Community Is Medicine - Open Source Wellness [Podcast Series]
[:54] Dr. Bantham introduces her guests, Dr. Elizabeth Markle and Dr. Ben Emmert-Aronson
Dr. Markle is a psychologist, speaker, writer, researcher, and Associate Professor of Community Mental Health at California Institute of Integral Studies.
Dr. Emmert-Aronson is a psychologist, researcher, advocate and statistics consultant.
Together, they founded Open Source Wellness, a “behavioral pharmacy” operating at the intersection of healthcare and communities.
[1:28] Community Is Medicine
“So we set out to create the behavioral equivalent of a pharmacy, or an experiential delivery system for one universal prescription, which we abbreviate to be move, nourish, connect, be. So physical activity, healthy food, social connection and stress reduction.”
“There's nothing rocket science about physical movement, eating some vegetables, practicing some mindfulness. Really, in our experience, the active ingredient, the thing that helps people get traction and transformation in their health, their well being, in their lives, is about community.”
[4:57] Creating a trusted referral pathway
“Providers were desperate to have some referral source. They were desperate for the resources to help their patients make these changes. And they just weren't out there. And so to be able to partner with them in this way, and really spend a little time building that initial relationship so that they could trust the referral was crucial.”
[7:17] Integrating programs with group medical visits
“What we've learned is that even when a doctor refers a patient somewhere else, about a third of them don't make it for one reason or another. They don't feel safe, they don't feel comfortable, they don't have the social capital to show up or join a new group. And really a breakthrough for us was learning to deliver our program as a group medical visit in partnership with one clinical provider who could then bill for it.”
[8:23] Delivering programs in clinical- and community-based settings
“And we see almost identical outcomes, whether we're looking in the clinical setting or in the community setting. And so we know both of these programs are highly effective. And, arguably more important, both of them are a lot of fun. Both of them set up a really great system where patients don't want to leave at the end of it.”
[11:13] Transitioning from a clinical- to a community-based setting
“They complete their dose, and they graduate and they don't want to be done. And in some cases, we can offer them a transition to a community-based site, which starts to expand their comfort and their capacity to then go out into the community and get some of those needs for movement, connection, support, etc., filled.”
[13:01] The role of health coaches in behavior change
“And I think really connecting with patients on a one-to-one basis, connecting with patients in a really close manner, and then finding out the goals that matter most to patients is one of those things that our doctors are just not trained to do and don't have the time for. So it's a place where our use of health coaches is vital. So our health coaches sit down with our participants. They hear from the participants what it is that matters most to them, what are the goals that they want to change?”
[16:00] Integrating healthcare and communities
“I think there will be a world where there's a whole clinic community continuum and integration that that we just don't have as a system quite yet.”
[18:31] Sustainable, scalable models
“Our clinical provider, on average, given no shows, was seeing around eight and a half individuals in a clinical shift. And then when we ran the Open Source Wellness program, they were seeing 16 point something on average per four hour shift. And when you look at the FQHC billing rate, what that does is it just generates a lot of extra revenue that more than covers the cost of Open Source Wellness.”
[21:50] Evaluating program outcomes
“We want folks to know that this works. We've talked a little bit before about doctors not having the necessary training around behavioral prescriptions and helping folks to make these behavioral changes. I think so much of that is because the pharmaceutical lobby is much better funded than the exercise lobby or the broccoli lobby. So they're able to come in and share a lot more data. And it's incumbent on us to then gather these data and to share that in and to say, look, this really is an effective method of behavior change. This improves patient health.”
[24:55] Role of social support and structures
“And so I think we really need to have the courage to look not just at clinical structures, but also at social structures that make it possible, or really impossible, for people to do the things that our bodies and our psyches need to be happy, healthy and well. And that giving somebody a prescription that it's impossible for them to fill. They live in a food desert, the streets aren't safe, they don't have childcare, etc. It's actually not a service, right, we actually just potentiate shame and a feeling of powerlessness. So to go one step further than behavioral prescribing, I think we need to actually embed the social structures and conditions to make it possible for people to carry that forward and into their lives.”
