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Whole Person Medicine- Addressing Spiritual Issues in Primary Care and Psychiatry


Whole Person Medicine- Addressing Spiritual Issues in Primary Care and Psychiatry Teresa Cutts, Ph.D. Director of Research and Innovative Practice – PowerPoint PPT presentation

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Title: Whole Person Medicine- Addressing Spiritual Issues in Primary Care and Psychiatry

Whole Person Medicine- Addressing Spiritual
Issues in Primary Care and Psychiatry
  • Teresa Cutts, Ph.D.
  • Director of Research and Innovative Practice
  • Center of Excellence in Faith and Health,
    Methodist LeBonheur Healthcare
  • Annual Review Course for the Family Physician and
    3rd Joint Family Medicine/Psychiatry CME
    Conference, 3-25-2011

Spiritual Issues Roadmap
  • Overview of impact of spirituality on health
  • Overview of infusing spirituality into primary
    care and psychiatry
  • Best Practice models Individual, provider to
    patient (Kristeller, Koenig, Prochalski, Assets
    based tools)
  • Emerging Best Practice models for Community MLH
    Congregational Health Network, Emotional Fitness
    Centers, Dennis H. Jones LifeNet Center

Spirituality and Health
  • Majority of patients would like their healthcare
    provider to ask about and discuss spiritual
    aspects of their illness
  • 95 of Americans profess a belief in a Higher
    Power or God
  • 9/10 Americans pray regularly
  • 69 reported membership in church or synagogue
    40 attend regularly

Spirituality and Health
  • Definitional difficulties in spirituality
    (broader term referring to a dynamic, personal
    and experiential process, including quest for
    meaning and purpose, transcendence sense that
    being human is more than simple material
    existence, connnectedness (with others, nature,
    Divine) and values ( love, compassion, justice)

Spirituality and Health
  • Transcendence is hard to measure!
  • Measuring spirituality is difficult Measures of
    Religiosity (Hill Hood) cites over 200
    different scales and subscales (Mysticism scale
    measures assesses persons intense experiences,
    sense of unity, not necessarily religious ones)

Spirituality and Health
  • Methodological Problems
  • No control for confounders (age, gender)
  • Cross-sectional design cannot determine the
    temporal sequence of events
  • Inadequate measurement of religion/spirituality
    or of physical health
  • No statistical analyses
  • Earlier reports on the same cohort

Spirituality and Health
  • Regular church/service attendance may
  • Enhance social roles that promote self-worth and
    purpose through helping (Increase sense of
    personal control and decrease depression)
  • Be associated with ongoing experience of positive
  • May offer a lifeline of resources to those most
    disadvantaged (female, lower SES, minority)

Spirituality and Health
  • Evidence is strongest that Religion/Spirituality
    impacts physical and mental health by serving
  • 1) As a protective resource that prevents the
    development of disease in healthy people AND/OR
  • 2) As a coping resource that buffers the impact
    of disease in patients

Spirituality and Health
  • Regular church/service attendance
  • May increase the opportunity to observe
    vicariously and consistently those who model a
    variety of positive, hopeful, compassionate and
    caring behaviors, attitudes and beliefs that are
    highly conducive to living a healthy lifestyle
    Spiritual Modeling (Bandura Oman and Thoresen,

Spirituality and Health
  • Religion and Spirituality Linkages to Physical
    Health Powell, Shahabi, Thoresen, 2003, American
  • Looked at mediated model (impact of RI/SI on
    health, regardless of other mediators)
  • Looked at independent model (RI/SI as a new,
    independent protective factor on health)

Spirituality and Health
  • Church/service attendance protects against death
    Persuasive evidence for both mediated and
    independent models
  • Religion or spirituality protects against
    cardiovascular disease Some evidence for both
  • Being prayed for improves physical recovery from
    acute illness Some evidence

Spirituality and Health
  • Religion or spirituality impedes recovery from
    acute illness Some evidence from both models
  • The Why Me God? Hypothesis

Spirituality and Health
  • Religion or Spirituality DOES NOT
  • Protect against cancer mortality or slow
    progression of CA
  • Improve recovery from acute illness
  • Protect against disability
  • Protect against death (in deeply religious)

Spirituality and Health
  • Summary
  • The relationship between physical health and
    religion and/or spirituality is more limited and
    complex than some suggest
  • More research is needed to define these
    relationships and translate findings to clinical
    care delivery

Spirituality and Health
  • Specific studies on impact in primary care and
  • RI/SI associated with improved attendance at
    scheduled PC appts., greater cooperativeness and
    compliance and improved medical outcomes
  • RI/SI associated with less substance abuse,
    cigarette smoking, increased exercise

Spirituality and Health
  • Specific studies on impact in primary care and
    psychiatry continued
  • RI/SI may enhance coping ability by counteracting
    stress-related physiological changes that have
    negative impact on all organ systems (Allostatic
    load theory of response to stress, McEwen, 1998)
  • RI/SI associated with stronger immune function
    and lower cortisol levels

Spirituality and Health
  • Specific studies on impact in primary care and
    psychiatry continued
  • RI/SI (intrinsic religiosity) increased speed of
    remission in depression recovery in medical
  • RI/SI associated with better mental health,
    greater social support
  • RI/SI has mixed results in chronic pain (prayer
    vs. meditation and prayer)

Spirituality and Health
  • Specific studies on impact in primary care and
    psychiatry continued
  • Cognitive behavioral treatment for depression,
    couched within particular religious tradition had
    stronger impact on preventing depression
  • Pargament and colleagues have developed
    spiritually integrated psychotherapy to address
    mental illness, sexual abuse, cancer

Spirituality and HealthBest Practice Models
  • Jean Kristellar, Ph.D. at Indiana
  • Oasis (Oncologist Assisted Spiritual Intervention
    Study) Model for Oncology Patients
  • 5-7 minute patient centered intervention that
    improves patients quality of life and sense of
  • Used Spiritual Well-Being scale of Funtional
    Assessment of Chronic Illness Therapy, measuring
    domains of meaning/peace and faith
  • After 3 weeks, gt40 reported more satisfaction in
    care and 33 reporting improved coping
  • Kristellar JL, Rhodes, M, Cripe LD, Sheets V.
    Oncologist assisted spiritual intervention study
    (OASIS) patient acceptability and initial
    evidence of effects. Int J Psychiatry Med, 2005
    35(4) 329-347.

Spirituality and HealthBest Practice Models
  • Harold Koenig, M.D. at Duke
  • Clinical application information is missing
  • Less than 50 of physicians tackle this area
  • Asking about religious or spiritual beliefs is
    often a powerful intervention unto itself
  • Fiduciary Relationship Proselytizing is not
  • Invite, dont assume that a patient is
    comfortable with prayer or other spiritual
    offerings/questions. Be ready to refer to
    pastoral or spiritual advisor
  • Koenig H. An 83-Year-Old Woman with Chronic
    Illness and Strong Religious Beliefs, JAMA, July
    24/31, 2002 288(4), 1-7.

Spirituality and Health Best Practice Models
  • George Washington Institute for Spirituality and
    Health Dr. Christina Puchalski
  • 102/144 accredited medical and osteopathic
    schools incorporate spirituality into curricula
  • Through interdisciplinary collaboration provide
    physicians with insight into spiritualitys
    impact on patients well-being

Spirituality and Health Best Practice Models
  • George Washington Institute for Spirituality and
    Health, continued
  • 7 Hospital sites looked at failure of
    communication between providers and patients (75
    providers vs. 15 patients were satisfied that
    the spiritual dimensions were addressed)
  • Compassion and/or kindness are not
    sufficient.need specific competencies and
    training in this area

Spirituality and Health Best Practice Models
  • George Washington Institute for Spirituality and
    Health, continued
  • FICA Faith, Belief, Meaning Importance and
    Influence Community and Address/Action to Care
    is a spiritual history tool, with in-depth
  • Available on website http//www.gwumc.edu/gwish/f

Spirituality and Health Church Health Center or
RWJF Grant Rx for Health in Clinic Piloting

Piloted different permutations (N65) of
process with two M.D.s (Family Practitioner,

Physician Perceptions

Lots of extra work on top of acute patient needs

M.D.s felt they were not trained to handle
and mental concerns of patients that arose
Spirituality and Health CHC
  • Patients found the extra time and attention from

M.D. to be rewarding
  • Male AA patients were particularly responsive

  • No tracking of goals for follow up
  • Physicians could initiate process and be
  • for efforts
  • Need a full team of providers to implement and
  • through on making health behavior change

Spirituality and Health
  • Authentic Happiness (Seligman, 2004)
  • Values in Action Strength Survey (VIASS)
  • Identifies 24 values/Spiritual strengths/gifts
    across 6 domains wisdom and knowledge, courage,
    justice, temperance, humanity and love,
  • Life of Leaders assessment--helps craft a
    integrated health behavior change plan based on
    assets, not pathology

Spirituality and Health
  • Self-Disclosure (James Pennebaker, Ph.D.)
  • Series of experiments showing that confession
    is good for the soul or at least immune system
    and ANS!
  • Talking to person
  • Speaking into a tape recorder
  • Journalling

Spirituality and Health
  • Telling your Story (Trauma work)
  • Oakland earthquake survivors (all children)
    tracked over a several year period
  • Stories changed, took on more meaning, found a
    kernel of good, even in horrible circumstances

Spirituality and Health
  • Biology is your biography Caroline Myss, Ph.D.
  • We carry unresolved trauma in our bodies
  • Body work (exercise, therapeutic touch, massage
    therapy) helps resolve trauma
  • Why People Dont Heal and How they Can

Spirituality and Health
  • Forgiveness Everett Worthington, Ph.D.
  • Had magnificent opportunity to practice the
    tenets of his forgiveness program when his mother
    was murdered

Spirituality and Health
  • Aging with Grace, David Snowden, Ph.D.
  • Start something new later in life
  • Exercise
  • Eat green vegetables
  • Be optimistic
  • Manage depression

Spirituality and Health
  • Altruism .serve somebody
  • Helpers High
  • Long-term Effects
  • Alameda Study on volunteerism
  • Vicarious effects, too (Mother Teresa film)
  • Hands on service vs. giving money or material
    goods is best

Spirituality and Health
  • Optimism (Seligman, Kiecolt-Glaser)
  • Negative events are viewed as local, temporary
    and changeable
  • Impacts immune system functioning positively
  • Increase optimism via ABCDE model
  • Adversity
  • Beliefs that automatically occur.
  • Consequences of belief
  • Disputation of usual routine belief
  • Energization that occurs when you dispute

Congregational Health Network or CHN
  • What is the CHN?
  • The CHN is a partnership between the hospital and
    322 congregational partners developed by
    networking congregational, hospital and community
  • CHN builds healthier communities by creating a
    health system integrating clinical care in the
    hospital with outside caregiving

Volunteer Liaison Roles (gt500 Unpaid Staff)
  • Recruits congregational members into the
  • Collects data on network members
  • Notifies CHN navigators of developments/changes
  • Follows network members into and out of the
    inpatient setting
  • Coordinates transition from hospital
  • Marshals community resources
  • Provides information and referral services
  • Facilitates wellness activity participation

CHN Outcome Data
CHN Partner The Emotional Fitness Center
  • Led by Bishop William Young and Pastor Dianne
    Young of the The Healing Center Full Baptist
  • Partnered with Dr. Frieda Outlaw of State of TN
    Dept. of Mental Health and Developmental
  • Partnered with Magellan Health Services
  • 13 Local Memphis and adjacent churches

The Emotional Fitness Center
  • Work started in response to tragedy
  • gt 15 of Shelby county citizens have some form of
    mental illness or substance abuse problem
  • 6,000 children and 6,300 adults (TennCare
    eligible) dont access available services
  • Barriers to African Americans seeking mental
    health treatment fear, stigma, lack of support

The Emotional Fitness Center
  • Targets African American population to overcome
    stigma and cultural myths about mental illness
  • The African American church has unique connection
    in communities, historically and currently place
    of hope, renewal, restoration, sanctuary buffer
    to oppression
  • Power of the pulpit is strong in Memphis

The Emotional Fitness Center
  • Now Church successfully has become the hub for
    public health interventions
  • The Emotional Fitness Center has 10 sites in
    Memphis (most under-served zip codes) and 3 in
    proximal counties
  • Model uses church as the entry point for needed
    emotional distress services

The Emotional Fitness Center
  • Goals of Approach
  • Get services to individuals traumatized by life,
    including all types of abuse, violence, losses,
  • Provide preventive services to those at risk for
    becoming perpetrators of violent acts
  • Develop a live link between the faith community
    and health providers

The Emotional Fitness Center
  • Steps for Entry
  • 1. Call (901) 370-HOPE (4673) for phone triage
  • 2. Navigator will assign client to area or
    closest church (or site selected)
  • 3. Peer Advocate Liaison (PAL) makes initial
    contact within hours. Schedules and conducts

The Emotional Fitness Center
  • Role of PALS
  • Front-line triage via screening tool
  • Follow up via phone calls, to make sure those
    screened stay in the system
  • Have had mental illness or family member with
    mental illness themselves, so are advocates with
    training who know the landscape of mental illness

The Dennis H. Jones LifeNet Center
  • Methodist LeBonheur Healthcare is developing an
    initiative to help people cope with depression
    and anxiety, which sometimes expresses itself in
    suicide. Important life transitions, such as
    retirement, lay-offs, serious health issues,
    divorce, death of spouse, empty nest issues, and
    caring for the elderly and children (sandwich
    generation) often can trigger depression and
    anxiety, which may go unnoticed. We hope to
    create a Center that can provide a broad range of
    services and safety net for such individuals.
  • In order to accomplish this mission, we plan to
    use a multiple systems approach of community care
    - engaging physicians, clergy and business
    leaders along with traditional mental health
    providers, to address all aspects of health
    physical, mental and spiritual.

The Dennis H. Jones LifeNet Center
  • Community Wide Plan, in development, would
  • Provide training, support and networking
    resources for diverse stakeholders such as
    primary care physicians, clergy and human
    resource/business leaders.
  • Give these different professional groups
    additional, easy to access entry points for help
    for the individual in need.
  • Diminish the stigma of depression and anxiety in
    the community at large.
  • Highlight exemplary champions, meaning those
    who have overcome depression and/or anxiety
    symptoms and/or navigated life transitions
  • Successfully connect the dots between current
    mental health services and the stakeholders
    groups described above primary care providers,
    clergy, as well as human resource and business

Congregational Health NetworkEmotional Fitness
Centers, LifeNet
  • The Memphis Model Building a Health System for
    all, seamlessly connecting the hospital to other
    resources, particularly volunteer caregivers
  • More intentional integration with primary care
    providers and psychiatrists needed, to extend
    scope and scale of work further into the
    community, via CHN, EFC and LifeNet

Spirituality and Health
  • Questions Answers ?
  • Teresa Cutts, Ph.D.
  • (901) 516-0593
  • cutts02_at_gmail.com
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