Provider Strategies on Community Partnerships and SDOH

The buzzword of social determinants has demonstrated a shift in health care toward a greater focus on the person outside the patient. Health and provider organizations have found that a persons zip code is as much an indicator of health as their genetic code and that social barriers must be addressed to obtain the best outcomes.

Here are some conversations captured at #CCTC on how providers are addressing SDOH and demonstrating measurable ROI through creating successful partnerships, utilizing actionable data, and implementing sustainable health initiatives. For more lineup of speakers visit World Congress website.

Brian Bragg
Vice President, Behavioral Health and Community Integration
Access Community Health Network

Brian is a member of the Access Community Health Network Medical Operations Leadership Team, shepherding a variety of programs focused on men's health, maternal and child health, behavioral health, and infectious disease. His portfolio now includes the development and implementation of initiatives to address the social determinants affecting the health of the patients served by the organization.

Debbie Welle-Powell
Chief Population Health Officer
Essentia Health

In this role, she is responsible for integrating our community health strategy with population health. She works with market leaders, payer partners and community stakeholders to develop community-based population health and risk sharing models that focus on wellness and disease prevention for better health outcomes - with focus given to social determinants and our most vulnerable and needy populations.

Julianna Sellett is the Vice President of Community Health Initiatives for the Carle Health System.

She has over 28 years of health care experience, with special interest in organizational strategy, systems management, performance improvement, population health, as well as cross-sector community integration. Her current work focuses on improving the health, educational achievement, and economic prosperity of disadvantaged populations, with special focus on early childhood development. She is a Registered Nurse (RN) with a Doctoral degree in Nursing Practice (DNP), Master’s degree in Nursing (MSN), and Master’s degree in Business Administration (MBA). She is a Certified Professional in Healthcare Quality (CPHQ) and is Certified in Executive Nursing Practice (CENP).

Ashley Elliott, The Road to Sobriety; A Call for Resources in Rural Communities to Combat Drug Usage, Stigma & Addiction.

"The more we talk the more we bring it out and the more we bring it up, I think the quicker we can get past the stigma. Get past the negativity of addiction and see it simply as what it is and that's a disease" Ashley Elliot.


Ashley’s Health Journey Through Addiction

My story more often than not, coincides with addiction. I am a recovering heroin addict. I've been clean since December 28th 2012 and since I've gotten clean I decided to take a path to help others whenever they're struggling. I know for me when I felt hopeless if it wasn't for the women in my life that had lifted me up I don't think I would have made it .

My goal is to help those find hope that think there's no hope. In my darkest days I would say I probably had no idea what was going on at any given time. I went from being an all honor student in my freshman and sophomore years of high school-- straight A's to slowly decreasing my workload. I was a merit student my junior year and by the time was a senior I was a general student. Luckily enough I still graduated with merit a diploma.

That was the start of the dark days that really just kind of involved drinking along with experimenting with a few different substances, nothing too extreme. By the time I had graduated high school I would consider myself pretty deep into my addiction not rock bottom but still pretty deep. What would happen over the next twelve years would be me finding my own, falling in love.

I always made the joke that heroin was my first love, it never failed me, it never let me down. Every time I wanted to do something it changed the way I felt, it did just that. After that point it was really weird. I went from using to needing and I don't remember it. I don't remember when I went from recreational use to addiction, to dependency.

I would go through several different treatment centers, methadone centers. I tried suboxone. I tried moving to California. I thought if I just packed my bags, leave and go somewhere else where nobody knew me I could just start over and be whoever I wanted to be. The problem with that is wherever you go there you are you know. At that time I didn't realize the problem was me. I thought it was the drugs. I was in two very abusive relationships. The first one was we were living in Nevada and he ended up head-butting me and breaking my nose in the front lawn of our home. Shortly after that I had ended up running into an old friend out in California. She saw me and I think I’d probably been about 140lbs at the time. My collar bones were sticking out, I was rather frail. She bought me a plane ticket and three days later I came home.

When I came home I just got involved with the same people. When I did that, that’s is when the legal stuff started happening. The first time I ever got I trouble I had actually lived right up the street. The apartment that I was living in got raided and that was the first time I had been arrested. After that point it was just one after another getting arrested. Eventually I tried to do it on my own. Got involved with another boyfriend who was rather abusive. Fast forward my first treatment center I decided to leave AA, which is against medical advice. My thought process was; I was going to leave, come home, use go to court and go to jail

I was okay with that. I thought that was a solid plan to me. That's how crazy the disease of addiction is. I did that, I left, I came home, I used, went to court and the judge said “Punish her to rehab”, which was not a part of my plan. Over the next two months I had to wait 30 days because I left AA. I had to wait another 30 days for a bed to open up. Within those two months the apartment I was living in had burned down. Under the Influence I had fallen asleep on my hand for an extended period of time which caused something called Saturday Night Palsy.

It’s where an addict or an alcoholic passes out on the extremity and does nerve damage. I had no use of my hand for over three months. I was an I.V. user and there was a point in time where a needle had broken off into my arm and I left it there for six years until I had gotten clean and got a straight head on and I had surgery to have that removed. My kidney functions are extremely low. The way they explained it to me is that my kidney function is that of a 70 year old. I think that's due to all of the different opioids and the wear and tear on the body.

Emotional Health and Addiction

A big part of the health effects is the emotional state that people wanders in while being in addiction---I'm a very outgoing person and I can talk to just about anyone, anywhere about anything. When I was using, I was afraid to leave my house. I'd lived less than two or three hundred yards from a grocery store and it took everything inside of me to get up, get myself dressed to go to the grocery store just because my anxiety levels were so high. A lot of people use to try and escape their feelings of depression or anxiety.

In reality the only thing it does is increase this. I was going through panic attacks, and a lot of the different medications. I was having on medication induced seizures. I just think of it I felt like my body just couldn't go anymore. My sister pointed it out the most. The way that my family always knew I was using, was how much I weighed because I would get her periods of extreme weight loss while using and then gaining that back while attempting to get clean. The health effects I had have lasting effects, psychologically, physically, and emotionally. It takes a long time to heal all that stuff, to accept it, deal with it and move forward with it.

Finding a Support System in a Sponsor

I do honestly say that without my sponsorship family I don't think I would still be clean today. When I went into treatment the first thing I told my counselor was “I'm going to tell you I want to go home, not to let me go home. Don’t let me go home”. But she didn’t, she relocated me to a halfway house down in Frederick Maryland. While you're in treatment it's basically almost like a brainwash. I’ll say if I needed to be brainwashed to get away from whatever I was doing before I was totally okay with it. I really got involved in a twelve step program. It took me about six months after I was really involved in the program to be clean.

The reason that is like I said look for my clean is December 28, 2012. This was the first year I was down in Frederick, I was my first Christmas. I remember I was getting ready to come home and my sponsor and I had come up with this plan where I stay at my sister's, she's my safe zone. No contact with old friends or ex’s. I didn't do anything she suggested. When I went home I think the first thing I did was contact my ex. he brought my dog over. My sister's kids were so I ended up staying at my parents which I ended up using, so I'd used all over Christmas. It was December 27th, my best friend and my sponsorship family called me to wish me a Merry Christmas. I thought what we had was just a normal conversation. When I got off the phone probably less than five minutes later my sponsor called me and trying to walk me through my thought process.

I had my dog which meant I saw my ex, I was at my parents which is not a good place for me. She was trying to get me to realize all the decisions I was making weren’t necessarily the best ones. The last thing she said to me was---she worked the night shift as a security guard at a prison and she said “I don't have to work tonight. I don't know if you want to white knuckle your way through this situation, but if you don't I'll come and get you”. I was kind of just like “Okay you know I'll think about it. I'll call you back”.

When I hung up the phone it was at that moment that I realize that these people that I barely knew six months really wanted nothing but the best for me. I think that was my reality check. I ended up calling her back and I said “Come get me”. My sponsor and my best friend drove three and a half hours from Frederick up to Garrett County in the middle of a snow storm to pick me up and take me back home. That’s why I consider the 28th my clean date because I haven’t used since. I don’t drink, I pretty much don’t do anything.

Trials During Recovery

Throughout my early recovery and my first year or two I remember a period where it was around my first year clean and they say in the twelve step program that at your anniversaries you start going crazy. That's what I was experiencing. It was around my first year I had no idea why but I just wanted to mess things up. You know I knew I couldn't quit my job because I needed my job. I liked my friends so I didn't want to screw anything up with them.

I just couldn't come up with anything to ruin, but that's all I was thinking about because I was an addict. A lot of times my first thought is self-destruction especially when I can’t deal with feelings whether they be good or bad. I remember texting both my sponsor and my best friend and telling them that everything I was doing was reminding me of using.

My best friend sent me this long message of all of the things she knew about me through my active addiction, including you know the abusive ex's and going to jail and all that stuff. Then she sent me another message of everything that we had done in recovery and now. I'm saying your first year of recovery I lived more than I did in those twelve years of using even though I went all over the place, California, Nevada etc.. I still didn't really experience anything because I was never present in the movement. When she sent that to me she followed it up with “Think about those two and then tell me if you still want to use”. I was living with my sponsor at the time, I’d gotten home and she told me to get dressed and I didn't know why, she didn't tell me. She just tell me to get dressed.

I got dressed and my grand sponsor, which was her sponsor showed up and they took me to a baseball game and made me sit there. I sat at this baseball game and I cried. I cried and I cried and I cried and my grand sponsor's theory was always “When you don't know what to do you sit on your hands”. That's what I did. I just had to sit through it and here I am at the Frederick baseball game, everyone’s having a heyday and I'm bawling because honestly I don't know why.

Situations like that, like if they weren't there for me in those moments, if I were to allow my own thought process to continue I eventually would have came up with the idea of the best solution right now is to go use. I strongly agree that a social support, an emotional support, it is a key component of recovery, you cant do it alone. It’s a lot easier when you have people who understand what you've been through.

Sobriety & Stigma from the Medical Setting to Society.

I know for me sometimes it's tough with my health issue trying to talk to a doctor and being taken seriously. I'm a recovering addict and once they hear that, the word human being goes out the window. It's definitely tough and sometimes you've got to have thick skin because there are some pretty mean people that have a very closed mind and aren't very understanding. I kind of just smile and nod at those people. It’s been six years since I entered my first treatment center and in two days I'll graduate from college. That's crazy to me to think back to where I was.

Sharing Story to Impact Change

I remember when I went to MedX to speak on a panel session. Standing outside and seeing the big sign that said Stanford University and I just thought to myself “How did I get here?” I didn't understand it was so weird. I do attribute it a lot of this to Regina Holliday. If Regina hadn't brought me to Cinderblocks, if she wouldn't have asked me to share my story, all of these other people wouldn’t have heard it and I wouldn’t have had the opportunities that I've had over the past year. I remember when I told my family what was wrong with me, what was wrong with me being addicted to drugs at that time.

It was suggested to me by my counselor at the treatment center that I was at. I was an outpatient methadone treatment center. I gather my family together granted my family is well known in the community. My brother in the department of juvenile justice for 20 years. He’s the Cub Scout leader. Everybody knows my brother, both my sisters, one’s a teacher an elementary school teacher and the other one is a guidance counselor secretary. You could definitely say I was the black sheep of the family and I remember when I told them they didn't understand because they didn't know and they didn't know anything about it.

Public Health, Education & Addiction

If people were more educated about addiction, what causes it. The interactions, the pharmacology between the different substances. How they affect the brain. Just stepping outside of their shoes and trying to look at it from a different perspective I think that would have a huge impact on things. A lot of people feel shame and guilt because of their addiction and are embarrassed to talk about it. One of the doctors on the panel at MedX said it best, for years addicts have been lepers. That's what we are once you have that label there's no turning back. Again, when people don't have that in mind, the empathy or compassion to understand, they don't get it.

It’s a fruitless battle. I definitely feel that education, knowledge, understanding simple human being decency is needed. Nobody deserves to die no matter what they choose to do or chose to do it, I hear that a lot. “They chose to use so they deserve to die”. I can speak from experience that there were many times I used against my own will. I did want to be doing what I was doing but I knew physically I couldn’t go on without it because I was dependent on it. In our twelve step program we say “Drugs aren't the issue. Drugs are side effects of addiction”. Our real problem is the way that we think and the way that we feel and not being able to cope with those things. It's exhausting and it's long it does take a lot of motivation. I would say self-will but that's really nothing at all one has to deal with.

A Call for Resources in Rural Communities.

Whenever I was using in this small town I had no idea about resources because it wasn't something people talked about. I remember going to treatment and going to my first twelve step program and they're like “You’ve never been to a meeting before?” and I had no idea what a meeting was. I didn't have the resources here. The more we talk the more we bring it out and the more we bring it up, I think the quicker we can get past the stigma.

Get past the negativity of addiction and see it simply as what it is and that's a disease. Much like a diabetic who takes their insulin every day, an addict get a daily reprieve by simply choosing not to use and more often than not when the addict that chooses not to use is a miracle. Because everything in my being says use, use, use and every day that I choose not to do that is a miracle and nothing short of that.

Ashley Elliott is a recovering addict, patient advocate, psychology major, guest speaker at Medicine X and repeated speaker at Regina Holliday’s Cinderblocks5

Contact Ashley Elliott: Twitter

Rob F. | HIV Saved My Life; Living With Chronic Illnesses & Navigating The Public Health System

"The weirdest thing that you'll ever hear anybody say I'm going to say right now, HIV saved my life. Without that diagnosis I would have been unable and ineligible to get the help that I need to survive right now. Why does somebody with that list of diseases have to go to the very bottom of their lives to get any help at all" Rob F. 

Rob is a patient advocate living with type 2 diabetes, epilepsy, chronic asthma,  chronic environmental allergies, high blood pressure, a skin condition called ichthyosis and is also HIV positive.

I manage all these diseases with the help of medical assistance and I’m on SNAP. I have not had health insurance throughout life until I was diagnosed with HIV. Trying to get through those years prior to having insurance was a grind. I needed health care to hold the job, I needed to hold the job to get the insurance to get the health care. I was cycling through jobs every twenty days to eighty. I couldn't really keep anything. I tried my best to grind it out but I failed no matter what I did.
The weirdest thing that you'll ever hear anybody say I'm going to say right now, HIV saved my life. Without that diagnosis I would have been unable and ineligible to get the help that I need to survive right now. Why does somebody with that list of diseases have to go to the very bottom of their lives to get any help at all? Any one of these diseases can kill me. Diabetes is the most diabolical things I ever have to deal with because it involves changing your entire life. Without a disease that had a lobby, without a disease that had a high profile, I would be dead. It shouldn't be that.

Coping with Chronic Diseases on the Public Healthcare System

Coping with those diseases on the public health care system is really difficult because a lot of those disease have specialists. Those specialists even within the same hospital system like I have, rarely talk to each other. Giving information back and forth to them is difficult and also they don't understand exactly what's going on in each other’s care. It’s like learning how to juggle six halls but it's from six different people. They all teach you how to juggle one ball back and forth. They don't understand the interplay between all six.
In my case asthma which is treated with steroids; steroids will up your blood sugar. The higher blood sugar goes lower your immune system goes. That works with HIV and makes my skin dry, also the lithiasis makes my skin dry and plate off. I'm constantly itchy. I constantly have an open wound somewhere. My skin integrity is almost never 100% and I’m possibly fighting an infection.Recently I just spent a week in hospital on IV antibiotics and was discharged to two more weeks of more antibiotics. This happens to me sometimes 2-3 times a year. It's not like optimist infection.

Unemployment, Social Security & Disability

I'm not eligible for social security disability. I’ve tried 3 times. Makes it really hard to work and keep a job because I can’t keep a job long enough to get the insurance. To get the health care I need to keep a job. If I try to work I lose my health benefits. If I work the health benefits I get may not cover everything I need to have covered. Currently I spend retail, insurance covers about $100,000 worth of prescription drugs in a year for me. My HIV meds alone are almost $2,000-$3,000 a month.
If I were to afford that myself I would have to go straight from the unemployment to Google which is not going to happen. Fixing that really is almost fixing the entire system. Employment is difficult right now for me because of the doctors' appointments I have to keep. I was actually told in a job interview that they thought their job was not a priority for me, that I would be too busy in doctor's appointments to give them 100% of my time. Which is true I do enjoy breathing and walking on dirt and not being buried under it.
So they're right but I don't think it's a really good reason to keep me out of a job.  Trying to go back to school and get educated, is difficult to do monetarily, education is expensive. It rises faster than inflation. I have a hard time with attention. Sometimes balancing all these prescription drugs several of them say may cause drowsiness or dizziness and darned if they're not right. Sometimes I can sleep 10, 12, 13 hours a day.
I don't need to, I barely made it here (#Cinderblocks5) this morning but I do what I have to do. If not for love of a good woman and a good support group like here at CinderBlocks I would not make it. I feel like it's important to let people know that there are people like me out there in the world. They’re falling through the cracks. Between disability and unemployment and being eligible for things like food stamps and medical assistance. I was uninsured until I was 38. When I was 38 I was diagnosed with HIV.
Then I was worth helping, then I could get the medical assistance, then I could treat my diabetes, epilepsy and everything that came after. All of those things were being managed by me in patch-work. I knew they were there and a lot of times I just had to either ignore them or just live with the consequences. It has certainly made things harder now. I would love to have a low blood sugar, but testing supplies cost money insulin oddly is available over the counter but needles aren't; i.e you would have to find a doctor who would give you a prescription for needles and tell them “look I may not be able to come back for six months to a year please load me up”.
If I can find one who would do that, I would do that. But even then, maybe two to three doses a day, no long acting insulin. Trying to figure out how that works, kinda wrecked my life. I spent 20 years that way and if you can't get any traction, can't get anything moving, you find yourself where I’m at. You’re 45, you’re sick, you want to do more with your life but who wants a 45 year old straight white dude with no education? My time I feel like it’s passed. This story is all I have now. I will tell it to anyone that can benefit from it. This system needs to change!

Support System

Its hard to find a good support system. I don't have family that I can rely on. I was an unwanted child. I survived an abortion attempt. I was born 1/20/1973, Rode V. Wade was passed 1/23/1973. My mother told me “3 Damn days” for most of my life. I had to look it up to find out what she meant. She tried to abort me. I have a scar on my forehead, that lit up like a Christmas tree during my first MRI procedure and that's because there were metal fragments in my forehead. She tried to hang me.
I can't trust my family, there's really nobody there. I have drifted in and out of relationships, places to be, and places to go. I finally found one good woman. She from England, her name is Victoria, she just graduated nursing school and she saw the good in me nobody else could. She plucked me out of a gutter 10 years ago, took care of me, made sure I took care of myself, that I was okay, helped me through my diagnosis period. Helped me get back to the doctor. Helped me realize that it was worth it.
Regina Holliday and The Walking Gallery
Four years ago, my friend Regina Holliday reached out to me and let me know that she had an advocacy group going, for patients by patients. She thought my story was worth telling. I came, I took part in a panel and something inside of me just let loose, I spilt my guts in front a room full of people. Most of my family, friends, don’t know anything about what I’m going through but it was received well. Regina kept asking me to come back and tell my story. I’ve try to find different avenues, tacts, ways that it affects me because I feel like I’m presenting in front of all of these talented wonderful people that are changing the world and I can’t even change my own life.
I’m an advocate for this patient. I wish I can be an advocate for more people in my position but I feel like I don't have much credibility of standing to help those people. That's what the world tells me. Without Cinderblocks, without these people behind me, letting me know that I’m important enough to be listened to, be heard, be interacted with I probably wouldn't have made it through the last 4-5 years.

Health Politics & Patient Advocacy

We’re in an age right now where healthcare is a big issue, drug prices are a big issue. Its a political issue now. Half of the politicians just see me as an easy vote. I vote for them or the other half will demonize me, call me a lazy and take away my benefits. Non of them address my issues. Non of them will help me, others like me or people who watching/reading this, with affordable healthcare affordable drug prices, and matching the world in efficacy of treatment.
We spend the most, over 3 trillion dollars a year in healthcare, we’re not even top 10 in results. We’re definitely not one of the happiest places to live. It's almost like justice in this country, you can have as much as you can afford. The only way that can change is for people like me, and the people here at Cinderblocks people like Regina, people like you watching/reading, to stand up and to tell your story and to tell what needs to be done in your own life and how that can be done for you. The more that we know about what's going on the more people may be motivated to try to change it.