Behavioral Health - Key Activity 13

KEY ACTIVITY #13:

Optimize Patient Engagement and Activation

This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; proactive patient outreach and engagement; care coordination; behavioral health integration; address social needs.

Overview

This activity focuses on partnering with patients to foster engagement in care and health-promoting behaviors. Person-centered engagement methods are founded in the dignity of each individual to make their own decisions and the dual recognition that care goals are more likely to hold meaning when they are aligned with a person’s life goals and health outcomes are shaped by everyday behaviors. This activity includes shared decision-making, self-management support activities, and leveraging technology and other approaches to increase self-efficacy.

Action steps and roles

1. Cultivate a trusting and engaging environment where patients feel comfortable in accessing care.

Suggested team member(s) responsible: Leadership with IBH team.

A variety of ongoing training and skill development will support the care team in providing a welcoming environment to all patients:

• Everyone in the practice has a role in welcoming patients into care, so the full complement of staff needs to be trained in trauma-informed principles of care. See the resource: Trauma-Informed Population Health Management.
• Implement cultural humility training to address biases and promote equitable care. More about this is provided in Key Activity 6: Expand Access to Integrated Care.
• Care team staff should also have training in self-management support and motivational interviewing (see below).

Displaying posters, pamphlets and other materials in the waiting room is an effective way to provide health education,^[2] elicit patient engagement with behavioral healthcare, and assure patients of nonjudgement. Additionally, staff can wear lanyard buttons or badge stickers with messages, such as We ask because we care, to normalize universal screening. Some resources to consider:

• Brochures and fact sheets on mental disorders and related topics from the National Institute of Mental Health.
• Brochures on depression and anxiety disorders from the Anxiety and Depression Association of America.
• Brochures for purchase and infographics for print from the National Alliance on Mental Illness.
• ACE and resilience booklet from the Community Resilience Initiative.

Consumer advisory boards are a wonderful resource and can be effective partners to surface potential change ideas to enhance the practice’s welcoming nature, for example, by accomplishing clinic walk-throughs designed to look for opportunities to boost the welcoming nature of the physical space and limit negative experiences. For going deeper in developing an environment for supporting patient activation, consider sponsoring peer groups and group visits to foster peer engagement and support.
 

2. Train the care team in key self-management support skills.

Suggested team member(s) responsible: Leadership.

Some key self-management support techniques include the ask-tell-ask communication technique, motivational interviewing, person-centered goal-setting,^[3] and the therapeutic alliance.

Resources for developing self-management support skills include:

• AHRQ provides an introductory video, advice on shared action planning, and a Self-Management Support Resource Library, which describes several tools, materials and training in self-management support.

3. Develop team-based approaches to foster patient engagement and self-management.

Suggested team member(s) responsible: Clinic leadership, clinical champion.

In some practices, a social worker is trained to conduct the more time-intensive initial goal setting, and senior clinicians will review progress on patient goals during the visit. In other practices, peer support specialists or upskilled community health workers or medical assistants may provide behavioral health support. Your practice may decide to focus self-management in one patient subpopulation, and this will influence who is best suited to complete the tasks.

Regardless of your design, it will be important to establish clinic visit workflows that coordinate self-management support interactions that take full advantage of the skills of all members of the care team, technology, and other resources available to patients.

Tip: Case-rounding is integral to a team-based approach for supporting patient engagement. It is a mechanism to enable the team to have a shared understanding of patients’ action plans and can support care teams to collaborate around patient care.
 

4. Employ interview techniques that support partnering with patients, including identifying self-management goals that align with their preferences and building on their coping strategies.

Suggested team member(s) responsible: Integrated care team.

Below are steps for providing self-management support around a shared care plan modeled on the OARS approach common in motivational interviewing:^[4]

• Ask open-ended questions: Ask broad questions that allow patients the maximum flexibility to respond without fear of a right or wrong answer. It can be as simple as, “What's been going on with you since we last met?”
• Offer affirmations: Celebrate patients’ accomplishments and offer empathy for their struggles.
• Practice reflective listening: When practicing reflective listening, patients are able to express their thoughts and then that information, if shared back with them with the purpose of eliciting conversation, helps them arrive at an idea for change.
• Summarize the conversation: Recap what the patient has said, calling attention to the salient elements of the discussion, and allow the patient to correct any misunderstandings and add anything that was missed.

5. Leverage technology to support and document the development of a shared care plan.

Many EHRs have a module that supports the documentation of a shared care plan template. In the absence of using this type of module, patient self-management plans can be typed into the office visit summary and shared at the end of the visit.

Create a vetted list of condition-specific online or print resources that can be shared with patients of different ages and levels of health literacy. Some resources to start with:

• NIMH provides self-care resources around managing stress, anxiety, and when to seek professional health.
• Resources and posters linked in step one above.

For going deeper in this area, consider how telemedicine, remote patient monitoring, wearables, and new potentially artificial intelligence (AI) tools might supplement patients’ self-management ability. Consider both the health center’s capabilities and each patient’s ease with technology as well as whether the intervention is considered an emerging, promising or evidence-based practice. One such example of the use of technology is the Los Angeles County Office of Education (LACOE) partnership with K-12 public schools and health plans to offer a free third-party mental health telehealth service for students.