The movement to transform the country’s health care delivery system has been underway for several years now, and some moments of truth are approaching. The ultimate success of this monumental effort to improve the way we pay for and deliver care will be measured not only by cost savings, but also by how well payment reform results in better health outcomes and a value-based system that delivers genuinely person-centered care.
The Health Care Transformation Task Force—a unique private-sector, multi-stakeholder group whose 42 members represent six of the nation’s top 15 health systems, four of the top 25 health insurers, and leading national organizations representing employers and patients and their families—has been at the forefront of helping to accelerate the pace of this transformation. As part of our efforts to transition our health care system toward value-based payment, we strongly support ensuring that new models of payment promote a person-centered care system that improves the care experience for patients and family caregivers. We believe that, to do this, patients and consumers must be engaged as partners at all levels of care and care design including the building of alternative payment models.
Genuine partnership is essential to the success of health care payment reform overall and to the ability of individual health care entities to make sustainable progress in their journey from fee-for-service to value-based payment. Patients and consumers have unique experiences and perspectives that are essential to consider as we build a system that meets diverse patient needs and enables them to engage effectively in care and health. Ultimately, consumer engagement will be essential to improving outcomes and care, reducing costs, and increasing health equity.
To support health care organizations engaged in transforming how they develop and deliver value-driven care that is person-centered, the Task Force brought together its diverse members to create a new consensus framework: Addressing Consumer Priorities in Value-Driven Care: Guiding Principles and Key Questions. Our new framework is premised on the simple idea that, to realize the goals of payment reform and delivery system transformation, a person-centered (often referred to as patient- and family-centered) focus and authentic partnership with consumers and patients must guide all aspects of delivery reform:
While this concept is straightforward, it is often at odds with deeply entrenched attitudes and today’s dominant paradigm about the role of patients in health care.
Operationalizing authentic partnership can be a significant challenge requiring action and buy-in from many different stakeholders in health care. Gaining input from these stakeholders on how this can be achieved can be a challenge in its own right. The Task Force leveraged its unique, broad-based membership to develop this consensus framework to advance understanding of authentic partnership and what it means to be a person-centered care delivery organization.
Despite often good intentions, there is still great confusion about what it means for a system to be person-centered and, of course, there is no “one-size-fits-all” formula for getting there. We developed this action-oriented framework to help health care organizations assess current practices and develop new thinking and strategies about how to partner with patients and consumers and, in turn, deliver care that is truly person-centered. Task Force members are committed to using this framework as a starting point for their own efforts, and we urge others to follow suit.
The framework provides a set of building blocks organizations can use depending on where they are in the journey toward authentic partnership and person-centered care. Building blocks range from articulating a vision to identifying practices and tools to implement and evaluate progress.
The framework blends the perspectives of four key stakeholder groups that together represent the care delivery spectrum:
We reached consensus on the following definition:
A person-centered, value-driven health system provides safe, effective, personalized, affordable, and high-quality health care services that meet the needs of individual consumers as well as those who support their care, including family, friends, patient-authorized caregivers, and community service providers.
This definition provides overarching direction for organizations that are striving to deliver person-centered care.
In addition, the Task Force considered how best to engage patients/consumers in taking shared responsibility for their health and care. We converged on the idea that a person-centric, value-driven health system provides both patients and their caregivers meaningful and effective ways to share in decision-making and care-planning at each point in the process.
The Task Force used these consensus definitions of person-centered care and shared responsibility to develop guiding principles coupled with granular questions designed to help health care organizations consider important opportunities and benchmarks for fostering partnership and achieving a value-based care model that is person-centered.
This principles-based framework is action-oriented and designed to be a hands-on tool that facilitates change. It provides six guiding principles accompanied by operational questions to aid a health care organization in becoming more person-centered. Organizational leaders can use these questions to identify concrete ways to foster partnership, set benchmarks, and evaluate progress toward integration of the principles into their organization’s culture and transformation to value-based, person-centered care.
The principles and accompanying questions are available online and outlined below.
Are patients/consumers included as integral partners in all aspects of health care decision-making at every level, from system-level reform and design to point-of-care decisions?
Are patients/consumers and those who support them at the center of the care team?
Do APMs achieve cost-saving only through improvements in health and health care and do they ensure beneficiary rights and protections?
Do the health care transformation policies and practices generate meaningful feedback and information; do they drive continuous quality improvement?
Do alternative payment and care delivery models accelerate the effective use of person-centered health information technology (Health IT)? Do they enable people to better participate in their care and manage their health?
Does the health care delivery system and payment reform model promote health equity and seek to reduce disparities in access to care and in health outcomes for all?
Task Force members encourage industry leaders to consider all six principles as they develop and implement value-based care. The accompanying questions offer potential inquiries for organizations to consider as they design, implement, and assess value-based payment and care delivery models.
We hope and expect that the Task Force’s consensus framework will make a significant contribution toward advancing a person-centered, value-based care system, but we also recognize that it is only a start.
We encourage dialogue at health systems across the country and look forward to feedback as this framework is used. The Task Force members are committed to ongoing learning, to refining this consensus framework, and to offering additional guidance in the months and years ahead as we collectively work to shape a health care system that is value-based and person-centered and that delivers on the Triple Aim.
The authors are members of the Task Force’s Executive Committee and represent organizations from each of the four key membership constituencies. The authors recognize and appreciate the work of the Task Force’s Advisory Group for Consumer Priorities in developing this consensus framework.
September is I Stand with Kids Month
First Witness spends each day engaging the community in efforts to make our community a safe place for children to grow and thrive. This is our fourth year for individuals and businesses to come together and show that We All Stand with Kids. By sponsoring a blue kid, your donation goes directly to our Safe and Strong Child© Program. This program is a prevention/awareness curriculum. Each year, we do classroom presentations in the Duluth Public Schools and surrounding areas. This program is underfunded yet we work in collaboration with school districts to still offer the best prevention education. Why? Because it is too important not to. The curriculum is presented to children, parents and teachers so that everyone is being given the same information and all have an opportunity for questions. We started this campaign to help cover the costs of providing the Safe and Strong Child© program.
October 01, 2016 – I Stand with Kids Day!
This is the day at the end of the campaign where we celebrate our hard work raising money and awareness. We will display all the blue kids that were sponsored throughout the month and have food, games and other activities for all families! The event will be at Harrison Park on Saturday from 1PM – 3PM.
What are Blue Kids and why are they blue?
The blue kids are figurines cut out from wood, the size of a typical lawn sign. The figure is of two children. The color is blue because blue is the color of Child Abuse Awareness and Prevention. We put whatever names or picture you want (some can be funny, none can be degrading or obscene) on your figurine and we will display them at Harrison Park on I Stand with Kids day on October 1, 2016.
Personalize your blue kid(s):
You can put your name, your family name or picture on them! Buy one for each of your children or grand children, better yet…buy one for each member of your family! If you are a business or nonprofit, the more you buy the more blue kids will brighten the event at Harrison Park and inspire our community.
Super America’s are selling “mini blue kids”or $1 in their stores for the entire month.The stores have been competing to sell the most and in some, have covered the inside of their stores in years previous. Mike Letica, General Manager of Curtis Oil Super America’s, says “we are proud to support First Witness and the work they do again this year, the store employees really get into it and enjoy outselling others because they know they are raising money to help kids”.
“Community Matters” – SPECIAL EDITION – “Policing by Consent Decree” ~~ On June 15, 2001, following a number of scandals in the ’90s, the Department of Justice put LAPD under a Civil Rights ‘Consent Decree’ giving the DOJ control over the Department. There were significant accomplishments over the first four years, but it eventually took almost four more to institutionalize the required police reforms. A commitment to community-based policing was emphasized, as was revised police training and changes in the areas of integrity, use of force, duty to report misconduct, and critical incident management. LAPD preached that its officers cared about the community, and would do their job appropriately and in partnership with the community in the future. But many American police agencies still struggle with ‘doing it right’ and will benefit from oversight and moitoring by Justice Department officials. ~~ Bill Murray, our host, is also the well-respected community voice of public safety, violence prevention and a leader in anti-child abuse and trauma efforts. He’s the founder of both LA Community Policing (LACP.org) and the National Association of Adult Survivors of Child Abuse (NAASCA.org). ~~ “Where is the UNITY in ‘community’ these days?,” Bill asks. “Unless we can learn to set aside our differences and start paying attention to how shockingly similar our experiences, feelings and actions are we’ll not make progress.” CHECK OUT the new Facebook page at: www.Facebook.com/LACP.org
Widows in many African cultures are subjected to dehumanizing cultural and ritual practices passed off as mourning rites—practices, it must be noted, that widowers are rarely ever put through.
In Kenya, Tanzania, Zambia, Zimbabwe and Malawi, widows must undertake a requisite cleansing. It basically entails a widow having unprotected sex with her husband’s brother or other relative, or with a professional village cleanser to remove the impurities that have been ascribed to her. It’s done before widow is taken in marriage by the brother or the other relative of her deceased husband. In Kenyan tradition, it isn’t just after their husband’s death that they’re expected to go through this, cleansing is also expected preceding specific agricultural activities, building homes or making repairs to them, funerals and some other significant cultural and social events. It’s intended to provide protection for the widow, her children and the whole village. Failure to perform this rite leads to ostracism. Widow cleansing has been strongly linked to the spread of HIV/AIDs in these countries.
In the South-Eastern part of Nigeria, widows go through a period of confinement—ranging from 8 days to 4 months—beginning when the husband’s death is discovered. In this period, the widow is not allowed to leave her room and her hair is completely shaved. She is expected to sit on the floor and wail at the top of her lungs every morning and is not allowed to take a bath or change her clothes till the body of the deceased is buried.
It’s almost impossible to separate death from witchcraft in most West African cultures. There is a presumption that his wife murdered her husband, especially when the death occurred in middle or young age. In order to prove her innocence, the widow is made to drink the water used in washing the corpse. In some cultural variations, she is also made to sleep beside the corpse for some days. The logic is this: If she dies after doing all this, she is guilty. Refusal to comply is tantamount to a confession of murder, for which she must be punished.
One of the last stages of the Igbo culture’s widowhood rites is called Aja-Ani. It is essentially widow rape. At midnight, some days after her husband’s funeral, the widow is expected to go out escorted by an Aja ani—priest—or Nwa nri—dwarf—to a place where he is supposed to perform a ritual for her. The widow is expected to engage in sexual intercourse with the priest or dwarf. Her consent is immaterial. The community and dead husband’s family insist on her rape. After this, some of the Umuada±patrilineal sisters—escort her to a stream where she washes before returning home. It is done to severe her links with her dead husband for it is believed that any man who tries to sleep with her before it’s performance will die.
Economically, these widows are left impoverished. In some of the major Nigerian cultures, widows aren’t allowed to inherit property. They are seen as chattel and part of their husband’s estate. Upon his death, his property is usually forcefully acquired by his family, leaving the widow and children to fend for themselves.
Similarly, in the matrileaneal society of the Ashanti in Ghana, the properties of the deceased are inherited by his sisters’ sons or nephews. Among the patrilineal societies of the Anlos and Gonjas in Ghana, male relatives of the deceased inherit his property. The widow can only benefit from it if she has a grown male child, or she marries one of her husband’s brothers. In the Baule society of Cote d’ivoire, the widow must return to her family after the period of mourning, along with her young children. She gets nothing of her husband’s property.
This same principle applies to widows in Kampala, Uganda and in Cameroon. Seeking court redress on inheritance issues is slowly on the rise. But as it is right now, only a handful of people can afford to institute and maintain court actions.
Why don’t the widows out-rightly refuse to partake in these rites? The societies examined above, and indeed most others, are inherently patriarchal and traditionally against the economic independence of women. Most of the women have grown up believing that there’s nothing they can or should do to escape these customs. Some want to but can’t because they do not have the financial resources to uproot their lives—and that of their children if they have any—and leave the community.
Widows across Africa are treated as sub-human. Their fundamental human rights are constantly violated. The mental and physical health effects of these rites on widows are indescribable—but it’s important that we note their social and economic realities. We must observe the impact of these customs in order to define a fight against them moving forward.
At Darkness to Light, we’re in the business of preparing adults to shelter children from sexual abuse. But daily we also remember and embrace that we exist under a much wider tent of child wellbeing, which takes so many forms:
We know that protection from sexual abuse is simply one tent pole under the canopy of wellbeing – and we hold down that one down expertly. And in that role, we call particular attention to the dangers of childhood and how to mitigate them. Yes freedom from danger is fundamental to a child’s wellbeing. But there is so much more to a happy and healthy childhood.
Recently this article circulated around the office and it really captured our interest. The article is entitled, “Why Do We Judge Parents for Putting Kids at Perceived – But Unreal – Risk?” In short, the researchers featured in the article found that as a culture we’ve been through a radical, extremely rapid, and probably unintentional social change when it comes to leaving children ‘unattended.’ The article opens like this:
|“Many parents who grew up playing outdoors with friends, walking alone to the park or to school, and enjoying other moments of independent play are now raising children in a world with very different norms.
In the United States today, leaving children unsupervised is grounds for moral outrage and can lead to criminal charges.
Many of us would answer that question by saying that what was safe in the past may be unsafe today, and so children are genuinely in greater danger. But the author points out that, “…for the most part, the data don’t support this. Statistics from the National Crime Victimization Survey, for example, suggest that violent crime rates have decreased since the 1970s (and not only when it comes to children….).” And with reasonable certainty we know that even child sexual abuse rates have decreased in the last decade or two.
Instead of actual risk, the researchers believe that something called ‘the availability heuristic’ has played a significant role in the social change. The way it works is this: The easier it is for you to think of an example of something happening, the more frequently you think that thing happens. Take that in for a moment. When you can easily think of an example of danger to a child, you think that danger happens frequently.
“Take the example of child abduction by strangers. It’s actually incredibly rare. But when it occasionally happens, it is covered on the news 24/7. Intellectually, we know these are rare events, but they really scare us. It’s as if we’re seeing people we know get abducted and murdered, or sold into the sex trade or whatever, all the time. So we hugely overestimate the actual risk of that happening.”
The researchers show that in the wake of this perceived increased danger to children, the social norm against leaving children alone has emerged. And because the norm has changed, we have become remarkably judgmental of parents who leave their children unattended. Parents then, knowing this judgment is out there, and probably having ingested ‘the availability heuristic’ as well, are more and more reluctant to leave their children unsupervised.
The article has a tremendous depth and interest that I will not cover here, and I highly recommend it. What I want to talk about is the loss of self-efficacy in children that is potentially caused by this shift in social norms.
It pains me beyond description to think that as awareness of the prevalence of child sexual abuse grows in our culture, an unintended byproduct could be the loss of self-efficacy in children. Self-efficacy in children is the very reason I got into the business of prevention in the first place! In fact, child sexual abuse itself can cause a loss of self-efficacy. To think that the solution (growing awareness of CSA) could have the unintended consequence of shrinking self-efficacy is unacceptable to me.
Let’s unpack it.
At its core, self-efficacy is about self-esteem. It is a person’s belief in his or her own ability to succeed in a particular situation. Self-efficacy has less to do with concrete preparation for a task and more about one’s feelings about oneself as inherently capable. It is a core belief in having the power to achieve one’s personal goals by one’s own actions. People who have it are more motivated and have more full-engagement with their task. They will take multiple paths toward their goals. They relate to obstacles as challenges. They persist even in times of difficulty. People with self-efficacy believe that in the end they will be successful. They’ve got moxie.
And here’s the thing. Much of our self-efficacy is developed during childhood. And what does that have to do with being left ‘unattended’?
Children who are rarely left alone generally have less opportunity to act independently, to solve problems with the perception that they’ve done so through their own creativity, to develop a sense of self-generated empowerment. Children who are rarely left alone have less opportunity to take independent personal risks.
I asked some friends to tell me their top of mind memories of developmental, watershed moments for their children. Distinct times when their child grew. Here are their examples:
What do these milestone stories have in common? In each, the child took an independent personal risk. They did something they had never done before, independently. Yes, maybe they had support and coaching from someone nearby, but in that pivotal moment they had to step out on their own and act. A risk is an action we’ve never taken before that has an unknown outcome, but which once taken builds self-esteem and belief in oneself. Taking personal risks builds self-efficacy. Taking risks during childhood are the building blocks of confidence and really, self-love.
No I am not advocating for child abandonment, leaving small children alone, or flinging our children to the wolves. But I am reminded about mindfulness and discernment. That our fears, often engendered by the media and others judgments, would not cause us to create conditions in which our children cannot act independently, take healthy risks, and grow.
And I am reminded of the 5 Steps to Protecting Our Children™. Interestingly, none of them say, “don’t leave children unsupervised,” or “curtail a child’s opportunity for risk.”
In fact, child sexual abuse prevention is about creating self-efficacy in children. Because a child who is confident, who trusts herself, and who’s got moxie is often a safer child.
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Paula Sellars is Executive Vice President of Phoenix Possibilities Inc., a company that fosters social change and leadership through the skills of personal risk. Formerly a family therapist and cranio-sacral therapist, Paula specialized in family systems, adolescence, and trauma recovery. She designed and executed program content for an adolescent day treatment center, worked in supervisory capacities inpatient and outpatient psychiatric settings, and has worked extensively with families with sexual abuse dynamics. Paula is the author of Darkness to Light’s Stewards of Children®, a child sexual abuse prevention Docutraining® that uses consciousness training to effect behavior change. As a consciousness trainer with Phoenix Possibilities, Paula teaches the Cliff Jumping® Program and other leadership development programs for individuals, couples, and organizational groups. As a social change agent, she weaves her knowledge of the Enneagram, Spiral Dynamics and the Cliff Jumping Program to move communities to action. She is also a Oneness Blessing Giver through Oneness University in Chennai, India. Paula inspires vitality, spiritual connection, integrity and personal fulfillment.
Students excel when they feel both welcomed and supported. At Camino Nuevo Charter Academy (CNCA), we believe that quality schooling is dependent upon quality relationships with students and families. This philosophy creates a space to better serve our community in a socially just way.
That’s why CNCA created and sustained an educational model that uses the per-pupil funding that we receive from the state to support strategic resources like full-time mental health practitioners and professional development for teachers and administrators on trauma-sensitive instruction. We also conduct home visits and teach ethnic studies as part of the curriculum to both affirm our relationships with students and to assist them in navigating life circumstances. We’ve found that these types of school climate investments help our students redirect energy to learning and it shows in their academic performance.
For example, the CNCA Cisneros Campus enrolls a high percentage of students living in transitional housing and foster youth. The lives of these students are challenging, at best, and these challenges can sometimes present themselves within the school environment. When challenges arise that might harm the learning community, we begin a restorative justice process by understanding what happened, who was affected, and how we might resolve the situation in a non-punitive manner.
We confer with those involved individually before the larger community of students, families, and school staff are convened in a “healing circle”. The healing circle provides the group a space to share how they were affected and to collectively decide how to respond to the incident. Healing and justice emerge from this community – fully supported and facilitated by our staff.
When reflecting about the restorative justice approach at Cisneros, one parent shared, “I’m thankful that my child had an opportunity to go through this process. We all make mistakes in life and, although this was a really big one, this experience helped my son.”
Between 2012 and 2016, the Cisneros student suspension rate decreased from 5.3 percent to 1.4 percent as we moved away from punitive responses to student behavior and toward restorative interventions.
Supportive school environments understand the difficulty students and educators face when trying to separate that which occurs within the school from the stressors and uncertainties that envelope their lives when school is not in session. The use of restorative justice practices and other supports has been integral to CNCA’s ability to create a high-quality school environment that provides both students and teachers the conditions they need to thrive. It is through these conditions of mutual trust and respect that CNCA creates a space that allows for deeper levels of teaching and learning.
Randell Erving is Camino Nuevo Charter Academy’ School Culture Specialist.