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Whole Health in Your Practice

AGENDA

TUESDAY MORNING – WHOLE HEALTH PRINCIPLES

Time Topic/Title

7:30am – 8:00am Registration

8:00am – 9:15am 1. Introductions Leadership Welcome Who is in the room? Why are you here? Course Materials and Community Agreements Whole Health Bingo! Large Group Introductions

9:15am – 9:20am Movement

9:20am – 10:00am 2. The Big Picture Course Objectives Strategic Goals and the Vision of Whole Health Defining Whole Health: Essentials Implementation and Application Sneak Peek Discussion: What You are Doing Already Suicide Prevention

10:00am – 10:10am Break

10:10am – 11:30am 3. The Power of You Origin Stories Engagement: A Quiz Your Healing Presence

o Empathy o Communication o Insight o Expectation

Self-Assessment: How is Your Practice?

11:30am – 12:30pm Lunch


TUESDAY AFTERNOON – THE CLINICIAN’S ROLE

Time Topic/Title

12:30pm – 1:30pm 4. Me at the Center: Mission, Aspiration, Purpose Video: Purpose in Life 0-100 Exploring Your MAP Demonstration: MAP Partner Exercise: What Really Matters? My VA, My Story Group Discussion: The Power of Story

1:30pm – 1:35pm Movement

1:35pm – 2:30pm 5. Mindful Awareness Introduction to Mindful Awareness Defining Mindful Awareness Mindful Awareness Experience What the Research Tells Us Another Mindful Awareness Experience Discussion: Ways to be Mindful

2:30pm – 2:45pm Break

2:45pm – 3:30pm 6. Resilience and Clinician Self-Care Burnout: A Significant Problem in Health Care Preventing and Reversing Burnout Discussion: What Will Help You and Your Team? Enhancing Resilience Small Group Discussion: Resilience Superstars

3:30pm – 4:00pm 7. The Personal Health Inventory Introduction to the PHI Homework: Completing Your Own PHI

4:00pm – 4:30pm 8. Setting the Stage for Implementation: Local Resources

4:30pm End of Day 1—Wrap Up, Pulse Checks, and Adjourn


WEDNESDAY MORNING – SELF-CARE

Time Topic/Title


8:00am – 8:15am Pulse Check Review, Where We’ve Been & Where We’re Going

8:15am – 10:00am 9. Self-Care, Part I Introduction to the Self-Care Circles Surroundings

o Your Ideal Healing Space Working Your Body

o Yoga and Tai Chi o Movement Experience

Food & Drink o Nutrition Guidance o Mindful Eating

Recharge o The Power of Rest o Where Does Your Energy Go?

10:00am – 10:15am Break

10:15am – 12:00pm 10. Self-Care, Part II Family, Friends & Coworkers

o Who Really Matters? Spirit & Soul

o Partner Exercise: Spirituality Personal Development Power of the Mind

o Skill Building: Breathing Putting it All Together Demonstration: Exploring the Self-Care Circles Partner Exercise: Assessing Self-Care

12:00pm – 1:00pm Lunch


WEDNESDAY AFTERNOON – PROFESSIONAL CARE

Time Topic/Title

1:00pm – 1:45pm 11. Professional Care, Part I: Introduction to CIH What is Complementary & Integrative Health (CIH)? CIH in the VA The CIH Spectrum ECHO: When to Suggest a CIH Approach List One: A Deeper Dive Group Discussion: Implementing CIH in Your Practice

1:45pm – 1:50pm Movement

1:50pm – 2:45pm 12. Professional Care, Part II: Specific CIH Approaches Acupuncture Massage Therapy Tai Chi and Qigong Yoga Meditation Guided Imagery Biofeedback Clinical Hypnosis Group Discussion: Working with List One

2:45pm – 3:00pm Break

3:00pm – 4:00pm 13. Personal Health Planning Overview of Personal Health Planning Small Group Activity: Elevator Speeches Approaches to Goal Setting Education, Skill Building, Resources, and Support Discussion: How to Bring Personal Health Planning Into

Your Work

4:00pm – 4:20pm 14. Gratitude Practice

4:20pm – 4:30pm End of Day 2—Review Day 3 Teams, Pulse Checks, and Adjourn


THURSDAY – COMMUNITY AND IMPLEMENTATION

Time Topic/Title


8:00am – 8:15am Pulse Check Review, Where We’ve Been & Where We’re Going

8:15am – 8:30am 15. Loving-Kindness Meditation

8:30am – 9:30am 16. Community The Role of Community in Whole Health National Resources Online Resources Social Determinants of Health How Can You Draw in Community

9:30am – 10:15am 17. Application: Your Life, Your Practice Demonstration; Applying What You Have Learned Partner Exercise: PHPs Large Group Discussion: Debrief

10:15am – 10:40am Movement and Break

10:40am – 11:30am 18. Application & Implementation: Your Team What We Know About Teams Whole Health Coaches Peer Support A Transdisciplinary Approach Group Discussion: Effective Whole Health Teams

11:30am – 12:15pm 19. Implementation: Your Site Introduction to Small Group Activities Small Groups—Brainstorming and Planning

12:15pm – 1:15pm Lunch

1:15pm – 2:15pm 20. Implementation: Reports Small Groups Report to Large Group and Leadership

2:15pm – 3:00pm Closing Circle and Final Evaluation

Thank You for Joining Us!

WHOLE HEALTH IN YOUR PRACTICE—PARTICIPANT WORKBOOK

1 VHA Office of Patient Centered Care & Cultural Transformation March 2020

TABLE OF CONTENTS

Welcome .............................................................................................................................................................. 3

About the Course .............................................................................................................................................. 4

Primary Whole Health Resources .............................................................................................................. 6

Whole Health Bingo: Eight Areas of Self-Care ....................................................................................... 7

The Circle of Health ......................................................................................................................................... 8

Whole Health System Diagram ................................................................................................................... 9

Keys to Personal Health Planning ........................................................................................................... 10

The Journey to Whole Health Clinical Care .................................................................................... 10 Shared Goal Setting .................................................................................................................................. 11 Personal Health Inventory (PHI) ........................................................................................................ 12

The Power of Story ....................................................................................................................................... 16

Case Study – Dave ..................................................................................................................................... 16 My Life, My Story – Dave ........................................................................................................................ 17

Sample Questions to Explore the Eight Areas of Self-Care ........................................................... 19

Personal Health Planning Visit Outline................................................................................................. 21

The ADKAR Framework for System Change ....................................................................................... 23

Whole Health Implementation ................................................................................................................. 24

Common Examples of Implementation Strategy Topics ........................................................... 24 Outline for Team Implementation Discussion .............................................................................. 25 Worksheet for Team Implementation Discussion ....................................................................... 27

Blank Pages for Notes .................................................................................................................................. 29

Reflections on How to Apply Whole Health ........................................................................................ 33

Day 1—Pulse Check ..................................................................................................................................... 39

Day 2—Pulse Check ..................................................................................................................................... 41

Day 3—Pulse Check ..................................................................................................................................... 43



WELCOME Welcome to the Whole Health in Your Practice course!

This course is brought to you by the Veterans Health Administration (VHA) Office of Patient Centered Care and Cultural Transformation (OPCC&CT). The OPCC&CT was established in 2011 to lead one of the most massive changes in health care philosophy and delivery ever undertaken by an organized health care system. Since 2013, this course has been taught well over a 100 times at dozens of sites nationwide. You are joining the ranks of thousands of VA clinicians and staff who have participated!

Bringing the Whole Health approach into VA mainstream requires nothing short of system-wide transformation. How is a Whole Health System created? That transformation occurs at a grassroots level. You are encouraged to explore how the fundamental elements of Whole Health influence not only your one-to-one care of Veterans, but also how you coordinate care with other team members. You are also encouraged to focus at the big-picture level. How do you make changes at your facility as a whole? Also essential: How do you support your own self-care along the way?

VHA defines Whole Health as empowering and equipping Veterans to achieve what matters most to them. Whole Health is patient centered care that affirms the importance of the partnership between clinicians and patients. It focuses on the whole person and involves clinicians and Veterans co-creating a personalized, proactive, and patient-driven experience whenever possible. The Whole Health approach is informed by evidence, and it makes use of all appropriate therapeutic approaches and professionals.

Whole Health centers on asking Veterans what matters to them. What do they value most? Why do they want to be healthy? Veterans are often invited to complete a Personal Health Inventory (PHI), a tool that helps people reflect on their values, priorities, self-care goals, and their vision of what it means to live life fully. Using information from the PHI and other assessment tools, and building on shared patient and clinical goals, a Personal Health Plan (PHP) is co-created by the Veteran and the care team. The plan is evidence-based, focuses on self-care and empowerment for each individual, and enlists both conventional and complementary approaches as appropriate. It leverages support systems both within and outside of VHA. Veterans own the PHP and, ideally, it informs every aspect of their care.

We wish you well as you explore how Whole Health might fit into your practice...and beyond!



ABOUT THE COURSE Whole Health in Your Practice is designed to support VA clinicians with effectively incorporating the Whole Health approach into their care of Veterans. This three-day course supports the transition away from a disease-focused model toward personalized, proactive, and patient-driven care that honors what matters most to each individual. Since its creation in 2013, the course has been well-received by physicians, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, dietitians, chaplains, physical therapists, occupational therapists, respiratory therapists, medical support assistants, and many others who are responsible for making care of Veterans the best it can be.

As a participant in this course, you will be introduced to new skills, tools, and resources you can immediately start using the next time you take care of a Veteran. You will take time to explore your role in the creation of a broader Whole Health System, and you will network with your colleagues. Particular emphasis is placed on applying what you learn to your own self-care, exploring how you can most effectively enhance your resilience and reduce your risk of burnout.

Whole Health in Your Practice moves through the various components of the Circle of Health, with specific emphasis given to cultivating your therapeutic presence, mindful awareness (with techniques introduced throughout the course), self-care, and complementary and integrative health (CIH) approaches. Local, regional, and national resources to support Whole Health in practice are showcased. Each of the eight aspects of self-care is explored in detail, both through a look at the latest evidence as well as through small and large group discussions and experiential exercises.

You will emerge after the three-day course with a solid understanding of the personal health planning process. Working with your fellow participants, you will move step-by-step through applying each of the key elements of personal health planning:

1. Outlining mission, aspiration, and purpose (MAP) 2. Whole Health Assessment, based on use of the Circle of Health and other tools, such

as the Personal Health Inventory (PHI) 3. Goal Setting, including using shared goal setting, working with agendas, and the

creation of SMART goals 4. Offering education, skill building, resources, and support

By the time the course is complete, you will have co-created a Personal Health Plan (PHP) for at least one partner, and they will have done the same for you.

The final section of this course is dedicated to implementation. Participants divide into groups and brainstorm around how best to bring what they have learned about Whole Health into their practices, and beyond that, to a model that relies highly on transdisciplinary Whole Health teams. You will explore how you can assist with the adoption of Whole Health into your facility in general. You will share your ideas and plans



with leadership team members from your site and outline next steps you will follow after the Whole Health in Your Practice course has ended.

During this course, you are invited to: • Help lead the charge with advancing Patient Centered Care in the VA. • See why the VA is especially suited to adopting a new model of health care that will

likely shape the future of the U.S. health care system. • Explore how you can make the care of Veterans even better. • Consider how your work in health care can be as influential and meaningful as

possible. • Receive evidence-based tools and information to support Whole Health for yourself,

your patients, and your co-workers. • Share your experiences and your wisdom with your colleagues as you join the ranks

of your local—and national—Whole Health Community. • Learn more about local and national Whole Health resources. • Take some time to pause and focus on what you need to best take care of yourself

and others.

This course will help you to: • Define Whole Health and explore how it applies to your clinical work and personal

well-being. • Effectively describe Whole Health to Veterans and clinician colleagues. • Confidently incorporate the various aspects of the Circle of Health, as is appropriate

for your scope of practice. • Tailor personalized health plans to each Veteran you see. • Make care more values-driven, honoring what really matters to each Veteran and

engaging them in their care as fully as possible. • More effectively incorporate mindful awareness, therapeutic movement, breathing

exercises and communication skills into your work, as appropriate. • Work within a Whole Health System as part of a transdisciplinary team. • Explore how to make care more proactive, supporting each person’s innate healing

response through self-care and CIH approaches. • Create Whole Health implementation plans that support your self-care and

resilience, enhance your care of Veterans, and foster facility and system-wide change in health care delivery.

CME accreditation (20.5 hours) is available for physicians, non-physicians, pharmacists, dietitians, nurses, psychologists, and social workers. Attendance at all three days of training is a requirement of the course if you want to obtain Continuing Education (CEU) credits through EES.



PRIMARY WHOLE HEALTH RESOURCES Passport to Whole Health: The Passport to Whole Health is distributed in hard copy at courses and serves as a basic, yet comprehensive reference manual on the Whole Health System and approaches to Whole Health Care. The Passport is also available online. The manual begins with introductory chapters covering the system, the Circle of Health, Whole Health assessment tools, and personal health planning. Subsequent chapters cover each of the eight areas of self-care within the Circle of Health, as well as the fundamentals of complementary and integrative health. Whole Health Tools on a variety of specific topics are found throughout the manual to support the practicalities of application.

Course Workbook: The Whole Health in Your Practice course workbook can be found online.

Course PPTs and the Whole Health Library: The course PPTs can be found on the Whole Health Library website, https://wholehealth.wisc.edu. The website offers extensive materials related to Whole Health implementation and Whole Health care, including a number of handouts for Veterans.

Besides the Whole Health Library website, there are two additional primary and comprehensive Whole Health websites.

VA Whole Health. Internet site for Veterans and their families, as well as for clinicians. https://www.va.gov/WHOLEHEALTH/

VHA Office of Patient Centered Care and Cultural Transformation Whole Health SharePoint Education Hub. https://dvagov.sharepoint.com/sites/VHAOPCC/Education/SitePages/Home.aspx?AjaxDelta=1&isStartPlt1=1565725923678\

Course Workbook and PowerPoints

Passport to Whole Health

https://wholehealth.wisc.edu/wp-content/uploads/sites/414/2018/09/Passport-to-Whole-Health-3rd-Edition-2018.pdf

https://wholehealth.wisc.edu/wp-content/uploads/sites/414/2019/11/WHYP_Workbook.pdf

https://wholehealth.wisc.edu/courses/whole-health-in-your-practice/

https://wholehealth.wisc.edu/



https://www.va.gov/WHOLEHEALTH/

https://dvagov.sharepoint.com/sites/VHAOPCC/Education/SitePages/Home.aspx?AjaxDelta=1&isStartPlt1=1565725923678%5C

https://dvagov.sharepoint.com/sites/VHAOPCC/Education/SitePages/Home.aspx?AjaxDelta=1&isStartPlt1=1565725923678%5C



WHOLE HEALTH BINGO: EIGHT AREAS OF SELF-CARE Find people in your small group who match the descriptions on the bingo sheet. Write their name in the corresponding box. The winning “Bingo” table will have 5 consecutive squares (or 4 corners) with a different name for each box.

B I N G O

1

Did something just for yourself

this month

(Self-Care)

Ate both fruits and veggies one day in the past

week

(Food & Drink)

Have a spiritual community

(Spirit & Soul)

Remember special days, like

birthdays and anniversaries

(Family, Friends, & Coworkers)

Spent time on a farm or park in the past month

(Surroundings)

2 Sleep 7-8 hours

each night

(Recharge)

Play a sport regularly

(Working Your Body)

Listen to Classical music

(Surroundings)

Go to a fitness class at least once

a week

(Working Your Body)

Did an art or craft project in last

month

(Personal Development)

3

Did an activity outside this past

week

(Surroundings)

Currently taking a class outside of

work


WHOLE HEALTH

FREE SPACE

Play a musical instrument


Take at least one 15 minute break daily while I am

at work

(Recharge)

4

Went on a personal or

outdoor adventure in past

year

(Surroundings / Personal

Development)

Read an inspirational

poem in the past month

(Spirit & Soul)

Have a vegetable or flower garden

(Food & Drink, Surroundings)

Have a pet

(Surroundings / Family, Friends &

Coworkers)

Do a relaxation practice at least

three times a week

(Power of the Mind)

5 Have a live plant

at work

(Surroundings)

Ate lunch with someone last

week

(Food & Drink / Family, Friends,

Coworkers)

Ate a handful of raw nuts in the

last week

(Food & Drink)

Exercised for at least 30 minutes

yesterday

(Working Your Body)

Volunteered in the community in

the past year




THE CIRCLE OF HEALTH

The Circle of Health

To learn more visit https://www.va.gov/WHOLEHEALTH/

https://www.va.gov/WHOLEHEALTH/



WHOLE HEALTH SYSTEM DIAGRAM

Key Elements of the Whole Health System



KEYS TO PERSONAL HEALTH PLANNING THE JOURNEY TO WHOLE HEALTH CLINICAL CARE



SHARED GOAL SETTING



PERSONAL HEALTH INVENTORY (PHI)

Personal Health Inventory Use this circle to help you think about your whole health.

• All areas are important and connected.

• The body and mind have strong healing abilities.

• Improving one area can help other areas.

• The inner ring represents your mission, aspirations, or purpose. Your care focuses on you as a unique person.

• Mindful awareness is being tuned in and present.

• Your self-care and everyday choices make up the green circle.

• The next ring is professional care (tests, medications, supplements, surgeries, examinations, treatments, and counseling). This section includes complementary approaches like acupuncture and yoga.

• The outer ring includes the people and groups who make up your community

Rate where you feel you are on the scales below from 1-5, with 1 being miserable and 5 being great.

Physical Well-Being 1

Miserable 2 3 4 5

Great Mental/Emotional Well-Being

1 Miserable

2 3 4 5 Great

Life: How is it to live your day-to-day life 1

Miserable 2 3 4 5

Great

What is your mission, aspiration, or purpose? What do you live for? What matters most to you? Write a few words to capture your thoughts: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________



Where You Are and Where You Would Like to Be For each area below, consider “Where you are” and “Where you want to be.” Write in a number between 1 (low) and 5 (high) that best represents where you are and where you want to be. You do not need to be a “5” in any of the areas now, nor even wish to be a “5” in the future.

Area of Self-Care Where I am Now

(1-5)

Where I Want to Be (1-5)

Moving the Body: Our physical, mental, and emotional health are impacted by the amount and kind of movement we do. Moving the body can take many forms such as dancing, walking, gardening, yoga, and exercise.

Recharge: Our bodies and minds must rest and recharge in order to optimize our health. Getting a good night’s rest as well as recharging our mental and physical energy throughout the day are vital to well-being. Taking short breaks or doing something you enjoy or feels good for moments throughout the day are examples of ways to refresh.

Food and Drink: What we eat and drink can have a huge effect on how we experience life, both physically and mentally. Energy, mood, weight, how long we live, and overall health are all impacted by what and how we choose to eat and drink.

Personal Development: Our health is impacted by how we choose to spend our time. Aligning our work and personal activities with what really matters to us, or what brings us joy, can have a big effect on our health and outlook on life.

Family, Friends, and Co-Workers: Our relationships, including those with pets, have as significant an effect on our physical and emotional health as any other factor associated with well-being. Spending more time in relationships that ‘fuel’ us and less in relationships that ‘drain’ us is one potential option. Improving our relationship skills or creating new relationships through community activities are other options to consider.

Spirit and Soul: Connecting with something greater than ourselves may provide a sense of meaning and purpose, peace, or comfort. Connecting and aligning spiritually is very individual and may take the form of religious affiliation, connection to nature, or engaging in things like music or art.

Surroundings: Our surroundings, both at work and where we live, indoors and out, can affect our health and outlook on life. Changes within our control such as organizing, decluttering, adding a plant or artwork can improve mood and health.

Power of the Mind: Our thoughts are powerful and can affect our physical, mental, and emotional health. Changing our mindset can aid in healing and coping. Breathing techniques, guided imagery, Tai Chi, yoga, or gratitude can buffer the impact of stress and other emotions

Professional Care: “Prevention and Clinical Care” Staying up to date on prevention and understanding your health concerns, care options, treatment plan, and their role in your health

Reflections Now that you have thought about what matters to you in all of these areas, what is your vision of your best possible self? What would your life look like? What kind of activities would you be doing? _________________________________________________________________________________________ _________________________________________________________________________________________ Are there any areas you would like to work on? Where might you start? _________________________________________________________________________________________ _________________________________________________________________________________________

After completing the Personal Health Inventory, talk to a friend, a family member, your health coach, a peer, or someone on your healthcare team about areas you would like to explore further.


14 VHA Office of Patient Centered Care & Cultural Transformation February 2020

Blank PHI

Personal Health Inventory Use this circle to help you think about your whole health.

• All areas are important and connected.

• The body and mind have strong healing abilities.

• Improving one area can help other areas.

• The inner ring represents your mission, aspirations, or purpose. Your care focuses on you as a unique person.

• Mindful awareness is being tuned in and present.

• Your self-care and everyday choices make up the green circle.

• The next ring is professional care (tests, medications, supplements, surgeries, examinations, treatments, and counseling). This section includes complementary approaches like acupuncture and yoga.

• The outer ring includes the people and groups who make up your community

Rate where you feel you are on the scales below from 1-5, with 1 being miserable and 5 being great.

Physical Well-Being 1

Miserable 2 3 4 5

Great Mental/Emotional Well-Being

1 Miserable

2 3 4 5 Great

Life: How is it to live your day-to-day life 1

Miserable 2 3 4 5

Great

What is your mission, aspiration, or purpose? What do you live for? What matters most to you? Write a few words to capture your thoughts: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________


15 VHA Office of Patient Centered Care & Cultural Transformation October 2019

Where You Are and Where You Would Like to Be For each area below, consider “Where you are” and “Where you want to be.” Write in a number between 1 (low) and 5 (high) that best represents where you are and where you want to be. You do not need to be a “5” in any of the areas now, nor even wish to be a “5” in the future.

Area of Self-Care Where I am Now

(1-5)

Where I Want to Be (1-5)

Moving the Body: Our physical, mental, and emotional health are impacted by the amount and kind of movement we do. Moving the body can take many forms such as dancing, walking, gardening, yoga, and exercise.

Recharge: Our bodies and minds must rest and recharge in order to optimize our health. Getting a good night’s rest as well as recharging our mental and physical energy throughout the day are vital to well-being. Taking short breaks or doing something you enjoy or feels good for moments throughout the day are examples of ways to refresh.

Food and Drink: What we eat and drink can have a huge effect on how we experience life, both physically and mentally. Energy, mood, weight, how long we live, and overall health are all impacted by what and how we choose to eat and drink.

Personal Development: Our health is impacted by how we choose to spend our time. Aligning our work and personal activities with what really matters to us, or what brings us joy, can have a big effect on our health and outlook on life.

Family, Friends, and Co-Workers: Our relationships, including those with pets, have as significant an effect on our physical and emotional health as any other factor associated with well-being. Spending more time in relationships that ‘fuel’ us and less in relationships that ‘drain’ us is one potential option. Improving our relationship skills or creating new relationships through community activities are other options to consider.

Spirit and Soul: Connecting with something greater than ourselves may provide a sense of meaning and purpose, peace, or comfort. Connecting and aligning spiritually is very individual and may take the form of religious affiliation, connection to nature, or engaging in things like music or art.

Surroundings: Our surroundings, both at work and where we live, indoors and out, can affect our health and outlook on life. Changes within our control such as organizing, decluttering, adding a plant or artwork can improve mood and health.

Power of the Mind: Our thoughts are powerful and can affect our physical, mental, and emotional health. Changing our mindset can aid in healing and coping. Breathing techniques, guided imagery, Tai Chi, yoga, or gratitude can buffer the impact of stress and other emotions

Professional Care: “Prevention and Clinical Care” Staying up to date on prevention and understanding your health concerns, care options, treatment plan, and their role in your health

Reflections Now that you have thought about what matters to you in all of these areas, what is your vision of your best possible self? What would your life look like? What kind of activities would you be doing? _________________________________________________________________________________________ _________________________________________________________________________________________ Are there any areas you would like to work on? Where might you start? _________________________________________________________________________________________ _________________________________________________________________________________________

After completing the Personal Health Inventory, talk to a friend, a family member, your health coach, a peer, or someone on your healthcare team about areas you would like to explore further.



THE POWER OF STORY My Life, My Story https://www.youtube.com/watch?v=fpzgVlExS20&feature=youtu.be

CASE STUDY – DAVE

• 68-year-old male who is an Army Veteran (Vietnam)

• Married (2nd marriage) and has one son (47) and one daughter (45)

• Previous car and engine mechanic, now retired

Current concerns: • Difficulty falling asleep, occasionally reports flashbacks and nightmares

• Diagnosed as diabetic for 25 years

• Struggles with managing blood sugar levels

• Right below-the-knee amputation 4 years ago

• Chronic pain in left leg with poor circulation and leg sores

• Left foot was removed 3 days ago, and he is currently in the hospital preparing for surgery to remove his lower left leg tomorrow

https://www.youtube.com/watch?v=fpzgVlExS20&feature=youtu.be



MY LIFE, MY STORY – DAVE

I had a good life until I was about 9 years old. My dad died from a heart attack and my mom remarried about a year and a half later. My stepdad was bad news; he and my mom burned down the family house to get the insurance money. After that there was nothing but craziness and alcohol at home. When I was 11 my parents lost custody of the 5 youngest kids and we moved to the Holy Family Orphanage in Marquette, MI.

Two years later I went into a foster home and they were a nice couple but the husband lost his job and they had to move so I went back to the orphanage. After that my younger brother and I got placed with an elderly couple that lived on a farm. Looking back on it I can see that they only wanted us there to help them work the farm. So that’s what we did. We went to school when we had the chance and basically ran the farm for them. They were mean people and used to lock us in our bedroom at night until it was time to milk the cows in the morning. I ran away when I was sixteen and half.

The state sent me to a reform school. I didn’t feel like I’d done anything to deserve that and I told them that I would run away again the first chance I had. Eventually they gave me permission to join the Army early so that I wouldn’t have to go back into foster care. I enlisted shortly before my 17th birthday.

My basic training was in Fort Knox, KY and I did my AIT training in Fort Dix. My MOS was 11-B-10, Weapons Specialist Demolition. Eventually I joined the Rangers (an elite infantry unit in the US Army). In December of 1964 I got my papers for Vietnam and was sent to Da Nang. It seemed like fun at first. I was 18 and a happy-go-lucky kind of guy. At that time, we were serving as advisors in Vietnam and were not technically fighting the war. We did a little bit of advising and a little bit of fighting. I know that we could have wiped out the enemy at that time if we had been allowed to. They hadn’t built tunnel systems yet and there were a lot fewer of them then there were by ’68 and ’69. My unit had a lot of casualties but we done pretty good. The guys never lost their spirits.

In 1965 I shipped out to Bamberg, Germany. Our unit did border patrol on the East German border. I saw as much action in Germany as I had in Vietnam but the public never heard about it. We lost 7 guys to snipers in one year. They would fire 60-100 rounds a night at us but we could not shoot back. One night we were driving a deuce and a half truck down the road and we got ambushed. The last thing I remember was an explosion. They killed my buddy and I woke up 4 days later in a hospital with 253 stitches and a brain concussion. I’d been shot in the leg and hip and spent almost 2 months in the hospital. Like I always say, “It’s not the bullet that says To Whom It May Concern that you’ve got to worry about, it’s the bullet that’s got your name on it that you’ve got to worry about.”

I had a terrible homecoming when I came back to the States. I was still limping from the bullet wound in my leg and I went to buy some shoes. The salesman noticed my military uniform and said, “You’re one of those baby killers, aren’t you?” I threw him up against the wall and never went back. When you get home, who wants to talk about the war? You



want to get on with your life. It was hard back then: I felt that the only people who understood me were other Vets.

I got married in 1966 but it only lasted 5 years. We had a son but I didn’t know that until 20 years later. He called me over the phone and told me. I told him that I was sorry that we had missed out on all that time but that I wanted to have a relationship with him going forward—and we do.

I married my current wife in 1972 and we’ve been together over 40 years. She stuck with me through a lot of shit but I’ve never been abusive to her and she never had to work a day in her life. We had one daughter who is now 45.

I became a mechanic on large diesel engines and got a job with a company that repaired mining equipment. For 18 years I travelled all over the world to different countries. After that I had my own shop in Michigan where I sold and repaired cars.

I was diagnosed as diabetic in 1986 and I’ve struggled with managing my blood sugar levels ever since. Four years ago my right leg was amputated below the knee at the VA hospital in Milwaukee. Now the same thing is happening to my left leg. They removed my foot a couple days ago. They will be taking off the lower portion of my leg tomorrow. When I recovered from the last amputation I found that physical therapy wasn’t as important as having a positive attitude. If you sit around and dwell on what’s bad, it’s going to get worse. You have to keep busy and occupy yourself with something else.

My wife is also sick which makes things hard at times. She was diagnosed with Milroy’s disease 25 years ago and her legs have swelled up hugely because of the disease. The only known cure is to keep your legs elevated at all times, which isn’t very helpful if you want to have a life and stay busy. We get frustrated like anybody but the Good Lord and family have helped us through. Sometimes I wonder how much we can handle.

My wife and I were foster parents from 1969 until last year, 2012. During that time, we raised 45 foster kids in our home. That’s actually the longest that any couple has been foster parents in the US. We are close to all our kids. Every year a dozen or more of our kids come home to visit during the holidays. We started doing foster care after we took in my youngest brother. He was still living in the orphanage at the time and was about to be sent to reform school. We took him in and just kept doing it. Raising the kids was always something that was very important to me. I wanted to give them something different. I wanted to give them something that I never had—a hand up.



SAMPLE QUESTIONS TO EXPLORE THE EIGHT AREAS OF SELF-CARE The following questions are provided as examples of self-care topics you can bring up during a partner exercise or patient visit. Feel free to ask other questions, as you prefer. The page numbers listed after each topic are the pages in your Passport to Whole Health that feature a more detailed question list. The questions are typically on the second page of any given chapter.

Moving the Body: Energy & Flexibility (Passport, Chapter 5) • What kind of activities do you enjoy? • How active have you been in the last week? • Do you have a favorite way to exercise or bring movement into your life? • How are your balance, strength, and flexibility?

Surroundings: Physical & Emotional (Passport, Chapter 6) • Tell me about your living situation.

o What do you like about it? o What would you change about it? o Who do you live with? o Do you have any pets?

• Does your work environment support your physical health and well-being? • How often do you spend time outdoors or in nature?

Personal Development: Personal Life & Work Life (Passport, Chapter 7) • What are your greatest strengths? • What has helped you to get to this point in your life? • What helps you to be resilient? • How do you invest your time each day? Would you like to change anything? • Do you have any hobbies, or do any volunteer work in the community?

Food & Drink: Nourishing & Fueling (Passport, Chapter 8) • What are your favorite foods? Do you crave any specific food? • Does anyone else participate in food choices and preparation at your home? • Have you noticed a reaction after eating certain foods? What happens? • Have you ever changed the way you eat, and what was the result? • Are there any changes that you would like to make to your diet?

Recharge: Sleep & Refresh (Passport, Chapter 9) • What energizes you? What drains you? • Are you satisfied with your energy level on a daily basis? • What time of the day are you most energized, and least energized? • Do you wake up feeling rested? How much sleep do you get per night? • Have you ever used any techniques or practices to help you sleep? • Do you take regular breaks from work during the day? • Do you take vacations? Do they recharge you?



Family, Friends & Coworkers: Relationships (Passport, Chapter 10) • Do you get the support you need from family and friends? • Do you have someone you trust and can talk to about your health? • Is there someone in your life you share your thoughts and feelings with? • Do you feel supported by your co-workers? • Who do you support? • Do you do any volunteer work?

Spirit and Soul: Growing & Connecting (Passport, Chapter 11) • Do you have a sense of meaning and purpose in your life? • What does spirituality mean to you? • Are you part of a spiritual or faith community? • What gives you strength during difficult times? • What or who inspires you?

Power of the Mind: Relaxing & Healing (Passport, Chapter 12) • When do you feel most at ease and relaxed? • How do you manage stress in your life? • Where do you carry your stress in your body? • Do you have a meditation or mindfulness practice? • Have you ever tried any mind-body approaches? If so, which ones?



PERSONAL HEALTH PLANNING VISIT OUTLINE Name:

Date:

1. SET THE STAGE Tell them what Whole Health and personal health planning are about (e.g., give your Elevator Speech)

2. SELF-REFLECTION: EXPLORE MEANING, ASPIRATION, PURPOSE (MAP) Ask the big questions: What really matters? Why is their health important? My mission, aspiration or purpose in life is…

My Long-Term Goals:

3. REVIEW THE PERSONAL HEALTH INVENTORY (PHI), ASSESS THE CIRCLE Strengths (what’s going right already):

Challenges/Areas to focus on:

4. SET GOALS Are there any areas on the Circle of Health they want to focus on? Use the circle to guide you. (Need not fill all of these out – focus on one to start.) Start with shared goals. Fine-tune to one or more SMART goals. SMART = Specific, Measurable, Action-Oriented, Realistic, Timed.

Write your goal(s) in the appropriate sections below: Mindful Awareness:

Areas of Self-Care:

• Moving the Body

• Surroundings

• Personal Development



• Food and Drink

• Recharge

• Family, Friends and Co-Workers

• Spirit and Soul

• Power of the Mind

Professional Care: Conventional and Complementary:

• Health concerns

• Prevention/Screening

• Treatment (e.g., conventional and complementary approaches, medication, and supplements)

5. EMPOWER AND EQUIP – EDUCATION, SKILL BUILDING, RESOURCES, SUPPORT (What happens to help them achieve their goals?)

• Referrals and Support Team

• Complementary and Integrative Health (CIH)

• Skills

• Handouts, websites, community resources

• Follow up – when will you connect with them again?

Please Note: This plan is for personal use and does not comprise my complete medical or pharmacological data, nor does it replace my medical record.



THE ADKAR FRAMEWORK FOR SYSTEM CHANGE The ADKAR model is used widely in the VA to support system-wide change. For change to occur, a variety of elements are required, as listed below. As you consider how you might implement Whole Health more fully, it may help to consider these five areas:

Adapted from Prosci, Inc. Used under license. Customized and produced by US Dept of Veterans Affairs

Area Where you Want/Need to Progress Your Ideas: How Do You Make it Happen?

A To Build Awareness

D To Create Desire

K To Develop Knowledge

A To Develop Ability

R To Reinforce Change



WHOLE HEALTH IMPLEMENTATION COMMON EXAMPLES OF IMPLEMENTATION STRATEGY TOPICS

ADKAR Insights: Based on your reflections from the previous page, are there any areas where you want to focus?

Big question: How can you support your team or site with pre-existing Whole Health goals?

Examples

• Incorporate mindful awareness at team meetings/huddles (educate colleagues)

• Increase use of the PHI or Circle of Health with Veterans—individually, in groups/teams, or as part of group medical visits or classes

• Form a Whole Health group (for Veterans and/or staff) with rotating weekly topics

• Enhance Pathway Programming (e.g., collaborate more with Whole Health Partners or Coaches)

• Collaborate with other key partners at your facility (mental health, leadership, inpatient, outpatient, CBOCs, etc.)

• Develop (or expand) an updated resource list with referral information (including CIH info)

• Explore documentation options on the Electronic Medical Record (EMR) (National templates have been designed.)

• Enhance communication between different groups



OUTLINE FOR TEAM IMPLEMENTATION DISCUSSION

The intention for this exercise is to create clear and constructive action plans which will be shared with your facility leadership, OPCC&CT leadership and other participants at this course. (This is not a time to focus on frustrations and obstacles, but rather to empower solutions for your team and your facility.)

Using the template on the following page and designating a team volunteer to record notes, please:

• Discuss and list your ideas/strategies for implementing Whole Health into your work teams.

• Identify clear goals and action steps.

• What will be your timeframe?

• Who will take responsibility for various action steps?

• How will you know that you are successful?

• For sustainable change toward Whole Health, what support do you need from:

Yourself Your co-workers Your supervisor Your facility leadership Office of Patient Centered Care & Cultural Transformation (OPCC&CT)

The completed template should provide a summary document describing the changes in which you would like to be actively involved in bringing to your organization. The template will be submitted to the Whole Health POC and leadership at your site at the end of this exercise.

Please also designate a team spokesperson who will provide a brief oral report to the large group on your plans after the team work time, and serve as the point of contact.



WORKSHEET FOR TEAM IMPLEMENTATION DISCUSSION

This exercise is an opportunity to identify the ways in which you will apply what you have learned at the Whole Health in Your Practice course, in support of Whole Health transformation.

As a group, select a team recorder to write up notes and a team spokesperson to provide a brief oral summary of your plans. (Same person is OK!) As a team, create a summary of the actions you will take to advance your practice and/or program toward Whole Health. This worksheet will be shared with your site’s Whole Health POC and leadership.

WORK TEAM TITLE:

WORK TEAM MEMBERS (please note who is serving as Point of Contact and Recorder):

GOAL(s) ACTION STEPS (to achieve each goal)

TIME FRAME RESPONSIBLE ROLES

MEASURES OF SUCCESS

SUPPORT NEEDED



GOAL(s) ACTION STEPS (to achieve each goal)

TIME FRAME RESPONSIBLE ROLES

MEASURES OF SUCCESS

SUPPORT NEEDED



NOTES



REFLECTIONS ON HOW TO APPLY WHOLE HEALTH Use this section to jot down ideas you have about how you will apply and implement what you are learning.

Module 1. Introductions

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Module 2. The Big Picture

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Module 3. The Power of You

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Module 4. Me at the Center: Mission, Aspiration, Purpose

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Module 5. Mindful Awareness

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Module 6. Resilience and Clinician Self-Care

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Module 7. The Personal Health Inventory

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Module 8. Setting the Stage for Implementation: Local Resources

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Module 9. Self-Care: Part I

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Module 10. Self-Care, Part II

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Module 11. Professional Care, Part I: Introduction to CIH

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Module 12. Professional Care, Part II: Specific CIH Approaches

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Module 13. Personal Health Planning

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Module 14. Gratitude Practice

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Module 15. Loving-Kindness Meditation

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Module 16. Community

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Module 17. Application: Your Life, Your Practice

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Module 18. Application & Implementation: Your Team

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Module 19. Implementation: Your Site

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Module 20. Implementation: Reports

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DAY 1—PULSE CHECK

We value your input, and it will shape how we plan the rest of the course.

1) Please rate the following sections of Day 1:

MODULE Poor Excellent 1. Introductions

Leadership welcome, Bingo, large group introductions

1 2 3 4 5

2. The Big Picture Vision, Circle of Health, System 1 2 3 4 5

3. The Power of You Origin Stories, your presence, practice self-assessment

1 2 3 4 5

4. Me at the Center: MAP Power of story, MAP 1 2 3 4 5

5. Mindful Awareness Introduction, research, experience 1 2 3 4 5

6. Resilience and Clinician Self-Care Prevent burnout, enhance resilience 1 2 3 4 5

7. The Personal Health Inventory 1 2 3 4 5

8. Setting the Stage for Implementation: Local Resources 1 2 3 4 5

Rating of the facility Sound, temperature, comfort, etc. 1 2 3 4 5

OVERALL MATERIAL ON DAY ONE 1 2 3 4 5

2) What about the course today (Day 1) was most helpful to you?

3) What about the course today (Day 1) could be even better?

4) Other feedback and helpful suggestions (feel free to write on the back of this page, too):

DAY 1—PULSE CHECK Whole Health in Your Practice



Day 1—Pulse Check, Page 2

Please do not write your course notes on this page as you will be turning this sheet in at the end of Day 1. See note pages starting on page 29 for space to take notes.



DAY 2—PULSE CHECK

We value your input, and it will shape how we plan the rest of the course.

1) Please rate the following for Day 2:

MODULE Poor Excellent 9. Self-Care, Part I

Intro to self-care circles: Surroundings, Working Your Body, Food & Drink, Recharge

1 2 3 4 5

10. Self-Care, Part II Family/Friends/Coworkers, Spirit & Soul, Personal Development, Power of the Mind

1 2 3 4 5

11. Professional Care, Part I: Intro to CIH

VA, Spectrum, When to Suggest a CIH Approach

1 2 3 4 5

12. Professional Care, Part II: Specific CIH Approaches

Acupuncture, Massage, Tai Chi, Yoga, etc. 1 2 3 4 5

13. Personal Health Planning Elevator Speech, reviewing PHIs, goal setting

1 2 3 4 5

14. Gratitude Practice 1 2 3 4 5


OVERALL MATERIAL ON DAY TWO 1 2 3 4 5



4) Other feedback and helpful suggestions (feel free to write on the back of this page, too):

DAY 2—PULSE CHECK Whole Health in Your Practice



Day 2—Pulse Check, Page 2

Please do not write your course notes on this page as you will be turning this sheet in at the end of Day 2. See note pages starting on page 29 for space to take notes.



DAY 3—PULSE CHECK

We value your input, and it will shape planning for future courses.

1) Please rate the following for Day 3:

MODULE Poor Excellent

15. Loving-Kindness Meditation 1 2 3 4 5

16. Community Local, national, and online resources, success stories

1 2 3 4 5

17. Application: Your Life, Your Practice Partner exercise PHPs

1 2 3 4 5

18. Application & Implementation: Your Team Coaches, Peers, Transdisciplinary

1 2 3 4 5

19. Implementation: Your Site Small group activity, brainstorming, planning

1 2 3 4 5

20. Implementation: Reports Small groups report to large group and leadership

1 2 3 4 5


OVERALL MATERIAL ON DAY THREE 1 2 3 4 5



4) What was your favorite thing about the Whole Health in Your Practice course?

DAY 3—PULSE CHECK AND FINAL EVALUATION Whole Health in Your Practice

Please See Back of Page



5) What is the #1 thing you would change about this course?

6) As we move forward with future Whole Health Advanced Clinical Education courses, do you have any additional thoughts about how to optimize their experience?

7) Other thoughts and comments?



Do You Have a Supportive Statement to Share?

We hope you have enjoyed the course. If you would like to share a positive statement that can be passed along to the Office of Patient Centered Care & Cultural Transformation for use in brochures, courses, and other materials, please write it here.

Tear out this sheet and submit to the course administrator. Thank you!



Supportive Statement, Page 2

Please do not write your course notes on this page. See note pages starting on page 29 for space to take notes.

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