Evaluation of a Veterans Health Administration Whole Health for Mental Health Course for Clinicians.

Objectives: Veterans experience mental health disorders at higher rates than their civilian counterparts and also experience multiple barriers to mental health services. The Veterans Health Administration (VA) has implemented a Whole Health approach to make health care more person-focused and oriented toward promotion of health-sustaining behavior. We conducted an evaluation to investigate the effects of a Whole Health for Mental Health (WHMH) course for clinicians that focuses on shifting the perspective to a system of care in which mental health is incorporated as a core part of whole-person care. Design: We collected surveys before the course, immediately after the course, and at a 2-month follow-up. Settings/Location: The course was implemented in non-clinical settings in two VA medical centers (one in the Northeast and one in the Mountain West). Subjects: Our sample consisted of VA staff who enrolled in WHMH and completed a pre- and post-survey (n = 100) and follow-up survey (n = 99). Intervention: The WHMH is a 2-day face-to-face course that covers multiple aspects of mental health through a Whole Health lens. The course includes evidence-based practices within each aspect of mental health. The course also emphasizes implementation of Whole Health in clinicians' lives, their practice, and the health care system. Outcome measures: Attitudes were measured at pre-, post-, and follow-up assessments. The WHMH behaviors were measured at pre- and follow-up assessments. Results: There were statistically significant, large changes toward improvement from pre-test to post-test for all attitudes examined. These changes remained significant at follow-up, and the magnitude of change remained at least medium to large. Statistically significant, medium magnitude or larger improvements were found at follow-up for four of the five WHMH behavior outcomes examined. Conclusions: Our results suggest that clinicians can increase their attitudes and use of Whole Health concepts and both conventional and complementary approaches related to mental health issues.

Perceived Behavioral Control as a Key to Integrative Medicine.

The purpose of the present study was to identify the factors that are the strongest predictors of intentions and use of integrative medicine approaches in clinical practice. Ajzen's theory of planned behavior was used to guide our examination of these questions. Health care professionals exposed to a Veterans Health Administration program (N = 288) who completed survey instruments prior to and immediately after the program and 3 months later were the participants for this study. Findings suggest that the theory of planned behavior performs reasonably well in explaining our data showing the integration of integrative medicine approaches into clinical practice. We found that self-efficacy to use integrative health approaches and perceived preparedness to discuss nonpharmaceutical approaches with patients were the strongest predictors of intentions to use integrative health approaches and self-reported change in clinical practice. The implications of these findings are discussed.

Impact of a Clinical Educational Effort in Driving Transformation in Health Care.

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess whether a 2.5 day clinical education course focused on integrative medicine (IM), complementary health (CH), and patient-centered care strategies delivered to staff at Veteran Health Administration (VHA) facilities resulted in changes in attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies. The study also assessed whether there were differential impacts by participant characteristics. METHODS: The study used a pre-post intervention group-only design with participants who completed self-report pre, post, and 2-month follow-up surveys. The course was delivered to 15 VHA facilities, reaching a total of 655 participants with 407 participants completing the 2-month follow-up survey (65% response rate). RESULTS: Findings suggest that the clinical course was associated with changes in all outcomes at the 2-month follow-up, including attitudes, self-efficacy to engage in IM strategies, institutional support, perceived preparedness to discuss non-pharmaceutical approaches to care, intentions to engage in IM strategies, and greater engagement in IM behaviors during clinical encounters. Differential impacts were found for younger participants, longer tenured staff, non-nursing compared to nursing staff, and among those who volunteered as opposed to those who were required to attend. DISCUSSION AND CONCLUSIONS: The study found significant positive changes in all outcomes measured at the 2-month follow-up. Positive impacts were found across a variety of participant characteristics. Findings suggest that this brief experiential course, designed to be a foundational strategy in driving transformation is effective in shifting attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies.

Inflammation: nutritional, botanical, and mind-body influences.

Chronic inflammation is becoming an important risk factor to identify in regard to inhibiting disease onset and its progression. Nutritional science attempted to improve health by manipulating fats so that we could consume "healthy" nonsaturated fats while simultaneously allowing foods to have a longer shelf-life. However, despite our good intentions, trans-fats and partially hydrogenated oils have been found to promote inflammation and adversely affect health. This article reviews how essential fatty acids, the ratio of omega-3 to omega-6 fatty acids, glycemic load, the Mediterranean diet, specific foods and botanicals, and the mind-body relation influence the inflammatory cascade.

Optimal healers: igniting the spark and fanning the flame. Training academic medical faculty in optimal healing.

Optimal healing environments (OHEs) require optimal healers to keep them flourishing. Academic medical faculty are in a unique position, through their involvement in education, research, and leadership, to create and perpetuate OHEs. Means by which they might do so using a motivational interviewing model as a framework are discussed. A four-part process to facilitate faculty involvement is described: (1) means of assessing interest in creating OHEs; (2) methods for moving interested individuals beyond a merely intellectual interest to a deeper level of commitment; (3) ways of providing optimal healers with the tools they will need to successfully create OHEs; and (4) perpetuation of OHEs through support networks and educational methods. Resources and examples which can guide the creation of an optimal healing curriculum are provided.