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- Implement a trauma-informed approach in primary care settings.
- Implement trauma-informed approaches in communities, including child care settings, schools, and law enforcement.
- Ask the ACEs questions and use the information to inform treatment plans.
- Encourage and support healthy living, including sleep, nutrition, and physical activity.
- Incorporate self-care for healthcare providers and those in the helping professions, who often experience secondary trauma and compassion fatigue.
Six Strategies Identified in the State’s 2017 Diabetes Epidemic and Action Report (DEAR)
Below are the overarching strategies for action plans:
- Prevent type 2 diabetes.
- Support optimal self-management of diabetes.
- Use diabetes-specific data and information to guide decisions.
- Seek adequate funding for diabetes prevention and care.
- Include people affected by diabetes in decisions.
Specific actions are identified in Agency Action Plans, page 6 of the 2017 DEAR.
Aligning with these strategies, the report included 13 recommendations for how the Legislature could support reducing the incidence of type 2 diabetes, and improving the lives of people with all forms of diabetes. These recommendations can be applied at state, regional, local, and organizational levels:
- Maintain and further expand access to health care coverage.
- Help make out-of-pocket costs more affordable for patients with diabetes.
- Support the state’s movement toward value-based payment.
- Continue efforts to integrate physical and behavioral health care services.
- Encourage Accountable Communities of Heath to implement projects that impact diabetes.
- Ensure all health plans provide optimal diabetes benefits.
- Fund recommendations from the Governor’s Council for the Healthiest Next Generation.
- Support students with chronic health conditions.
- Expand staffing and coordination resources for evidence-based, community-based programs.
- Increase use of diabetes self-management education.
- Raise public awareness of diabetes prevention and management.
- Train health care providers to screen for diabetes, and to deliver high-quality diabetes care in culturally and linguistically appropriate ways.
- Support using data to drive decisions and improve linkages between health systems and community support services.
Strategies for obesity include, but are not limited to:
- Improve health care training and systems for prevention and care in obesity management, including promotion of evidence-based, interdisciplinary approaches.
- Develop obesity screening in health care settings, along with counseling and referrals that are tailored to patients and culturally appropriate.
- Screen for and manage obesity in pregnant women, using tools that are preventive and trauma-informed.
- Provide seamless breastfeeding support between hospitals and related clinics.
- Encourage hospitals to register for Breastfeeding Friendly Washington.
- Provide healthy foods in cafeterias, vending and other onsite food venues.
- Develop a prescription program for free or low cost physical activity and fruit or vegetable incentives.
- Partner with a local gym to offer free or reduced-cost memberships.
- Screen for food insecurity and provide related resources and assistance f applicable. An excellent resource: American Academy of Pediatrics food insecurity toolkit.
- Lead or participate in community initiatives to improve access to healthy food and physical activity, especially among populations that experience health inequities.
- Provide culturally appropriate support for obesity prevention and management, nutrition, physical activity, and breastfeeding.
- Promote physical activity to manage arthritic pain. Appropriate activities: low-impact aerobic activities, and exercises to increase muscle strength, flexibility and balance.
- Provide referrals to and coverage for chronic disease self-management education programs, diabetes prevention programs, and other evidence-based initiatives, such as EnhanceFitness and Silver Sneakers that increase healthy eating and/or active living.
Strategies for opioids include, but are not limited to:
- Reduce stigma around substance abuse disorders.
- Screen for opioid misuse/opioid use disorder.
- Follow Center for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain.
- Implement Prescription Monitoring Program
- Implement Medication-Assisted Treatment (MAT).
- Reduce insurance coverage barriers.
- Develop training for providers at all levels.
- Increase support services, including housing.
- Invest in upstream efforts to reduce risk factors and increase protective factors.
Resources and tools:
Frameworks and Strategies
- Six Strategies for Reducing Prescription Drug Abuse, National Governor’s Association.
- Opioid Misuse Strategy, Center for Medicare and Medicaid Services.
- Social-Ecological Model: A Framework for Prevention, CDC.
- Prevention Approaches, Substance Abuse and Mental Health Services Administration (SAMHSA)
- Screening, Brief Intervention, and Referral to Treatment SBIRT), including available reimbursement codes, SAMHSA.
- Chart of Evidence-Based Screening Tools for Adults and Adolescents, National Institute on Drug Abuse (NIDA).
Prescribing Guidelines, Prescription Monitoring
- Guideline for Prescribing Opioids for Chronic Pain, CDC.
- Guidelines for Prescribing Opioids and Prescribing Guidelines for Dental Practitioners, Bree Collaborative.
- Washington State Prescription Monitoring Program for providers and pharmacists, Washington State Department of Health.
- TelePain audio and video-based resource for providers treating chronic pain, University of Washington.
Treatment Recommendations, Overdose Reversal
- Opioid Use Disorder Treatment Recommendations, Bree Collaborative.
- Medicated Assisted Treatment information and guidelines, SAMHSA.
- Opioid Overdose Reversal information, NIDA.
Trauma Informed Approaches
- Adverse Childhood Experiences (ACEs) and Substance Abuse Prevention, SAHMSA.
- Policy Brief on ACEs and Opioid addiction, Campaign for Trauma Informed Policy & Practice.
Strategies for Tribal, Rural, and Homeless Populations
- Tribal Best Practices in Treatment for Opioid Use Disorder American Indian Health Commission.
- Treating the Rural Opioid Epidemic, National Rural Health Association (NRHA).
- Strategies to Address the Intersection of the Opioid Crisis and Homelessness, Interagency Council on Homelessness.
Strategies for tobacco include, but are not limited to:
Strategies for health systems:
- Adopt the Joint Commission Tobacco Cessation Measures.
- Integrate tobacco use screening and treatment protocols into electronic
- electronic health records.
- Adopt tobacco-free campus policies to reinforce healthy lifestyles.
- Participate in the Washington State Tobacco Quitline fax referral program.
Strategies for providers:
- Implement the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence, including the 5 A’s model.
- Refer patients who use tobacco to the Washington State Tobacco Quitline (1-800-QUIT-NOW) by submitting a fax referral to the Quitline, or suggest they download the 2Morrow Health smartphone app by visiting doh.wa.gov/quit.
- Get certified as a Tobacco Treatment Specialist by an accredited program.
- Promote the Tips From Former Smokers® campaign.
Strategies for health insurance carriers:
- Reimburse providers for individual (face-to-face) and group tobacco cessation counseling.
- Contract with a tobacco cessation telephone counseling service for members.
- Cover all seven FDA-approved tobacco cessation medications.
- Remove all barriers to counseling and medication coverage, including cost sharing and prior authorization.
Strategies for youth prevention:
- Strong tobacco-free role models
- Family expectations and communication
- Media messages that counter tobacco advertising
- Youth-friendly education and health promotion, like the Truth campaign
- Laws and policies that reduce access to tobacco products
Strategies to address health equity:
- Promote culturally appropriate tobacco education and cessation resources
- Honor American Indian/Alaska Native traditional tobacco use as separate from commercial use
- Create tailored prevention and intervention programs for identified populations with greater prevalence of tobacco use and/or tobacco related disease burden
- Recruit, train and support community health workers from the identified population to deliver tobacco prevention and cessation services
- Smoking Cessation Leadership Center
- CDC’s 6|18 Initiative to Reduce Tobacco Use
- National Behavioral Health Network for Tobacco & Cancer Control
- University of Wisconsin Center for Tobacco Research and Intervention
- Rx for Change
- American Academy of Family Physicians
Initial recommendations from interagency partners include:
Increase Access/Reduce System Delays
- Adjust clinic hours to offer well visit appointment after school/work hours so children do not have to miss school and parents do not have to miss work.
- Offer well visit appointments during weekend hours. This may be a consideration particularly for providers who operate walk-in clinics on weekends. Drop-in appointments are helpful for families whose circumstances make their schedules unpredictable.
- Reducing wait time to schedule appointments
- Reducing wait time during scheduled appointments
Send friendly reminders:
- Parental scheduling reminder
- birthday postcards
- automated calls from provider’s office
- Adolescence specific scheduling reminder
- automated calls from provider’s office
- birthday postcards
- Gift cards certificates
- Gift cards
- Movie tickets
- Concert tickets
- Sporting event tickets
- Demonstrate importance and value of early detection and treatment
Tool for organizing strategies to increase Well Child Visits
A Population Health Driver Diagram is a visual tool developed collaboratively with partners, designed to identify a desired change and the activities that will drive that change.
Using a template provided by the Public Health Foundation, a small group of interagency and local partners developed a Well Child Driver Diagram. This diagram is intended as an example, and may be tailored to the issues and resources of unique populations and communities.
Conceptual Framework for increasing Health Access
The International Journal for Equity in Health provides a highly recommended resource: Patient Centered Access to Care. It is downloadable as a PDF, and includes a visual template for a conceptual framework (Figure 2.) that addresses both supply and demand.