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Promoting a Collaborative Approach in Treating the Complex Issues of a Homeless Veteran

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Getting Started 

1.  Listen to the monologue of Butch Sampson or download the printed copy

  • What social determinants of health are influencing Butch's situation? 
  • What are Butch's expectations of seeking help for his foot? 
  • What is the health care team’s expectation of caring for Butch? 
  • Is Butch's housing situation compromising his health situation? If so how? 
  • Can you foresee Butch's independence being compromised?
  • What do you see as the priorities in caring for Butch?
  • How do you feel about Butch's resistance to "do-gooders"?
  • How is Butch's vague paranoia contributing to any health concerns? 
  • Does Butch fit the criteria for schizophrenia or any other psychiatric diagnosis?
  • How is Butch's need for independence highlighted in the monologue? 

2.  The exploration of the provider's views on a  patient's situation often has an effect on how information is communicated.  For example, if the provider has negative feelings about an aspect of the patient's life, it could be a barrier to teaching and ultimately outcomes. This exercise allows the student to explore their own feelings about patients like Butch. It can either be down with an audience response system download the powerpoint for the audience response system here or with KAHOOT IT https://play.kahoot.it/#/k/25bdf8cb-9ba0-49a1-bd0d-afcb4f16fe81   a free system allowing students to respond using their cell phones. Both of these allow for anonymous responses by the students, and help to launch rich discussions in the classroom. The power point   document includes speaker notes. The questions in this activity are as follows: 

  • Most people who are homeless have put themselves in that situation
    1. I totally agree
    2. I agree with most cases
    3. Sometimes this is the case
    4. I totally disagree 
  • Being homeless may be a better alternative to living in a home with rules 
    1. I can't imagine that anybody feels this way
    2. This may be true depending on the rules
    3. In rare cases this might be the case
    4. I believe this is the case with many people 
  • People who are homeless are lazy and need to get a job 
    1. This would solve their problem
    2. There are many factors that contribute to homelessness
    3. People who work can still be homeless
    4. Most people who are homeless are unable to get a job 
  • There is a higher percentage of homelessness among: 
  1. Veterans
  2. Mentally Ill  People
  3. Middle Aged People
  4. Substance abusers
  • I will never be homeless
  1. I can't imagine a situation where this would happen to me
  2. Never say Never. This could happen if a series of events goes wrong
  3. I know how to access resources to prevent this
  4. I have been homeless 
  • My Independence is:
  1. Not that big of a deal for me
  2. Fairly important to my well- being
  3. A significant part of who I am
  4. Not something that I can control 

3.  As you listen to Butch's monologue how you would use a motivational interview approach to collaborate with him to optimize his health? Watch this video on motivational interviewing to better understand the technique where a conversation is centered around a collaborative approach to changing behaviors rather than telling the patient what they need to do. http://youtu.be/5ePJw0NjEec

These questions are all included in a power point slide in the materials section to use as part of a class discussion or assign in groups for the students to process. It is also an appropriate tool to use in an online setting.

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