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>View discussions about this entry Country: United States
Organization: Pat Deegan PhD & Associates, LLC
Focus of activity - Service/process
Year the initiative began (yyyy) - 2006
Positioning in the Mosaic of solutions
Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? The main focus of CommonGround is to amplify the voice of mental health clients and promote shared decision making in psychiatry. It involves the transformation of the waiting area in a traditional psychiatric clinic, into a peer-run Decision Support Center. A medication appointment is redefined to include 30 minutes of work in the Decision Support Center prior to seeing the doctor. People in recovery from psychiatric disorders staff the Decision Support Center and invite clients to use a web-based software program that helps to organize and amplify the important issues that clients want to raise with their psychiatrists. The software program can be completed in 10-20 minutes depending on whether clients choose to read or listen to the program. In addition to a customizable survey about "How I Am Doing" and "Common Concerns About Medicine", the program also features 3-minute vingettes of ordinary people describing their recovery from major mental disorders and it encourages clients to explore their own Personal Medicine or the things they do to create wellness in their lives. The software generates a 1-page CommonGround Report that clients print and bring to their appointment. The report also feeds forward to practitioners' laptops. Together the dyad is prompted with cues that lead to collaboration and shared decision making regarding the next steps in the treatment process.
Clients may also interact with an electronic version of their report which serves as an information portal connecting them to methods for managing symptoms, information on legal rights and advanced directives, decision aids, and fact sheets about the risks and benefits of using psychiatric medications. Additionally, clients can pursue personal data mining activities and, through a simple interface, graph their recovery along a variety of parameters. For instance a client could plot his/her use of drugs/alcohol as correlated with symptom severity over the previous 12 months. Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. CommonGround is transforming traditional mental health related systems through a series of critical disruptions. The software and 1-page CommonGround Report disrupts medical paternalism by amplifying the voice of clients and bringing clients' agenda to the center of the psychopharmacology consultation. It disrupts the assumption that people with major mental disorders can not speak for themselves because the software program serves as assistive technology that can help organize clients' concerns and efficiently communicates them to practitioners, even when a client might be anxious or disorganized. It disrupts the idea that a patients role is passivity by redefining a medication appointment as beginning 30 minutes prior to seeing the doctor. It disrupts the idea that medicine is a simply a "pill" by introducing clients to the importance of Personal Medicine or the things they do to create meaning and wellness in their lives. Recovery, or building a meaningful life in the community despite the presence of psychiatric symptoms, often requires finding the right balance between Personal Medicine and psychiatric medicine. CommonGround disrupts the assumption that it is the practitioner's job to make us well. In other words, it supports clients in becoming activiated health care consumers who participate in making treatment decisions and actively manage their disorder. CommonGround disrupts the assumption that people with psychiatric disorders do not get well by presenting clients with 3-minute vingettes of ordinary people talking about their recovery from mental illness and their use of personal medicine in the recovery process. Finally, CommonGround disrupts the mystification of psychiatric knowledge by making evidence based knowledge and best practices information transparent and availabe through the portal of the electronic CommonGround Report.
Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? CommonGround is a web based application. It is available to clients who use psychiatric services at clinics that are enrolled with CommonGround. Once enrolled, clients, case managers, and medical staff can access CommonGround remotely or at the clinic, by simply having a computer with a browser. We are currently conducting research on CommonGround at one psychiatric clinic. We have plans to begin research in a second clinic in September of 2007.
When the waiting area in a psychiatric clinic is transformed into a peer run Decision Support Center, every effort is made to make the software program fully accessible. Health literacy, and even basic literacy, is not an issue as the program requires no keyboarding and users can choose to listen to the program. The Decision Support Center and CommonGround software are currently being used by very poor people receiving public sector mental health services in a large urban area. People diagnosed with schizophrenia, bi-polar disorder, schizoaffective disorder, major depression and co-occuring substance use disorders use the software with little difficulty. Doctors and prescribing nurses say the program creates efficiencies in thier practice and enhances the therapeutic alliance. Our client focus groups have indicated that the videotaped recovery vingettes give hope for recovery. The videos do not create unfounded expectations for short range cure but, rather, give hope that life can get better in ways that are meaningful i.e., getting a job, raising children, living in a home rather than housing, living in the community rather than an institution. The innovation does not ignore the importance of medicine to many people's recovery. Indeed, it supports people in learning to use psychiatric medicine and personal medicine in optimal ways that support recovery. Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. Key partnerships have included the School of Social Welfare at the University of Kansas under the guidance of Charles Rapp PhD. KU has funded the implementation and research related to CommonGround. The Wyandot Mental Health Center, Community Support Services Division, in Kansas City Kansas has been our test site under the leadership of Leslie Young, Ally Mabry and Michael Leeson, MD. Dartmouth Psychiatric Research Center under the leadership of Robert Drake MD, PHD has participated in collaboration of methodological designs and networking of resources.
Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? CommonGround has been developed through personal money and on a very low budget. Research and training related to CommonGround has been provided through the University of Kansas School of Social Welfare. It is not making money at this time, though it has the potential to do so using a monthly clinic enrollment fee for this web-based service.
Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? We currently have an adult and a young adult case management team enrolled in CommonGround (n=178). The pilot is underway at the Wyandot Mental Health Center in Kansas City, KS. We began our pilot on October 24, 2006. Our focus group data indicate that involvement in CommonGround is creating time efficiences in the work of the doctors and nurses, is creating a fuller exchange of information during the consultation, is helping clients achieve their goals during the consultation, is providing assistive communication technology to some, is creating hope for recovery and increasing clients' perception of being heard, understood and respected during the psychopharmacology consultation.
Scaling up Strategy - What is your priority for the next 3 years and please describe why. My priority for the next 3 years is to expand the number of beta research sites in adult outpatient psychiatric clinics that are enrolled in CommonGround. Once we have established the efficacy of the intervention, then I will consider how to market it. In September of 2007 we will begin a controlled clinical trial at the Wyandot MH Center in Kansas City, KS. We will introduce 200 clients to the intervention in September 2007 and another 200 in December of 2007. We will follow the groups and record proximal and distal outcomes. With Emily Woltman, a doctoral student at the Psychiatric Research Center at Dartmouth I will begin to study the impact of video vingettes of recovery on dimensions such as hope and confidence. In September of 2007 I will join with Community Care Behavioral Healthcare, a managed care company in Pennsylvania, to start up a second implementation site for CommonGround. In January of 2008 I will start a third CommonGround site at another clinic in Kansas.
Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. I was first diagnosed with schizophrenia at the age of 17 years. I was told that I would never get well and would have to take antipsychotic medication for the rest of my life. In time I rejected this prognosis of doom and decided I wanted to live my life, not my diagnosis. My recovery began with simple tasks like pushing a shopping cart down the aisle of the supermarket while my grandmother placed items in it. Then I took a course at a local community college. Eventually I got a doctorate in clinical psychology. I have devoted my life to carrying a message of recovery and hope for others who are diagnosed with mental disorders. I created CommonGround because I believe that those of us with psychiatric disabilities have something important to say to our doctors and that we must have a voice in our treatment.
Contact Information:
Patricia Deegan
small business owner Pat Deegan PhD & Associates, LLC (disability owned and operated business) pat@patdeegan.com 17 Forest Street, Byfield, MA 01922 United States Tel: 978-462-7258 Website: http://www.patdeegan.com Discussions about this entry
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CommonGround
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Given that more than 30 billion dollars a year is spent by patients on alternative therapies about which they are afraid to speak with their doctor in most instances, any approach such as the one described here that encourages the patient to describe her/his set of solutions or proposed solutions has up front face validity.
If nothing else it will encourage the health professional to be aware of the time, effort and expense patients now spend in seeking more holistic solutions to their problems. In primary care practice one needs "practice assists" to get at this information efficiently and effectively. Although this is not aimed at primary care practices, I could see its great utility from this point of view.
Hi. Thanks for you post. Wow - 30 billion a year for alternative therapies. That's a huge industry. I didn't realize that. I share your sense that this innovation has potential for use in primary care. It really gets at the idea that patients are not passive. Most are actively trying to cope with their problems and, as you said, often don't share the details of their health strategies with primary care practitioners or psychiatrist.
Pat
I thought I would shared this recent email from of the nurses who sees young adult clients in the clinic. I think it is a good example of how CommonGround can be a means of getting one's agenda into the medical consultation and how the software program can act as assistive technology for people who are experience disorganized thinking related to psychosis. Here's what the nurse wrote:
"Hello, something happened yesterday, that I thought you would like to hear about. It was late afternoon, the peer specialist had left for the day. My last appointment was a young man who no-one saw enter the med clinic. He sat down and did his CommonGround report. What is interesting about this , is he was very symptomatic, hallucinating, and reporting severe paranoia , as well as severe depression. He had described the night before as the worst in his life. Doing the report was apparently very important for him, and helped with the appointment. Of note this is a young adult, who rarely has much to say, is most like symptomatic most of the time, but this time , he must have felt like he had a ‘voice’ Anyway just wanted to share. Debra"
CommonGround is a wonderfully simple approach to the complex issues of psychiatrist-patient relationship and informed decision making on the part of persons with psychiatric disabilities. The medical profession (and in many cases law-enforcement) have approached this issue as one of medication "compliance" or "adherence" (the European, slightly more gentle version). In some states, individuals are forced by law to take certain medications. The question is often framed as "how can we get him/her to take her medication?" Too frequently the individual feels pressured to make a decision without regard to how that decision will effect his/her goals and without adequate information on the prescribed medication. Psychiatrists in many cases are forced into brief encounters with their patients (insurance may cover 15 minutes with 3 out of the 15 dedicated to record keeping). In busy clinical settings, the psychiatrist may not have or take the opportunity to get to know their patient sufficiently. Medication recommendations may not be based on full knowledge of the individual's health, goals, strengths and limitations.
Pat Deegan first spoke of "recovery" in 1982 and broke ground for much of the current emphasis on recovery oriented systems. She is a highly respected author, speaker and researcher and often thinks about issues in the field of mental health with a fresh approach. CommonGround addresses many of the problems and challenges by creating an equal partnership between doctor and patient, by increasing the patient's knowledge of the medications and the pychiatrist's knowledge of the patient. The peer supports can make all the difference in how one approaches the medication regime and Pat Deegan has included this very important component.
Joan C. Rapp
Thanks for you post Joan. I wanted to echo that idea of simplicity. Sometimes the most disruptive interventions are very simple. I think we all know how boring an extended stay in the waiting area of a medical clinic can be. The conversion of the waiting area into a Decision Support Center - a productive space with peer support and a method of preparing for one's appointment - is simple. Perhaps that why it's working so well! The intervention changes the balance of power in the doctor patient relationship.
This is really a great idea! Through the web based program, you invite people not only to answer certain questions in a good context, but you also invite people to think certain thoughts about recovery and empowerment. By asking them about their personal medicine, you create awareness towards their own resources and strengths. By showing them the video clips of people who have recovered in very different ways, you present some very individualized hope.
Good luck!
Kirsti Malterud (Norway)
Thanks for your comment Kirsti Malterud. I like that idea of locked dialogues. The bisu physicians and disempowered patients can create a locked dialogue in which the lived experience of struggling to find a path to recovery gets obscured. I think of Paolo Freire's notion that oppression submerges consciousness into a culture of silence. Patients are often silenced through medical paternalism and perhaps psychiatric patients more than others! This software program seems to empower patients to bring new topics into the medical discourse and, importantly, those topics are defined by patients themselves.
Let me share a brief vingette with you. I just got a note from a psychiatric nurse who is involved with the CommonGround progject. She said a patient came into the Decision Support Center near closing time. All the peer specialists were busy and unavailable. The client was quite psychotic and disorganized and was coming to see the nurse. With no prompting from a peer specialists or medical staff, this young adult sat at the computer screen and completed his CommonGround Report, printed it and walked into the nurse's office unassisted. She wrote to me to marvel at this young man's investment in telling his story, via the computer. Being heard, breaking out of locked dialogues, is good medicine!
Pat Deegan
What kind of responses are you getting from people who use CommonGround?
Hi and thanks for your post. We have been running a series of focus groups made up of users of CommonGround. The focus groups include MH clients, medical staff, case managers and peer specialists. Docs and nurses say that using the software program has created efficiencies in their work. By this they mean that it does not save time, but uses existing time (15-20 minutes per visit) more efficiently. They feel the software helps them get to the client's concerns more quickly and to address them more thoroughly when compared to standard operating procedure. Most clients value the program as a means of more effectively communicating with their doctor or nurse. They feel it helps them be understood and listened to. The program also gives them a personal portal into the internet based on their expressed concerns. This individualized portal helps them get health related information such as medication fact sheets from the National Institute of Health or to have a chance to learn about nutrition and exercise through an online tutorial. Internet access and peer support to use it valued because so many folks are poor and otherwise have not access. Clients also really like the3-minute recovery videos. They have asked that I develop lots more! They want to be able to choose from a large data bank of videos. They want to learn from these videos i.e., How can a parent with mental ilness get their kids back from foster care and How did you handle the decision to use or not use an antipsychotic medication knowing that if you do, you risk getting diabetes? etc. Case managers have been surprised to learn that clients can and will use the software in the medication clinic. They have been surprised to learn about clients' personal medicine and the resilient, health seeking strategies clients discover on their own. These are strengths that sometimes the case managers had not realized. The case managers have also reported that clients seem less "upset", "angry" and "irritated" after leaving their med clinic appointment. They attribute this to the software program opening up more meaningful dialog between client and medical practitioner. They also attribute it to the availability of peer specialists to talk and "bring hope" for recovery.
The idea of having computers in the waiting rooms of psychiatric clinics is potentially intriguing. The case vignettes of patients’ successful recoveries and disease-specific information may empower a few high-functioning and highly literate patients. However, it may also put an undue expectation of quick recovery onto patients already suffering from anxiety, depression, or even schizophrenic paranoia. Psychological healing is often a long recovery and the implication that the healing can somehow be “willed” into effect is controversial to say the least. Also the criticisms against psychopharmacology is a bit extreme. There is a role for both therapy and psychiatric medications in mental health. This project also appears to assume high levels of health literacy in the patients, levels that can’t be easily overcome by touchscreens or other “easy fix” interventions. One would have to assume that patients most likely to succeed would be relatively high-functioning, highly motivated, and relatively well-educated. Thus, it is skeptical whether this program has the democratic potential to increase access. Nonetheless, it deserves further consideration and perhaps further clarification.
Thank you,
Changemakers Team
As an individual with severe depression issues, who has been making wellness my goal for over a decade, I can certainly relate to the idea that a lack of education (both generally, and illness/medication specific) can be of great detriment to a person on this journey. However, like most challenges, this presents an opportunity for a person to seek out the education.
The Common Ground approach utilizes Peer Support workers. As a former clinical peer support specialist and current advocate and trainer, I'm the first to attest to the benefit of peer support. In this instance, peer support is utilized to bridge the gap between what a person receiving services knows right now, versus what they have the opportunity to learn.
That is, what recovery is about. Opportunity. Community Care (the latest test site for CommonGround) distributes a bracelet that says, very simply, "Recovery...imagine the possibilities."
You mention that it is an illusion that recovery can be "willed." I have to disagree with this statement. There is a delicate balance between the psychiatrist, the service recipient, and other service providers. That balance is inherently unable to function if the person in recovery does not have the "will" to recover.
It has been said that as humans, we only believe possible, those things that our experiences support as being so. For a person in recovery, the stories of other people, long ascended up on their path to the life they want to live; witnessing that people with mental illness can and do get better, is often the most powerful way of making that POSSIBILITY a REALITY.
Keep up the great work, Pat! Be Well.
As someone who provides recovery education to people in recovery who the system considers low functioning, unmotivated and who do have low literacy levels (we take a different view and see folks as people with strengths who are living with the consequences of a psychiatric illness), I am very excited about the potential for Common ground to empower people to take charge of their health in a relevant and meaningful way. I would strongly disagree as a provider of services for people with serious psychiatric illnesses, that people have to be highly functioning and highly educated to use such a tool. Our experience here is that people at all levels of education and at all phases of healing are seeking to create meaning and wellness in their lives and in their bodies. People often are labeled as unmotivated because they don't want to take advantage or don't know how to take advantage of a system process or program. Commonground provides people with a tool to level the playing field in such a way that provider behavior will change without formal training and people will be heard in the clinical encounter about what is important to them and what they need to improve their functional health. In our program we actually accompany people to their doctors appointments to make sure they are heard and that their personal medicine drives the treatment plan, but Commonground holds the potential to ensure that many many people can direct their health care in a way that is mutual and respectful. This tool puts the focus on the process of care which in turn will influence the outcome of care. It puts a spotlight on the blackbox of the clincial encounter..what goes on behind those closed doors..and you can't improve outcomes without understanding and changing the process.
I am very excited about the possibilities of this unique program. And I don't think it sets up unrealistic expectations at all. On the contrary, for a long time in the mental health field we have set such low expectations for people with mental illnesses, including schizophrenia. As a result, many lives have been lost or wasted, which is a national tragedy.
I am currently assisting several community mental health centers to transform how they are working with clients to improve their treatment outcomes; specifically to provide more recovery-oriented services, and to measure success based on recovery indicators, especially achieving permanent stable housing and returning to work.
The first step in this transformation is changing the dialog between therapist and client - focusing on wellness goals and instilling hope. We know that people heal faster from most serious health conditions when they have hope for recovery, some choice among treatment options, and excellent, evidence-based treatment. It seems that our field has focused a lot on the evidence-based treatment part of this equation - but the other two elements - hope and informed choice - are also incredibly important. As a parent and a practitioner, I applaud the developers for this exciting innovation, and can't wait to share it with my colleagues.
Hi and thanks for your post. When a waiting area in a psychiatric clinic is transformed into a peer run Decision Support Center, every effort is made to make the software program fully accessible. Health literacy, and even basic literacy, is not an issue as the program requires no keyboarding and users can choose to listen to the program. The Decision Support Center and CommonGround software are currently being used by very poor people receiving public sector mental health services in a large urban area. People diagnosed with schizophrenia, bi-polar disorder, schizoaffective disorder, major depression and co-occuring substance use disorders use the software with little difficulty. Doctors and prescribing nurses say the program creates efficiencies in thier practice and enhances the therapeutic alliance. Our client focus groups have indicated that the videotaped recovery vingettes give hope for recovery. The videos do not create unfounded expectations for short range cure but, rather, give hope that life can get better in ways that are meaningful i.e., getting a job, raising children, living in a home rather than housing, living in the community rather than an institution. The program is not critical of psychopharmacology. It supports people in learning to use pill medicine and personal medicine in optimal ways that support recovery.
I hope these comments help to clarify your concerns.
Pat Deegan
Disruptive innovations… what a great idea. As a person in recovery from serious mental illness I’ve spent a fair portion of my life experiencing disruption. One of the most significant challenges I’ve had has been in finding a way to challenge the myths and misconceptions about mental illness. So many treatment interventions are provided from a deficit perspective; where the goal is stabilization and maintenance rather than recovery.
Many people get confused about the concept of recovery in mental health and fall into meandering discussions about biochemistry, stress tolerance, medication adherence, and side effects. They seem convinced that the language surrounding psychiatric symptoms is what predicts the outcome for people - that if you use the words “chronic or persistent” then you have, by definition, limited the possibilities for that person.
Yet, when I am among the community of my peers, other people who experience psychiatric symptoms, I hear about recovery. The conversation turns to one of healing - healing the pain and the shame of mental illness. We talk about wellness and hope and meaning and purpose. It seems there is a clarity that comes with living the life, and that clarity brings many gifts. It pushes us – it pushes me – toward innovation!
Last year I had the opportunity to become involved in the progressive work that Pat Deegan is doing in shared decision-making. I was hired as the project manager with my major responsibility being the implementation of a peer-run decision support center. I worked with a group of recovering people and we interviewed and hired the first “peer specialists” to staff the center. The skill that the new employees brought to the table was the experience of recovery.
The people we work with in the decision support center are people just like us. Most people do not have previous computer skills; a few (though not many) have limited literacy skills. They come from every walk of life, though many struggle with poverty as a condition placed on them due to the myths around mental illness. Every person we work with has been diagnosed with a serious mental illness (thought and mood disorders, primarily.) And every one of these people has the capacity to recover. Each person’s recovery will look different, it will follow a unique path, and it will take a different amount of time. For some it will lead to independence, for others it will lead to interdependence – but for everyone it is necessary for someone to believe in them… to believe that recovery is possible – because that it how we break through the oppression of deminished expectations.
There is no “quick fix” the same way there is no "magic pill". Recovery takes hard work. It must be nurtured. It takes time. It takes aggressive, progressive practices… that push beyond the soft discrimination of low expectations. It takes disruptive innovations.
Hello. Thanks for your post Charlie Brown. The web-based CommonGround software program includes user forums that are currently in development. The vision is that peers will have a place to interact with peers around topics of interest. Of course, the touchscreens and semi-private kiosks at the Decision Support Center are peer run features. Peer to peer interaction is the foundation of that work. Peer support makes a big difference in how CommonGround is received and used. Peer specialists can bill Medicaid for their work in many states, including Kansas. That means that the staff of the Decision Support Center generate revenue to sustain their work. Here is a poignant example of the power of peer support in the Decision Support Center: A man diagnosed with schizophrenia had had case management support for many years but mostly kept his distance and was difficult to engage in services. He did not find psychiatric medications to be helpful and refused to use them. When he came to the peer run Decision Support Center, he did the CommonGround Program with some support from a peer specialist. It turned out that the man recognized the peer specialist - they had both been in the hospital together. The man was impressed that his friend had done so well in her recovery. The next time the man came to the DSC he bathed and put on fresh clothes in anticipation of meeting his friend. It's the first time he had bathed in a very long time. The next month he called his casemanager to remind him to get him to cinic on time because he had important business with the peer specialist at the clinic, etc. I guess the point is that sometimes peers can support peers in hope-filled ways. The human dimension is so important! One more quick example. A woman with bipolar disorder who was using mood stabilizers, was doing her CommonGround report in the DSC. She was intermittantly chatting with the peer specialist as she completed her report to take into her doctor's appointment. As they spoke, she happened to mention to the peer specialist that she was trying to get pregnant. The peer specialist asked if she had indicated that on her CG report and if she had told her doctor. She had not done either. The peer specialist directed her to the part of the CG report where she could enter concerns about medication and pregnancy. With peer support and the software program she was able to communicate her concerns effectively to her doctor and adjustments to her medications accordingly.
I was struck by the importance of this innovation in psychiatry. It engages the patient actively with the decision-making process of prescription in a participatory and comprehensive manner. I believe “CommonGround” is an excellent initiative and much needed. I am also interested in the support offered to your clients in using the software. It seems to be very accessible, but how would it work with clients whose psychological impairments may hinder their ability to use this tool?
If possible, could you share with us some successful cases, in which doctors have utilized this tool and “influenced” their decision while prescribing medicines?
How accessible is this tool now? What would it take to implement this innovation in other clinics?
Hi Roberto. Thanks for your post. You are right in saying that the software is accessible. Even people who are new to computers use it with little fuss. Peer specialists are available in the Decision Support Center to support clients in using the program. It has been interesting to see the various ways that people approach the kiosks. Most people read the program and put on headphones only to listen to the 3 minute video vingettes in which people diagnosed with major mental disorders describe their recovery process. About 20% of people prefer to listen to the program. Sometimes the choice to listen is a function of low literacy. Sometimes choosing to listen is just a preference. Some people, even though they can read, prefer to have a peer specialist read the questions to them. When asked, these folks indicate that they like the human, interactive aspect of being read to.
One of the unexpected outcomes is that the CommonGround software program can act as assistive technology for some people with psychiatric disabilities who are experience acute symptoms of psychosis. For example, a young woman came to clinic in a very disorganized state. She was hearing distressing voices and, though she had a lot to say, it was difficult to make sense of what she was saying. Peer specialists invited her sit at the kiosk to do her CommonGround Report. To our surprise she completed her report while listening to the program on headphones. She produced a coherent report that communicated her concern to her doctor. Through the report she basically told her doctor - HELP, the medicine is not helping me. In other words, though she presented at clinic as disorganized, the software provided assistive technology that organized her story in a way that others could understand it, not unlike the way that assisitive communication devices might help us understand the intentions of a person with cerebral palsey. In any case, the psychiatrist was deeply moved to discover intentional consciousness at work in a young woman who was acutely psychotic.
We see the CommonGround tool influencing the work of the doctors and nurses. In our focus groups the prescribers and nurses report that the CG program creates efficiencies and allows them to focus quickly on areas of concerns to clients. The 1 page report brings to their attention a more holistic view of who the client is and what their strengths and concerns are. For instance, a man diagnosed with schizophrenia presented as very quiet over many months and his reserved presentation was thought to reflect the negative signs of his disorder. Through the CG program this man had a chance to express his "personal medicine" or those things he did to create wellness in his life. His personal medicine included listening to hip hop music. This appeared on this 1 page CG report and opened rapport with his prescriber. Since that time he has become increasingly engaged with his prescriber and more active in making decisions about his psychiatric treatment. The CG program has meant that the culture of the medication clinic is evolving ton include a more holistic, person centered view of clients, their strengths and concerns.
In terms of bringing this tool to other clnics, the architecture of the software was built to make it relatively easy to enroll new clinics. As we scale up over the time, adding a new clinic simply involves identifying a clinic administrator to assign user names, passwords and permission to docs, nurses, casemanagers, clients, peer specialists, researchers, etc. Hardware needed include computers with browsers, broad band connections and touch screens if desired. Training of peer specialists, case managers and medical stafff is recommended. An internal plan for phasing in clients to the new program is needed and then clinics would be ready to begin.
I enjoyed reading your entry and was wondering if the web based system has user feedback loops that allow the patient to provide feedback on what seemed to work or not work. Also, is there a community element to this where patients can help each other?
Thanks.