Social Determinant Of Change Case Study

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Social Determinant Of Change Case Study



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Change management case study: GSA

States that received Round 2 grants are pursuing a variety of approaches to identify and prioritize population health needs; link clinical, public health, and community-based resources; and address social determinants of health. A number of delivery and payment reform initiatives within Medicaid include a focus on linking health care and social needs. In many cases, these efforts are part of the larger multi-payer SIM models noted above and may be part of Section Medicaid demonstration waivers. Several other state Medicaid programs have launched Accountable Care Organization ACO models that often include population-based payments or total cost of care formulas, which may provide incentives for providers to address the broad needs of Medicaid beneficiaries, including the social determinants of health.

DSRIP initiatives link Medicaid funding for eligible providers to process and performance metrics, which may involve addressing social needs and factors. The state also has invested significant state dollars outside of its DSRIP waiver in housing stock to ensure that a better supply of appropriate housing is available. Medicaid programs also are providing broader services to support health through the health homes option established by the ACA. Under this option, states can establish health homes to coordinate care for people who have chronic conditions. Health home services include comprehensive care management, care coordination, health promotion, comprehensive transitional care, patient and family support, as well as referrals to community and social support services.

Health home providers can be a designated provider, a team of health professionals linked to a designated provider, or a community health team. A total of 21 states report that health homes were in place in fiscal year Some states are providing housing support to Medicaid enrollees through a range of optional state plan and waiver authorities. While states cannot use Medicaid funds to pay for room and board, Medicaid funds can support a range of housing-related activities, including referral, support services, and case management services that help connect and retain individuals in stable housing.

Through a range of optional and waiver authorities, some states are providing voluntary supported employment services to Medicaid enrollees. Supported employment services may include pre-employment services e. States often target these services to specific Medicaid populations, such as persons with serious mental illness or substance use disorders and individuals with intellectual or developmental disabilities. For example, under a Section waiver, Hawaii offers supportive employment services to Medicaid enrollees with serious mental illness SMI , individuals with serious and persistent mental illness SPMI , and individuals who require support for emotional and behavioral development SEBD.

Medicaid MCOs are increasingly engaging in activities to address social determinants of health. Some providers have adopted screening tools within their practices to identify health-related social needs of patients. Other organizations and entities have created screening tools, including Health Leads, a non-profit organization funded by the Robert Wood Johnson Foundation, which has developed a social needs screening toolkit for providers and CMMI, which released an Accountable Health Communities screening tool to help providers identify unmet patient needs. The ACA provided a key opportunity to help improve access to care and reduce longstanding disparities faced by historically underserved populations through both its coverage expansions and provisions to help bridge health care and community health.

To date, millions of Americans have gained coverage through the coverage expansions, but coverage alone is not enough to improve health outcomes and achieve health equity. With growing recognition of the importance of social factors to health outcomes, an increasing number of initiatives have emerged to address social determinants of health by bringing a greater focus on health within non-health sectors and increasingly recognizing and addressing health-related social needs through the health care system. Clinical experiences within the acute care setting constitute the majority of clinical hours a pre-licensure nursing student completes.

Reconsideration of both curricular content and traditional acute care clinical experiences is necessary to prepare new nurses for future practice Murray, An effective curriculum should include multiple SDOH experiences, community engagement, and student reflection Sabato et al, Nursing faculty should design learning opportunities that occur in a variety of locations.

Faculty should consider these settings for all nursing courses, even those that have traditionally used the acute care setting to provide clinical education. Before a major shift in clinical placements can occur, some consideration must first be paid to the commitment of the organization to address the SDOH, and then to accessibility, safety, and sustainability. Nursing students need to develop an understanding of and ability to screen for SDOH so that they can intervene as nurses on behalf of patients. Integrating SDOH into the curriculum as either content or concept serves as the foundation. However, it is through the experiential learning experiences across the curriculum that increases competence and confidence of students to serve as advocates in addressing SDOH.

Each of these is briefly reviewed below. Interprofessional Education and Collaboration Interprofessional collaboration is an often-untapped experience that provides an interesting opportunity for educators to integrate content related to SDOH into existing curricula. The Institute of Medicine has highlighted the benefits of interprofessional education IPE and called for its use to improve healthcare delivery and health outcomes.

For nurses to be prepared for interprofessional collaborative practice, they must first be socialized to this role. Interprofessional collaboration is an often-untapped experience that provides an interesting opportunity for educators to integrate content related to SDOH into existing curricula. IPE has been shown to have a profound impact on student knowledge and attitudes on practice issues Buckley et al. IPE experiences among health professionals that do not tend to collaborate in actual practice can also be beneficial. For example, Sabato et al. During this two-year program, students from both dentistry and nursing participated in a number of activities as they collaboratively worked through case studies.

Each team member applied discipline-specific knowledge as the group analyzed and managed the cases. During the first year, students focused on the critical skills needed to address SDOH on an interprofessional team. They learned about the experience of receiving care, reaching health goals, access to resources, and motivational interviewing. Participants demonstrated an overall increase in the perceived value of interprofessional teamwork as well as ability to engage patients in issues related to SDOH Sabato et al. Challenges that SDOH present for those in our care require a close examination of legal, economic, social, and political implications. Partnerships between professions vested in health equity can address the needs of the community while enhancing the student learning experience.

For example, an interprofessional education opportunity to complete a community needs assessment can be provided for nursing and education students, or nursing and law students. Collaboration develops interventions that move beyond a single discipline and address SDOH from a higher level. Interprofessional education and collaboration can occur throughout nursing education programs, including the use of simulated scenarios. Simulation Simulation can provide students with first-hand experiences that increase awareness and support the need to reconsider individual biases.

Simulation is utilized as both a teaching strategy and method of evaluation within nursing education. The majority of students related social conditions to lifestyle choices, rather than circumstances, during the initial exploration early in their program. Overcoming these biases is necessary to properly address SDOH. Simulation can provide students with first-hand experiences that increase awareness and support the need to reconsider individual biases. These simulation experiences can help nursing students identify life circumstances and SDOH that influence overall health. Nurse educators using poverty simulations must be careful not to perpetuate stereotypes or assumptions about poverty.

This requires careful planning and tool consideration in addition to structured debriefing. This simulation provides participants with the opportunity to address food, shelter, and other basic needs while playing the role of families living with low income, coping with real-life scenarios, and interacting with community resources. Simulation can also be used to enhance student understanding of literacy, culture, transportation, availability of food, and access to healthcare.

A key component to addressing SDOH is screening; the skills needed to properly screen can be practiced and evaluated within simulation to better prepare students to integrate screening for SDOH into their assessments. Screening for SDOH requires skills that allow the nurse to ask potentially sensitive questions, and encourage an interview that is less data driven and more relationship driven.

Motivational interviewing and empathic inquiry can support this process and should be included in nursing curricula. Empathic inquiry is an approach to conducting SDOH interviewing that is based in motivational interviewing and trauma-informed care. The focus is on collaboration and emotional support, while addressing patient priorities and planning Oregon Primary Care Association, Empathic inquiry requires listening without judgement and understanding the importance of the environment in which the inquiry takes place. Didactic content in both the classroom and simulation can provide opportunities for students to master interviewing and inquiry skills that can better elicit information regarding SDOH.

While motivational interviewing and empathic inquiry are seemingly focused on the individual, this is also an important area of health promotion at the community level. The overall health of a community is determined by the health of its members. Developing self-efficacy and self-awareness enables community members to improve the overall health of their communities through sustainable actions. Social Justice and Advocacy Social determinants of health result in health inequities that often require a social justice perspective. Social determinants of health result in health inequities that often require a social justice perspective. Social justice is built on the concept that there is a need for fair and just relationships between individuals and society.

This mandate affirms the need to prepare nurses to understand the need to address social justice issues in a manner that acknowledges their relationships to health. The foundations of professional practice and values in nursing, including altruism, autonomy, human dignity, integrity, and social justice, should be addressed not just at the beginning or end of program coursework but as threads throughout curricula AACN, These threads can be easily tied to those related to SDOH. This strategy enables students and nurses to identify how SDOH relate to the overall health of individuals and communities, and also identify how seemingly individual parts of nursing practice contribute to the greater purpose of nursing as a whole.

Influence of nurse leaders at all levels on the development and implementation of health policy must address SDOH to improve health equity by specifically addressing upstream, or larger systematic, factors. These include policies that address topics like economics, education, criminal justice and transportation Adler et al. These connections can further assist students in their understanding of health policy. Service learning opportunities can also help solidify these connections within nursing education.

Nurse educators must consider innovative opportunities for students at all levels to develop a deep understanding of the issues that these groups face. It is important to distinguish service learning from volunteerism and clinical experiences. Service learning is based on collaboration between the academic institution and the community partner. These experiences can range from screening clients in a health clinic for the homeless to health education in elementary schools. However, it has been noted that one service learning course may not be enough to observe a significant change in these areas.

Reasons for this decrease included unrealistic expectations of the student and community-based organization CBO ; incompatible interest between the student and CBO; lack of student understanding about the CBO; and lack of attention to reflection. All of these reasons can be addressed by a thoughtfully developed service learning thread within a nursing education program. In particular, reflection offers an opportunity for both students and faculty to explore the difficult issues related to SDOH that can be uncovered through the service learning experience. It is important for faculty to consider multiple ways of reflection, such as journaling, artwork, storytelling, and portfolios. Traditionally, service learning has been incorporated into undergraduate nursing education.

However, graduate nursing students are moving into areas of practice that require understanding about how SDOH impact the health of individuals and populations. Though direct engagement with the community, students broadened their understanding of the healthcare needs of the population they will serve Bryant-Moore et al, Service learning can also successfully be integrated into nontraditional models, such as a post-licensure, online RN-BSN program. Students self-selected a population based on their geography, personal interest, and goals. Workshops were integrated throughout the course to guide students through the experience and ensure that the outcomes were being addressed. The workshops focused on introducing service learning concepts, gaining knowledge, developing compassion for others, and reflecting on the experiences.

These students also showed a significant increase in their belief that they can have influence in the community. This is critical as nurses must not only have the knowledge related to SDOH, but also the confidence to influence change. Threading content related to SDOH throughout an entire nursing curriculum requires that all faculty are adequately prepared to teach this content within the context of their individual course s. Faculty development is essential for those interested in integrating SDOH into nursing programs through the various strategies discussed. Graduates of nursing programs must be equipped with the knowledge and skills needed to effectively address SDOH.

Program leaders must commit resources needed for both faculty and student development. Possessing the skills to offer transformative learning opportunities is essential not only for full time faculty, but also for clinical instructors, mentors, and preceptors,. Nursing education leaders at all levels must consider innovative ways to cultivate diverse graduates who sincerely desire to address SDOH. Transformative changes are needed in nursing education to prepare nurses to adequately address SDOH and improve health equity.

Literature that supports the abilities of practicing registered nurses to address SDOH is very limited. Nurses are uniquely positioned on the frontlines of healthcare to address SDOH that impact health inequities; therefore, nurse educators must proactively develop curricula to include the use of interprofessional education, teaching new skills, utilizing new teaching methods, and forming new partnerships. This pressure to remain happy can have various effects.

In The Bell Jar, by Sylvia Plath, Esther struggles with the pressures of society while witnessing her own downfall and seeks medical help for the sake of her physical and mental health. Similarly, in The Catcher in the Rye, Holden deals with depression after flunking out of school. Although their situations are quite different, both characters change as a result of their experiences and find ways to cope with life. On the other hand, Holden struggles with the idea and pressures of growing up. As far as her marriage, Edna was never truly happy with her marriage with Leonce. Furthermore, Edna states she truly cares for her children, but sometimes her search for herself may conflict with this.

This then further discourages readers even more due to the fact that this gives insight to her actions, and somewhat justifies them. One was the importance of honesty. Annabel was always keeping her emotions to herself to avoid her friends or family from getting hurt. Rowling uses anecdotes to draw attention to the benefits of failure and imagination. According to Rowling, failure is a means of eliminating unnecessary burdens in one's life, which facilitates growth in areas that are truly meaningful.

Rowling describes one of her most epic failures, in which "the fears that [her] parents had for [her], and that [she] had for [herself] had both come to pass" Rowling 2. The uncertainty of her future plagued her, until she realized that she still had things and people for whom to live. Therefore, Rowling's failure had not eradicated her future, but made her realize the importance of her present.

Signed consent forms were obtained from participants, and permission to be audio-recorded and quoted anonymously in research outputs were also granted. Climate change adaptation Who Still Believes In The American Dream Analysis in Who Still Believes In The American Dream Analysis tend to neglect two important concepts. However, Peter Pan Movie Vs Book nursing students are moving into areas of practice Social Determinant Of Change Case Study require understanding about how Social Determinant Of Change Case Study impact the health of individuals and Social Determinant Of Change Case Study. The community was subjected to injustices on many levels.