This session will begin by describing a typical experience for a student struggling with multiple health and mental health challenges as they navigate the Central Valley’s complex and siloed adolescent healthcare system. Drawing on their experiences working in integrated healthcare settings, the presenters will share their vision for a local system that incorporates psychosocial screenings with a referral network that includes medical providers, social workers, therapists, nutritionists, reproductive health services, and more. By facilitating relationships between clinical and non-clinical providers, and integrating physical and mental health services, an integrated system can shift providers’ thinking from a focus on health to a focus on overall well-being for Central Valley youth.

1. MOVING FROM HEALTH TO WELLNESS:
COMMUNITY CENTERED INTEGRATED HEALTH
MODELS
KALILA BANKS, PHYSICIANS ASSISTANT, CLINICAL SIERRA VISTA
ASHLEY ROJAS, EXECUTIVE DIRECTOR, FRESNO BARRIOS UNIDOS

2. MOVING FROM HEALTH TO WELLNESS
MEETING A FRESNO TEEN
▸ Andrew* showing up for a well-child check
▸ 17 y/o AA Male
▸ Good student, extra curricular involvement
▸ Living in SE Fresno
▸ Senior in HS
▸ Single Parent Household - healthy familial relationships
▸ Parent experiences chronic health conditions
▸ Low-income family
▸ What health disparities might this teen
face?

3. What are Social Determinants of Health?
Social determinants of health are the conditions in which people
are born, grow, live, work and age.
They include factors like socioeconomic status, education, Built/
physical environment, community norms/societal norms,
employment, and social support networks as well as access to
health care.
Source: https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-
equity/
MOVING FROM HEALTH TO WELLNESS

4. MOVING FROM HEALTH TO WELLNESS
SOCIAL DETERMINANTS OF HEALTH

5. MOVING FROM HEALTH TO WELLNESS
▸ Concentrated Poverty / generational poverty
▸ Urban sprawl - weak transportation system -geographic isolation
▸ Unhealthy air quality, drinking water, lack of green space, unfinished
neighborhoods
▸ Food insecurity
▸ Toxic stress/ ACEs / generational trauma
▸ Historical and systemic racism
▸ Lack of cultural humility in service delivery
STATUS OF ADOLESCENT SODH HEALTH IN FRESNO,CO
https://www.sierrahealth.org/assets/pubs/A_Region_and_Its_Children_Under_Stress-Web.pdf
https://www.brookings.edu/wp-content/uploads/2016/06/1024_concentrated_poverty.pdf

6. ADOLESCENTS HAVE ONE OF THE LOWEST
RATES OF PRIMARY CARE USE OF ANY
AGE GROUP IN THE UNITED STATES AND
ADOLESCENTS FROM DISADVANTAGED
BACKGROUNDS ARE AT THE HIGHEST RISK
OF NOT HAVING REGULAR HEALTH
MAINTENANCE VISITS.
Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2004 summary. Advances in Data Analysis and
Classification. Jun 23 2006(374):1-33.
Nordin JD, Solberg LI, Parker ED. Adolescent primary care visit patterns. Annals of Family Medicine. Nov-Dec 2010;8(6):
511-516.
Irwin CE, Jr., Adams SH, Park MJ, Newacheck PW. Preventive care for adolescents: few get visits and fewer get services. Pediatrics.
Apr 2009;123(4):e565-572.

7. MOVING FROM HEALTH TO WELLNESS
SILOED SYSTEMS CULTIVATE GAPS IN CARE
▸ Back to Andrew*:
▸ Presented for well-child visit
▸ Treatment plan
▸ What was learned…

8. We live in a world where most
people still subscribe to the belief
that shame is a good tool for
keeping people in line. Not only is
this wrong, but it’s dangerous.
Dr. Brene Brown

9. MOVING FROM HEALTH TO WELLNESS
BUILDING BRIDGES AND CLOSING GAPS
‣The solution lies in integrated care, the systematic coordination of general and behavioral
healthcare. Integrating mental health, substance abuse, and primary care services produces the
best outcomes and proves the most effective approach to caring for people with multiple
healthcare needs.
‣Why? Normalize. Relationship centered
‣Universal psychosocial screeners: adding the 4th S
https://www.integration.samhsa.gov/about-us/
Understanding_Primary_and_Behavioral_Healthcare_Integration_2010-09-15_FINAL.pdf
H: Home
E: Education/Employment
E: Eating
A: Activities
D: Drugs (incl smoking &
EtOH)
S: Sexuality
S: Suicide/Depression
S: Safety
S: Strength/Spirituality
H: Home
E: Education/Employment
E: Eating
A: Activities
D: Drugs (incl smoking & EtOH)
S: Sexuality
S: Suicide/Depression
S: Safety

10. OPPORTUNITY OF ADOLESCENTS
▸ Multiple transitions creating organic
opportunity to interface with system
of care
▸ Stepping into independence -
preparing for adulthood and/or
parenthood
▸ High desire for autonomy and
sovereignty of self
▸ Desire to succeed
▸ Willingness to learn/ Adaptability
https://policywise.com/wp-content/uploads/
2016/07/40-Developmental-Assets.pdf

11. MOVING FROM HEALTH TO WELLNESS
SHOWING UP FOR ANDREW
In an integrated health model - what might have care looked like for this young
man?
‣ Trauma informed psychosocial screener
‣ On-going care
‣ Health education
‣ Advocacy ( Clinicians, community based providers, Family)
‣ Primary care inclusive of Behavioral health
‣ This would have (in practice) resulted in
‣ Individual and family mental health support
‣ Earlier intervention and treatment plan for HIV diagnosis

12. MOVING FROM HEALTH TO WELLNESS
STRENGTHS OF INTEGRATED CARE MODELS
▸ Psychosocial screeners as standard practice create
opportunity to identify students with higher needs who
may not be presenting with Academic or Behavioral issues
(prevention v. Intervention — early identification before
urgent symptomology)
▸ Toxic stress and chronic trauma v. Traumatic events
▸ Variable symptomology

13. MOVING FROM HEALTH TO WELLNESS
HOW DO WE GET THERE?
▸ Building Community
Resilience - leveraging
community (youth, parents/
caregivers, community based
providers) as EXPERTS
▸ Dismantling silos of care and
building integrated systems
of care
▸ Redefining SAFETY
▸ Cultural humility training
addressing racial bias
▸ Developing shared
understandings/shared
language
▸ Trust and #anythingforkids https://www.academicpedsjnl.net/article/S1876-2859(16)30552-6/
pdf

14. MOVING FROM HEALTH TO WELLNESS
GETTING STARTED
▸ Identify your stakeholders
▸ Assess how your System of Care
functions
▸ Convene stakeholders
▸ Develop community agreements
▸ Build trust
▸ Build capacity
▸ Ask for support

15. QUESTIONS/
COMMENTS?
Thank You for showing up
for OUR KIDS.