Mental Health: There’s an App for That

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myStrength Mobile App Extends Treatment 24/7

Mary is a single parent who works hard to support herself and her two children, ages 4 and 7. In addition to her work at a bank, she attends church, visits her parents when she can, and tries to keep herself fit through exercise and diet. She dates on occasion and has friends she tries to see once in awhile.

Mary also experiences episodes of depression and anxiety. For the past two years she has been in recovery from alcohol addiction. It has been difficult to attend her Alcoholics Anonymous meetings and see her therapist on any regular basis, but she does the best she can.  She would like to see her therapist more often, but just can’t find the time.  

According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB) an estimated 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness. In the past year, 20.2 million adults (8.4%) had a substance use disorder. Of these, 7.9 million people had both a mental disorder and substance use disorder, also known as co-occurring mental and substance use disorders.

Today Mary is feeling particularly tense and worried. She knows she tends to overreact and worry more than she needs to, but once she starts thinking about all of the things going on and what might go wrong she can’t seem to turn it off. She has been doing pretty good, and is proud of her progress and recovery from addiction. Since she stopped drinking and started therapy, her life is no longer in chaos. Still, she struggles with managing her mood and anxiety.

Mary takes out her smartphone and opens her myStrength app. She has already set the app up with shortcuts to helpful videos and tools that have been tailored to her own personal issues and challenges. She quickly pulls up the video she wants on reducing worry. Take a deep breath, focus on the here and now, interrupt the internal chattering, relax. The video helps guide Mary on the steps to take to relax and focus.

She reviews some of the things that she and her therapist have been working on. The app has been set up to remind her of how to manage her feelings and racing thoughts.  It is really helpful to have something to look at and not just try to remember everything talked about in her therapy sessions, especially when her anxiety seems to take over.

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According to Monitor On Psychology (November, 2016), there are more than 165,000 health-related apps worldwide, helping users track their diet and exercise, monitor their moods, and even manage chronic diseases. Nearly 30 percent of these apps are dedicated to mental health (Novotney, 2016).

In May of this year Aspire made the web-based myStrength program and the mobile app version available to all of its employees. Clients with substance use disorders (SUD) were also provided access to both the web-based and smartphone versions. Starting this November ALL clients at Aspire are now able to sign up for myStrength at no charge.

myStrength provides videos, motivational content, brief articles, and many other tools for working on issues related to depression, anxiety, emotional trauma, and substance abuse. Information on topics ranging from anger management, parenting,  PTSD, and the effects of different drugs is now available at the client’s fingertips.

Some of the tools ask a client to rate feelings, put in thoughts, create action plans, and monitor their successes. In this way, myStrength becomes a very individualized and personal tool.

The information a client shares in myStrength is absolutely confidential. Aspire does not collect any personal information entered into myStrength. While Aspire does track aggregate data on total number of clients using myStrength and on what problem areas seem to interest clients the most, no individual or personal information is tracked or traced to a specific person. This is true for employees as well.

In addition to the personal benefits of using myStrength, Aspire therapists, care coordinators, recovery coaches, and life skill trainers are discovering how myStrength can be a useful tool in “extending” the impact of treatment. While not a direct connection to the therapist (like a chat line or e-mail/messenger service), using myStrength helps keep the client connected to the focus of treatment and provides important motivation for success.

This extension of therapy means that at any time a client can simply log in to get personally tailored information and numerous tools directly related to their therapy goals. It provides coaching, reminders, and a library of information…. all in their pocket.

U.S. smartphone penetration is now approaching 80% and shows signs of slowing growth as the market nears saturation—since 2013, the rate has gone from 65% to 75% in 2014 and 79% in 2015. More than 93% of 18-34 year-olds have smartphones now, and more than 58% of those older than 55 have smartphones. We’ll probably never see smartphone penetration reach 100% due to socioeconomic, technological and cultural issues. DigitalGov, April 2016.

If a client does not have a smartphone or computer they can use a computer while in a session at Aspire. The clinician can work with the client to identify relevant content and print information to take home.

Aspire is continually looking for ways to enhance treatment and better serve an ever-increasing client population. myStrength is a tool that does both.

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About the Author:  Dan Brown is the Lead Clinician of Addiction Services at Aspire Indiana’s Outpatient Services office in Carmel, Indiana. 
Learn more about Aspire Indiana on our website or on Facebook

 

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How do we face addiction?

Aspire is actively participating in a project with Ball State University entitled, “Facing Addiction”.  The objective of the partnership is to strengthen communities through the stories of people.  What stories would the people who face addiction every day have to tell?  I think they will say that they feel shame and guilt and stuck with their addiction.  I think they will say that there are not enough resources for them and that they are tired of feeling sick and tired.  I think they will say they are terrified and angry and sometimes feel hopeless.  As treatment providers, we hear their stories and their pain. Our clients often  hear the voice of their addiction that tells them that they will never be free of their addiction.  

The truth is that today, there are not enough treatment providers or facilities to take care of all the people who need care.  Incarcerating people who are addicted without treatment doesn’t help them recover. It doesn’t help to shame people about why they started in the first place.  Nobody ever wakes up one day and thinks, “I want to be an addict.”

Addiction does not discriminate and neither should access to recovery.  There remains a very large gap between people who have the ability to access treatment and those who do not. At  Aspire we join others in advocating for people who need treatment versus incarceration and we invest in recovery supports, like medication assisted treatment to help people get back on their feet, get back to work, and support themselves and their families. We come alongside our criminal justice partners to educate and work with them so that there is a mutual understanding about what trauma does to a person’s spirit.  People who are not able to abstain from drugs frequently have a history of trauma, whether that trauma is physical, verbal, sexual or emotional.  We want to help without judging because many treatment providers have traveled on the same  road, albeit years ago, and know that, but “for the grace of our Higher Power” we may not have lived long, useful and happy lives.

My hope for the Facing Addiction project in which we are participating, is that we continue to chip away and finally eliminate the shame and stigma that prevents people from coming to treatment.  I think we are actually making some progress in this battle.  More and more people who have struggled with addiction are coming forward to tell their story and how they came to accept that they needed help.  Few people recover without supportive others who are holding them accountable and helping them understand that they aren’t bad people.  Today, Nov. 3, 2016, my father would have been 100 years old had he lived.  What is important to me is that he died at age 85 as a sober man who enjoyed life, sports, and his grandkids.  People who suffer from an addiction are ill.  As we hear the stories of family members, co-workers, friends, and those who are addicted, we hope to shed more light on recovery, and help our communities understand that addiction is treatable, and treatment works!  

Susie Maier, LCSW, LCAC & Business Development & Marketing Director for Aspire Indiana.

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Integrity–A Personal Code of Conduct

binocularsWelcome back to my blog!  In the space between my last Blog in May and this one, I lost a little steam.  This is the fifth blog post in a series of six that focus on the Aspire Values.  Ironically, this one is on Integrity.  At Aspire, we define Integrity as “doing the right thing, even when no one is looking.”

So let me do the right thing by fulfilling my commitment to writing this blog, even if no one is reading!

Integrity isn’t about following rules; it is a personal code of conduct, defined by one’s values. Integrity means living out your values without regard to how it reflects on you.

Organizations can also be intentional about its values.. Aspire has done that with its PILLAR values – People, Integrity, Laughter, Learning, Accountability, Relationships. I recently attended an executive roundtable led by Jim Schleckser, an author who advises leaders and companies. He said that an organization’s values help all employees know what to do when there is no one to ask. It is how we manage the ‘white space’ or what I would refer to as the behaviors and actions that are not covered in rules, policies, procedures and written codes of conduct. This is a great extension of our value of integrity–doing the right thing when no one is looking or when there is no one to ask!

So, next time you encounter a difficult situation at work where your behaviors are totally up to you, ask yourself, “Am I living out the Aspire Values?” If you can’t confidently say yes, consider an alternative behavior, even if it is the more difficult action! Notice how you feel. Living intentionally is powerful!
While Integrity is personal and not meant to be bragged about, we didn’t say anything about not bragging on each other! Remember, we have a NEW recognition program at Aspire called, “Way to Go!” This is an opportunity for Aspire employees to recognize each other, and for the community to recognize Aspire staff for outstanding work. Everyone can find the recognition form on our website AspireIndiana.org, under “Way to Go!” and Aspire employees can also find it in the Aspire App under “People”. Aspire, I encourage you to be on the lookout for integrity in the workplace, along with our other values, and don’t hesitate to recognize and celebrate each other!

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bios_scottAbout the Author: Barbara Scott is the Executive Vice President and Chief Operating Officer at Aspire Indiana. Learn more about Aspire Indiana on Facebook or at its website.

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Suicide Risk: Clinical Training

In my last post I wrote about Aspire’s BHAG (Big Hairy Audacious Goal) of 0 after 5 (zero suicides after 5 years), in a post titled, “0 in 5: Our Suicide Goal”. In that post I outlined our 5 steps to achieving that goal:

  1. Train employees
  2. Supply clinical decision support tools
  3. Engage those at risk
  4. Implement care protocols that will provide the greatest safety
  5. Use data to improve the effectiveness of these over time

In this post, I will be giving an update on our progress and the strategies utilized to train employees. For those with Zero Suicide Initiatives underway,  I hope this post will provide an opportunity for dialogue on best practices and lessons learned for mutual benefit; I welcome your feedback! For all others, I hope you find encouragement from the progress being made and that this post will help you lend your voice to Zero Suicide Initiatives by staying informed and engaged with this issue. So now to the topic at hand…

When Aspire first began working on this zero suicide initiative in mid 2014, we formed a work-group (the opportunity was missed for “A-Team” or “Z-Team”) of clinical managers, crisis manager, and administrators to lead the effort. Before charging into the fray, we spent several months learning about how other organizations are working to improve care in this area.  In doing so, we found some sound advice from peers that suggested we survey our employees to determine what they already know (or don’t) and what their attitudes and perceptions were surrounding suicide.  So we did! We had a tremendous response from our employees, with about 70% of respondents being clinical providers.  Only 39% of respondents reported any classroom (graduate or undergraduate) level training surrounding suicide and 29% reported they don’t always ask about suicide with new clients.  Finally, only 2% accurately reported the number of deaths by suicide at Aspire that year, with 39% underestimating the number and 59% responding “I don’t know”.  This survey gave us a great deal of information about where we were and how to start the training process.

qprAs we analyzed the results of the survey, we recognized a glaring need that had to be addressed immediately, and that was for our front-desk employees. Anyone who comes through our organization is first met by a front-desk support employee, so it was imperative that they knew to recognize the signs of someone who may be suicidal so they can be connected the proper services as quickly as possible. So we began by providing training for front-desk support employees in QPR (Question Persuade Refer).  This is a national training to assist the public in identifying and acting when they encounter someone who may be suicidal.

Building a training paradigm for our behavioral health service providers was no small task. Many of our behavioral health service providers seemed to believe that treatment of suicide risk occurs in an inpatient setting or is best addressed by treating an overarching condition such as Major Depression.  Neither of these responses reflect the most recent research or inpatient discharge data. So we were struck by this question: How do you impart a lot of information, tools, and techniques onto an audience that is spread across 4 counties, among 18 clinical teams, with new clinical employees arriving every week?  We decided on a training program that consists of several tiered training sessions.

Live training was provided by our clinical trainer and a facility director on how to assess individuals for suicide risk.  This was training in large part about how to have the clinical conversation about suicide, what to look for, and when and how to question deeper than the initial response.  It was also designed to supplement our existing online training, while educating employees about misconceptions and information obtained in our survey.

notes-macbook-study-conferenceAfter the trainers made their rounds to teams for the live training, we initiated training in the use of the Columbia Suicide Severity Rating Scale (CSSRS).  The work-team selected this tool to replace our existing, outdated risk factors rating system, because of its researched validity and reliability, widespread use among fellow treatment providers and ease of use and training for clinical employees.  The CSSRS has been identified as the premier tool for identifying those at risk for suicide and developing an initial care plan, and we wanted the best.

We are now in the process of rolling out new treatment protocols, which were developed with the assistance of Jeffrey Garbelman, Ph.D.  Dr. Garbelman is a trainer for CSSRS, and was able to share treatment protocol ideas from other service providers. The workteam has established and is piloting a set of clinical guidelines/protocols to improve the safety of our consumers at various levels of risk for suicide.  Dr. Garbelman endorsed our protocols, and as we implement them and finalize them, he has committed to work with us to seek endorsement by Columbia University. Live training has been provided to our roll out teams about the content of these protocols and they have set out to begin using them.

In the fall we are providing training in Cognitive Behavioral Therapy for Suicidality.  This training will provide clinicians with evidence based training in the treatment of suicide.  This treatment is applied directly to suicidal thoughts and behaviors, rather than working to only treat an overarching condition.

Finally, we intend to wrap up all trainings with one overall final training that utilizes case examples and has the provider apply the knowledge of all four trainings into the review of the care of sample cases.  Sort of a final project, if you will, on using the information obtained in the training.  

These tiered trainings and the details within them are highly complex, require new learning (as well as some “unlearning” of old paradigms) and require ongoing decision at the provider, team, and supervisor levels. For full and effective adoption, we are planning for annual refreshers to ensure skills and knowledge aren’t lost. To assist in that effort we are introducing clinical decision support tools within our EMR.  Built in items like Safety Plans, CSSRS, flagging for high risk missed appointments, protocol explanations, etc will be vital to assist everyone to be on the same page and provide consistently high safety care to our consumers.  

That wraps up our efforts thus far to train staff and our plans to keep them trained in the future in order to know how to recognize the signs of suicide risk and the proper steps to take in order to prevent it.

Stay tuned…more about our Zero Suicide Initiative in future postings!

So what do you think? What is your organization doing to reduce the rate of suicide in your consumers? As a member of society, what do you see as your role in reducing and eliminating suicide? Share your responses to these questions or thoughts and feedback of your own using the comment feature below!

ProfileAbout the Author: Jim Skeel is the Senior Director, Performance and Outcomes of Aspire Indiana. Learn more about Aspire on our website, or on Facebook.

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0 in 5: Our Suicide Goal

sunset-flag-america-fieldsMany of us have seen on Facebook  the #22PushupChallenge to honor the 22 deaths by suicide within our veteran population a day.  And you may or may not know that suicide continues to be identified as a one of the leading causes of death in the US across all age groups, gender, and race and is now ranked 2nd as a leading cause of death for individuals aged 15-44 .   Unfortunately, Indiana exceeds the national average in deaths by suicide per 100k people and Madison County, where we are the largest behavioral health service provider, has an even higher rate of deaths by suicide per 100k residents compared to the state and national averages. We’re right in the middle of the “hot zone” and at Aspire, we have seen an alarming increase over the last few years of deaths by suicide for the people we serve.

Our response? Enough is enough. That is why one of Aspire’s 4 Big Hairy Audacious Goals (BHAGs) is 0 after 5. This means we want zero suicides after five years among those we serve. In an agency where we do behavioral health treatment every day with people contemplating suicide, the idea of zero seems more than lofty, it seems impossible.

So, in a state and community where people are killing themselves at a higher rate than the rest of the country, why make such an outlandish goal to eliminate suicide?  Simple, Aspire is articulating the approach that we, as individuals, want for ourselves, our families, our friends and our communities.  No one who works here wants to lose anyone we know through suicide.  And, since we work in an industry designed to treat this problem, we intend to put forth every effort we can imagine to end it and quickly. In order to meet it, it will require our organization, teams, and employees working together with everyone we serve to achieve it.

Fortunately, we are not alone.  I have been amazed at the successes being made within organizations who have taken on a Zero Suicide Initiative.  Sometime around 2008, while attending the annual conference of the National Council for Community Behavioral Health, I became aware of the initiatives at large healthcare organizations to dramatically reduce or eliminate suicide as a cause of death for their service recipients. Large providers like the Henry Ford Health System, in Detroit Michigan, provided dramatic data on the decline in suicides by improving the identification, engagement, quality of their care, and improved transition planning for those with suicidal thoughts or plans.  In the years that follow, I have seen similar results from places like Kaiser-Permanente, Johns Hopkins, and others large healthcare programs. More recently, within Indiana, other healthcare entities have adopted the Zero Suicide approach in an effort to eliminate suicides within their communities.  Community Health Network and Centerstone have formally launched these efforts, and are inviting others to join.  Aspire will be learning from its peers in order to utilize effective practices and to share our successes with others. While our goal is to eliminate suicide from those we serve, it should be everyone’s goal to eliminate suicide in their circle of influence and we want to play our part in creating synergy and progress towards that goal on a community level.

The gauntlet has been thrown down; the banner has been raised. Zero suicides after five years. In order to reach this goal, Aspire has created a 5 part plan:

  1. Train employees
  2. Supply clinical decision support tools
  3. Engage those at risk
  4. Implement care protocols that will provide the greatest safety
  5. Use data to improve the effectiveness of these over time

Work has already begun on these parts, and in future postings I will share more details about each and the progress being made to reach our zero suicide goal.

References: 

Center for Disease Control. “FastStats – Leading Causes of Death.” Center for Disease Control and Prevention. Center for Disease Control and Prevention, 27 Apr. 2016. Web.

Suicide Prevention Resource Center, and National Action Alliance for Suicide Prevention. “Zero Suicide.” Zero Suicide. Education Development Center, 2015. Web.

World Life Expectancy. USA Life Expectancy. World Life Expectancy, 6 Jan. 2016. Web.

 

 

ProfileAbout the Author: Jim Skeel is the Senior Director, Performance and Outcomes of Aspire Indiana. Learn more about Aspire on our website, or on Facebook.

Posted in Clinical Protocols, Mental Health, Suicide Prevention, Uncategorized, Veterans | Tagged , , , , , , , , , | 4 Comments

“Medal Winning” Videos of Homelessness

With the Olympics wrapping up yesterday, our minds have been saturated over the last two weeks with the images of bronze, silver, and gold. These colors have taken on great symbolism as the brand of remarkable achievement. In this spirit of this time honored ranking system, Jerry Landers (Executive Director of Aspire Indiana Health, and Vice President, Chief Development Office for Aspire Indiana) and I have taken it upon ourselves to award the bronze, silver, and gold medals to 3 movies for their excellent depictions of homelessness in the United States.

BRONZE MEDAL: “TIME OUT OF MIND”

Time out of Mind

Richard Gere (George) plays the lead in the movie “Time Out of Mind”, which depicts George’s existence as a homeless man on the streets of New York City, struggling with his identity
Unlike the two movies to follow, Director Oren Moverman’s focus of the film was not on the circumstances that led to George becoming homeless. Instead, the film takes an observer’s perspective, narratively and visually. What we do learn of Gere’s character is that he has suffered tremendous loss and in the process lost his sense of purpose and identity. We see George use alcohol as a coping mechanism, manipulate others, suffer the harsh rejection of almost all other characters in the film, and struggle through a dysfunctional shelter and social services system as he tries to get by each day. The power in this film is in what isn’t said, in the unknown. Too often there is the temptation to jump to conclusions about those who are homeless. Viewers of “Time out of Mind”, if they have the patience, will gain new insight and appreciation for all that can be happening “below the surface” in this unique population.

SILVER MEDAL: “PURSUIT OF HAPPYNESS”

Pursuit of Happyness

“The Pursuit of Happyness” is based on Chris Gardner’s true story as a struggling parent being homeless and raising a young son during the early 1980s. Directed by Gabriele Muccino, the film stars Will Smith as Gardner and Smith’s son, Jaden Smith.
“The Pursuit of Happyness” plays an important role in highlighting the misconception that all individuals who are homeless are just lazy. The truth is that nearly 40% of all homeless persons have a job, and when surveyed, the majority of those without employment say they are willing and want to work. “The Pursuit of Happyness” demonstrates how quickly anyone’s circumstances can change, and how challenging the process can be to re-establish stability while homeless. There is inspiration to be found in this story, but viewers should be careful to check their “rose colored glasses” at the door, as Gardner’s intellectual talents and people skills gave him the opportunity for a way out not accessible to most who find themselves in similar situations.

GOLD MEDAL: “THE SOLOIST”

The Soloist Based on the book by Los Angeles Times columnist Steve Lopez, “The Soloist” is the story of an unlikely friendship between an LA reporter (Robert Downey Jr.) and a homeless musician dealing with a serious mental illness ( Jamie Foxx).
“The Soloist” made our top 3 videos list for multiple reasons. The first is that it powerfully depicts the link between mental illness and homelessness. With a masterful performance by Foxx, the audience is able to glimpse into the world of someone struggling with mental illness and how what seem like simple solutions are extremely complex. On the other side, Downey’s performance as a LA Times columnist reflects what many individuals, both in the mental health field and outside it, feel when confronted with mental illness: frustration, disappointment, and the temptation to look down on those with mental illness. However, Downey’s character, Lopez, has the redeeming quality of passionately and persistently believing in Ayers’ (Foxx) potential and intrinsic value. The ability of this film to realistically portray both sides of homelessness in a way that resonates, convicts, and elicits empathy from viewers is what gives “The Soloist” the gold.

So what do you think? Do you agree/disagree with our rankings or did we leave out a deserving film entirely? We want to hear your thoughts and feedback in the comment section below! For those who may not have seen these films, we encourage you to do so and then come back and share your thoughts.

If you know of someone who is struggling with housing, we encourage you to learn more about the housing programs (linked below) available through Aspire and share it with them. We have a 24 Hour crisis line available with caring folks standing by ready to help serve those in need.
Housing Services – Aspire

 

About the Author: Kevin Sheward, MBA, is a grant writer with Aspire Indiana. Learn more about Aspire Indiana on Facebook or through our website.

Posted in Addiction, Health, Homelessness, Housing, Mental Health, Mental Illness, Uncategorized | Tagged , , , , , , , , , , | 2 Comments

Housing, an Important part of HEALTH!

diabetes-blood-sugar-diabetic-medicine-46173When we talk about health, we often take our homes for granted. If you were to walk out of a doctor’s office with a prescription for insulin or orders to lower your stress by getting more sleep, how would you do that without a home? Where would you refrigerate insulin while taking shelter under an overpass? How would you get a restful night’s sleep in a noisy and crowded shelter with 50+ other men/women? These are just two examples of how, without a home, health is an uphill battle. Because of this simple truth, Housing is a significant social determinant for health.

The Social Determinants of Health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. The conditions in which we live explain in part why some Americans are healthier than others and why many Americans are not as healthy as they could be.

cold-snow-person-winterSadly, roughly 500,000 people were homeless in the US last year. More than a quarter of them were children. According to HUD’s 2015 point in time count, 565,000 people were living on the streets in cars, in homeless shelters or in subsidized transitional housing during their one-night national survey. Nearly one-fourth were aged 18 or under. Many studies suggest that the real number is much higher.

This is why Aspire has such a strong focus on housing. By working to establish practices that positively influence social and economic conditions and those that support changes in individual behavior, we CAN improve the health of people in ways that can be sustained over time.

Aspire provides property management services and various housing assistance programs to the many counties we serve, which include Madison, Hamilton, Boone, Hendricks, Hancock, and Marion. Annually we work with hundreds of individuals that are living on the street. We access a variety of federal, state and local resources to help individuals gain housing. Once they are housed we continue to provide supportive services including working with our supportive employment team to address issues with unemployment or underemployment.

If you would like to learn more about our Housing services please check us out on the web http://www.aspireindiana.org/housing/ or follow us on Facebook https://www.facebook.com/AspireAffordableHousing/

Reference:

Johnson, E. (2015). More than 500,000 people homeless in the United States: report. Retrieved from http://www.reuters.com/article/us-usa-homelessness-idUSKCN0T908720151120

HealthyPeople.gov (2016). Healthy People 2020 Leading Health Indicators: Progress Update.  Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/Healthy-People-2020-Leading-Health-Indicators%3A-Progress-Update
CDC.gov (2016). Social Determinants of Health: Know What Affects Health. Retrieved from http://www.cdc.gov/socialdeterminants/

 

Jerry_LandersAbout the Author: Jerry Landers is the Executive Director of Aspire Indiana Health. You can follow him on Twitter @JerryELanders. Learn more about Aspire on our website, or on Facebook.

Posted in Health, Homelessness, Housing, Integrated Healthcare, Mental Health, Primary Care, Uncategorized | Tagged , , , , , , , | Leave a comment