This month is flying by.  I’m making progress at TCC, and getting used to the chaos. I try to be on site as much as possible on my scheduled days, but have arranged with my preceptor that if there is no one I need to meet with and no desk/computer space available, I can do some work from home. I am working on ideas for the Healthy Lifestyles program. The department of Health Education (HEO) within TCC is working on “branding” itself throughout TCC. I want to tag onto that with their Healthy Lifestyles program.

We want to have different “layers” to the overall program, starting with consistent Healthy Lifestyle visual messaging throughout all the clinics. Every lobby/waiting area/exam room should have the same visual health promotion messages. They are already using MyPlate graphics & Re-think your drink signage. We want to add physical activity promotion & stress management messages.  The next layer would be something the clinic has been working on called “charlas”, which are basically short scripts -Sound bites or elevator messages, kind of – about each of those topics. These will be given to patients waiting in exam rooms by Community Health Workers (CHWs). CHWs are used widely by TCC. These encounters should encorporate a component of Brief Motivational Interview, to help the CHW focus in on which message is most relevant for the particular patient. Ideally, the CHW can keep some sort of documentation of what was discussed & where the patient seemed to be in terms of stage of change (Transtheoretical Model), then follow up on that subject the next time the patient is in the clinic.  The third layer would be a one hour individual educational interaction with a CHW addressing components of healthy lifestyle. This class will incorporate Motivational Interview (MI), strategies to assess and improve self efficacy, and problem solving. It is available to any interested patient, and is also something that MDs are encouraged to refer patients for .  This class is followed by monthly telephone follow ups for three months.

The COO of the clinic wants this program developed yesterday, and wants it all to be evidence based.  The challenge here is that the director of HEO (my preceptor) and all the CHWs are already stretched very thin, and there is actually not much research out there to use to call this program idea “evidence based”. There is research showing effectiveness of intense individual counseling, but the interventions studied are much more intensive in terms of number of counseling sessions and follow up than this program is staffed or funded for.

I am working on a literature review for this program, and on writing up my/our ideas for the overall content of the program. I also have been creating a visual “flip chart” for the one hour class, and revamping the content to incorporate MI. I’ve been working with the CHW who provides this class (she has already been doing it, but with no guidance or support) to get her input and to help her with MI technique and accurate but basic health information. We have been “practicing” the class together. I have also edited the “charlas” to have accurate nutrition information. On the side, I have edited the charlas for the diabetes CHW (these types of brief messages are used in different programs throughout the clinic – asthma, diabetes, dental care…  The crazy thing is that they are often scripted by the CHWs themselves, who are motivated & eager but have only the training provided to them by TCC, or by volunteers who usually have degrees, but not necessarily in health or nutrition. I made many revisions to the diabetes messaging and am very glad I was able to get my hands on it!)

TCC is a great organization, and has been providing a medical home to the medically homeless for decades. Their HEO Department has grown tremendously in the past couple of years and has multiple grants for health education that they are working under. A problem at present is that they have not added the organizational structure they need to support their growth. The HEO director is in the process of hiring a manager for HEO, and promoting a CHW to a “lead” position. Once all this is done, and everyone understands their roles & who to report to, things will hopefully start to run much more smoothly.

So that’s the story for now. Onward and upward.