For individuals and families who were already struggling, the pandemic has only made things worse. Financial hardships and increased food insecurity and housing insecurity, among other stressors, have led to higher rates of physical, and mental health concerns. Harvard-affiliated Boston Children’s Hospital and the Veterans Health Administration (VA) both offer innovative programs that address these and other drivers of whole health.
Connecting Families to Resources
Among the 22,000 children and youth served by Boston Children’s primary care, about 70% are insured through Medicaid, which indicates a high degree of socio-economic instability. When a parent or caregiver brings a child for a well-child visit, clinicians routinely gauge how well the child and family’s everyday needs are being met. For example, Boston Children’s primary care providers routinely screen parents and caregivers to determine if families have enough food, can pay rent, have secure childcare and transportation, and can access other essential resources. Through a combination of hospital funding and philanthropic support, families receive help meeting urgent needs, including diapers, formula, cooking supplies, clothing, and grocery store gift cards, as well as medication copays, if needed.
Primary care providers, as well as other leaders and advocates within the health system, also step in to look more holistically at the factors that impact the health of every child, including social and behavioral drivers, and they try to address any gaps they identify. They also connect families to a network of resources outside of the traditional health system, including community organizations and services that can provide long-term access to support related to food, housing, jobs, transportation, and childcare, so children and families can have the resources they need to thrive.
“In order for children and families to live happy, healthy, and active lives, we need to recognize and consider the health-related social needs of our families and the significant role we play as pediatric providers to be part of finding solutions,” explained Shari Nethersole, MD, Vice President of Community Health and Engagement at Boston Children’s.
Although no formal data currently exist to show the full impact of these efforts, healthcare professionals, social workers, and other care providers affiliated with the system see the benefits firsthand, including improved health and reduced stress, in families that receive assistance.
Rethinking Care in a Comprehensive Way
The Veterans Health Administration (VA) takes a similar approach with the 6 million veterans they serve, going beyond strictly clinical needs to identify and respond to other stressors. They do this through a comprehensive Whole Health initiative that is currently operating at 18 VA flagship health centers located throughout the country.
The VA system’s whole-health approach grew out of the recognition that the traditional healthcare system wasn’t built to meet all the needs that impact people’s health, many of which (like access to food, employment, and housing) occur outside of the traditional healthcare setting. “The national healthcare system and the VA have done a really good job with disease-oriented care, but that care is very fragmented,” said Benjamin Kligler, MD, MPH, Executive Director of the Office of Patient Centered Care & Cultural Transformation for the VA. He pointed out that in the traditional care model people typically must go from one type of doctor to another for different ailments. The VA Whole Health program focuses on the veteran’s needs and preferences—not just medical symptoms—and engages in a partnership to address what matters most to the veteran.
The program offers peer support groups; online classes in nutrition, cooking, or exercise; and health coaches who can focus on goals like improved diet or more exercise.
“There is no cookie cutter model in the VA’s Whole Health initiative. The concept is that the care is developed for each individual,” Kligler added.
Treating Veterans with a Whole-Health Approach
VA clinicians ask the individuals they treat if they have enough food, a job, transportation, and housing. VA social workers step in as needed, to connect people in need to services that can help support their overall health and wellbeing.
This is an important way to address social drivers of health and ensure everyone has all the resources they need to stay well, according to Klinger. He says that approximately 500,000 people in the VA system used the Whole Health program in 2021, and engagement has continued to grow.
Early research reveals that the whole health approach is paying off for veterans. While it’s still too soon to know the full impact of this program, Kligler said recently published data show veterans in the Whole Health program are more satisfied with their care. They are also likely to recommend Whole Health to their peers.
This approach may also be cost effective; preliminary data reveal that people with back pain who engage in the VA’s Whole Health offerings are less likely to need expensive surgery, injections, or other procedures. There is also a decrease in opioid use among people with pain who use whole health services.
These findings speak to the value the rest of the health system may realize by adapting the VA’s model. Kligler points out that clinicians (including primary care doctors, specialists, and behavioral health providers) in any setting have a valuable opportunity to improve an individual’s whole health. But they also need support from other health system stakeholders, including payers, to achieve meaningful results. Kligler directs groups interested in this approach to the VA Whole Health website to access professional resources, trainings materials, and a Whole Health Library that are available at no cost and may be used by non-VA providers. This can guide their efforts to provide comprehensive care that is tailored to meet the unique needs of each individual.