participatory management practices
• Is based on working in partnership with others.
The barriers to an
empowerment-based
practice:
•
•
•
•
funding sources
social environment
intrapersonal issues
interpersonal issues
- Gutiérrez, Glenmaye, & Delois, (1995)
- Image: Curse of Mr. Bean (1990)
Reasons to H O P E
Macro
 Social Work’ s projected employment increase of 19% from 2012 to
2022 due to health care reform
- Bureau of Labor Statistics (2014)
 #WayForward – Suicide Attempt Survivors Taskforce:
using insights from lived experience (qualitative research)
- National Action Alliance for Suicide Prevention (2014)
Mezzo
 Primary care – where individuals with depression are showing up
- Robinson & Reiter (2007)
 Dr. Quinnett – QPR: using technology to empower a gateway culture
- Lancaster, et al. (2014)
Micro
 Freebirds of SE OK – Out of the Darkness Walk – Tulsa, , (October, 2014)
- Action Alliance for Suicide Prevention
H O PE – I’m not diving in alone …
- Dana Kunze: World Record High Dive
Source: Share Amazing Vidz… (2012)
“If you’re beating death
then take your dive,
but shut-up if you’re
not”
-
Adapted from Difference Maker, Source:
Need To Breath
- Image: Dupre (2015)
References
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http://www.abc.net.au/local/photos/2013/11/04/3883685.htm
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Handbook, 2014-15 Edition, Social Workers,
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elements of a dive. About.com. http://diving.about.com/od/
meetscompetitions/a/judgingBasics.htm
Gehlert, S., & Browne, Teri Arthur. (2012). Handbook of health social work (2nd
ed.). Hoboken, N.J.: John Wiley & Sons.
Greenwood-Clark, D.K., (2015). Embracing the future: Social workers attitudes
about integrated physical and behavioral healthcare. [student abstract
accepted for presentation at the OU-Tulsa Research Forum, 2015].
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Quarterly, 36(2), 256-281.
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[presentation] The Future is Now Symposium. University of Oklahoma Tulsa.
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National Action Alliance for Suicide Prevention: Suicide Attempt Survivors Task
Force. (2014). The Way Forward: Pathways to hope, recovery, and
wellness with insights from lived experience. Washington, DC: Author.
http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicide
prevention.org/files/The-Way-Forward-Final-2014-07-01.pdf
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Contamination and Earthquakes
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012-0512-frackings-alleged-links-water-contamination-earthquakes.html
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http://www.ok.gov/health/Organization/Center_for_Health_Innovation_a
nd_Effectiveness/
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implementation plan for provision of integrated services for individuals and
families with or at risk for co-occurring mental health and substance use
(and other addictive) disorders, (rev.).
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Original Proposed Title of This Presentation
Hope in precarious water:
An ACP social work student’s dive into
integrated care in a frackin’-drought-stricken (s)State
Extra Slides for Clinical-ACP Collaboration
Establishing the Lexicon:
Possibly Useful Definitions
 ACP: Administrative & Community Practice MSW Focus
 Five Elements of Diving (Franklin, 2015):





Starting position
Approach
Take off
Flight
Entry
 Treatment-tank:
A cow tank used in Oklahoma’s tight
economy as an integrated community resource for watering
cattle, after-school recreation programs, faith-based
baptisms, health & wellness immersions, and training of
ACP MSW divers
More Possibly Useful Definitions
 F.D.S.D:
Acronym for “frackin’-distressed-statesdisorder”. Not found in the DSM. May be related to
diving into allegedly contaminated and earthquake
prone treatment tanks.
 Drought-Lander: A person with a predisposition to
dive into – or land in – less than favorable conditions.
 Wonky Spot:
According to ACP drought-landers
affected by F.D.S.D., the “sweet spot” for entering
social work. The place where geeky wonks hang out;
possibly equivalent to a OK redneck honky-tonk
The need for Collaborative Clinical and ACP Skillsets:
Case Study & Logic Model Example of ACP student with F.D.S.D.
presenting in the Integrated Care dive setting
 Student describes feeling distressed.
Uses slang expletive “frackin’” often.
Describes textbooks as liquid theory
and asserts that it is being forced into
her brain matter.
Attributes the
escape of gaseous assumptions in class
to this processing of theory.
Describes having frequent thoughts of
escaping deadlines, *hallucinations of
social work peers in their underwear
while she is presenting, and irrational
fear of death from not following APA
citing requirements.
 May be indications that student is:
Behavi
oral
Theory
Leader
ship
Theory
Organi
zation
al
Theory
*I have
these scary
thoughts
every
Friday the
13th
brain
farts
addicted to wonky substances, and,
 [older student] has aversion to
modern, “smart-alec” technology

- Image Adapted from GoGraff (2015)
Clinical and ACP Orientations
to how “frackin” might present in an ACP student
The Clinical Question:
What functional, brief intervention to use?
The ACP Question:
What do I report as the outcomes measurement to
funders?
H O PE for Recovery for F.D.S.D. ACP Students:
 Assess Student Support Network:
Does student have access to policy blogs , budget summits, webinars,
healthcare symposiums, and other geeky-wonky supports?
 Does student have plenty of coffee?
 Psycho-education:
 Regular use of peer-reviewed articles for gray matter formulation
 Regular intake of coffee
 CBT:
 Emphasis on program and community planning that includes reasoned
evaluation, measurable outcomes, and thoughts, feelings, and
behaviors focused on sustainability of the triple aim
 Offer student free coffee samples supplied by partner industry
 Psychotherapy:
 For older students only: participation in a tech-for-dummies support
group;
 Make sure coffee is available at group sessions to promote participation

MI:
Ask student about willingness to change caffeine habits!