Islands of Common Stewardship – TLC/Dartmouth/ReThink Health UCRV/Schweitzer Fellowship/RCP

Posted on | September 12, 2016 | 2 Comments

Mike Magee

A little over a year ago, I made a quick trip to Washington – one day, back and forth, from Hartford, CT. I was there to seek advice from an old friend, Fitzhugh Mullins, as we completed planning for the second decade of the Rocking Chair Project. This early childhood intervention program targets young, economically disadvantaged, expectant mothers, supporting them with a health professional-led home visit which includes the gift of a upholstered glider rocking chair and ottoman as a “gift of nurturing” for both mother and child. The visits, repeated over 1000 times in the past 10 years, include reinforcement of healthy messages, nurturing, and emphasize long term continuity with the health care system.

We had been relying on individual 2nd year Family Medicine residents around the country to identify the target moms, and to follow through with these “high-touch” visits. The challenge now was how best to scale up to the general population of economically disadvantaged families.

Our lead adviser, Yale Professor Emeritus, Ed Zigler (Father of Head Start), told us a long time ago that the intervention was so low cost and powerful, tapping into two critical social networks (Medicine and Family), that it should be offered to entire populations, not just a lucky few individual patients.

Fitz summed up the challenge immediately. He said we were seeking a vertically integrated network with existing distribution channels. In other words, a well organized, efficient, and financially sustainable system that had the ability to identify the target population prenatally, and already was accustomed to making home visits in the immediate postnatal period.

Our next stop was Hanover, NH, to garner the advise from another old friend from the Chick Koop days, Joe O’Donnell, Senior Advising Dean and Director of Community Programs at the Dartmouth Geisel School of Medicine. Joe is a brilliant and empathetic clinician, and within weeks we were introduced to Steve Voight, Executive Director of ReThink Health – Upper Connecticut River Valley. ReThink Health focuses on healthy collaboration and meaningful disruption. In their words, “We spur big-picture thinking that allows leaders to step outside their own frames of reference. This lets them better see how the various parts of the system interact in unexpected ways and determine how and where they can exert influence. We do this by deeply understanding their challenges, listening to diverse voices, and working together to harness the information, insights, and actions needed to overcome entrenched beliefs and disrupt the status quo.”

Steve’s regional organization has focused on two counties in New Hampshire and two counties in Vermont. Through their active and inclusive planning process, they have identified many of the challenges and opportunities, and the key personalities and health service organizations. One of those organizations was the TLC Family Resource Center in Claremont, NH. Joe and Steve introduced us to Executive Director, Maggie Monroe-Cassel, and Clinical Supervisor, Melony Williams. Several meetings later, we committed to working with each other.

We defined four separate goals for the collaboration:

1. To expand the recruitment of eligible expectant moms (with a special focus on teens) into existing TLC comprehensive health programs. The primary strategy is to offer the high quality RCP glider chair and ottoman, assembled in a home visit, to eligible moms, who agree to a comprehensive pre-natal TLC intake interview and to one follow-up home visit.

2. To create a high impact experience, through the RCP visit, which will enhance the relationship between the moms and families and the TLC health professionals, and aid therefore in long-term retention.

3. To include highly motivated, and well-trained, carefully selected medical students from Dartmouth Geisel School of Medicine, and positively impact the formative training of humanistic medical students with a focus on empathy and community service.

4. To reinforce inclusiveness of mothers and family as part of the team and positively impact the future trajectory of family members and child.

The collaboration, launched on Mother’s Day, May 8, 2016, received an immediate boost when two Dartmouth Medical Students, Emily Johnson and Kristen Delwiche, who Joe had been mentoring, applied for and were granted a Schweitzer Fellowship focused on supporting our new home visit collaborative.

Kristen Delwiche

Emily Johnson

Where are we now? We are 5 months into the program. TLC recruitment of new moms into their programs has increased. They have already completed four Rocking Chair Project home visits, and have four new arrivals scheduled for births in the immediate future. The TLC professionals and medical students have blended well professionally. All say the experience has been rewarding. They have gained fresh insights into the home-based needs of economically disadvantaged families, and see important benefits of participation in team based approaches to care.

On every level, we are capturing insights to share and communicate with others in the future. For example, TLCs Melony Williams is presenting our program this October at the Healthy Families America (HFA) 2016 National Conference For America’s Families. Our two Schweitzer Fellows post monthly updates and will be preparing a summary paper in the future. ReTHINK HEALTH: UCRV is preparing a blog post of our progress together, which in turn will be shared with the national ReTHINK HEALTH program. And Dartmouth is planning a Grand Rounds on our collaboration.

For a health care system which has been historically silo’d, segmented and professionally segregated, the disruptive work of collaboration doesn’t just happen. We need projects and challenges that bring us together and simultaneously unite us with patients and families in their settings and on their terms. Judging at least from this one project so far, our gliding rocking chair is much more than a piece of furniture. It is a vehicle capable of bringing us together; strong enough to support the weight of widely differing professional points of view; and comforting enough to calm and encourage beleaguered families while reinforcing empathetic professionalism which is so often in short supply.

Will this model – uniting the Rocking Chair Project with regional home visitation family services, regional health promoters, health professional schools and students – be scalable? Only time will tell. But this much is already clear, when communities collaborate in caring ventures, those who give gain at least as much as those who receive.

Comments

2 Responses to “Islands of Common Stewardship – TLC/Dartmouth/ReThink Health UCRV/Schweitzer Fellowship/RCP”

Dan Ostergaard
September 12th, 2016 @ 5:43 pm

Thanks Mike for the exciting update to your Rocking Chair Project! I was impressed with it when you launched it, and hope it can still be utilized by FM residents.
Cheers, Dan Ostergaard
PS Fitz always has an idea which makes something good better!
Mike Magee
September 13th, 2016 @ 9:14 am

Dan-
As always, thanks for your encouragement and support. You and Doug were so instrumental in those early days of the Rocking Chair Project. And thanks to program directors like Todd Shaffer at UMKC thousands of moms have benefitted from a Family Medicine home visit and this unique expression of nurturing. The work now is focused on extending rather than replacing. As always, we welcome and value your continued help in spreading the reach of the RCP.
Best, Mike