C4 Innovations

Providing Whole-Person Care

An episode of “Changing the Conversation” podcast

Ken Kraybill and host Steven Samra discuss the importance and impact of whole-person care and how recognizing what is happening to, with, and around an individual supports healing and recovery.

January 24, 2022


Steven Samra, Host (00:05): Hi, and welcome to Changing the Conversation. I’m your host today, Steven Samra, Senior Associate with C4 Innovations. Our topic today explores the concept of whole-person care, what that looks like, what it is, and why it might be important. I’m joined today by my colleague, my friend, and the Senior Trainer for C4 Innovations, Ken Kraybill. Ken, I’m so glad you’re here today.

Ken Kraybill, Guest (00:34): Thank you Steven.

Steven (00:35): As we dive into this topic today, let me just say that I am a person in long-term recovery, and I am in recovery from an opioid use disorder. The truth is, I don’t think I’d be alive today if it wasn’t for that whole-person care approach. It’s the first time that I’ve personally worked with a treatment team to really identify, understand, and then actually treat all of me and not just my substance misuse, or my mental health challenges, or the trauma that I’ve experienced.

Steven (01:07): That whole-person care, it actually saw and it treated me as an entire person and not a deficit, like something broken that needed to be fixed. It really was no longer, “Hey. What is wrong with you,” but instead, “What happened to you, and how do we support you?” So, Ken, with that, what do we mean by whole-person care? What is it, and why is it important?

Ken (01:36): Let me say first of all, Steven, that you have been a wonderful teacher for me about what this concept means because you have freely shared of your own recovery journey, your own story. It’s from people like yourself and others that I have tried to put my own head around this concept. I will say that whole-person care is in the eyes of the beholder. If you look in the literature, people define it in different ways. The way that I have come to prefer to use it is to kind of take that concept that we often do talk about of providing care to the whole person, right, and just flipping that and saying, “Well, what does that mean? What is whole-person care?”

Ken (02:20): We recognize that human beings are incredibly, complexly, and wonderfully made, and they’re complicated, and there are lots of moving parts. We are, in particular, people who live in a set of circumstances, we’re influenced by different causes and conditions, and so no one of us is alike. Which means that whole-person care by definition is going to be dissimilar for every person. But we can talk about it nonetheless of bigger terms. I will just say this. I think whole-person care in my mind is really just a way to revisit and reframe what we all do typically refer to ourselves as health providers, or providing health care, providing behavioral health care.

Ken (03:08): And I go back to the meaning of the word health, which in its essence means wholeness, and being whole, and being sound, being well. It’s not just about an absence of disease or an absence of bad things happening in our lives. But it’s also about feeling happy, and feeling like we’re safe, and we’re loved, and we belong, and we are connected to people, and all of those things. That’s kind of where my mind goes initially when you first asked the question. I would love to hear what your thoughts are further around that.

Steven (03:44): Well, Ken, thank you. That’s a fantastic response. Through that response I kept thinking, “So why is this so important, whole-person care?” I think from the few words you had right at the end of your little spiel there, it’s around things beyond my substance misuse or my mental health challenges. It’s really around—what’s the environment this person finds themselves in. What’s the status of their finances even? Are they living in poverty? Are they experiencing homelessness, as an example? Because understanding those pieces often helps us connect the dots about why it is that Steven Samra has an opioid use disorder in the first place.

Steven (04:41): If you were coming at me in that sort of deficit way, the traditional medical model approach, you would’ve identified an opioid use disorder in me, and you likely would’ve treated that. That’s exactly what happened to me for the first 15, 20 years of my recovery. But what’s really interesting is that by only focusing on my opioid use disorder you absolutely would’ve missed my trauma and my mental health challenges, both of which through whole-person care I’ve identified as driving much of my substance misuse. So, from my perspective, being able to look at a person beyond just the health component and thinking about it in terms of what supports that person’s ability to maintain health or even achieve health, those things are extraordinarily important, and we often miss or overlook them.

Ken (05:50): Yeah, I really like that. What it leads me to think about is, what if we ask questions like, “What is the function in this case of you’re using opiates? What was the original purpose, right, or the desire? What were you trying to achieve? What did it do for you even?” Right? I think we recognize that if we only look at things in terms of what we see in the here and now, and in one slice in time, there’s a whole backstory, right, and a whole front story too that you can live out. But there’s a whole backstory we need to understand first, at some level at least, in order to create a whole-person plan that addresses all of those different pieces.

Ken (06:39): I want to be really cautious here. I don’t think any one person is capable of providing whole-person care to anybody else. I think it absolutely takes a team, and so we do our parts. But if we segment all of our care, which is the state of our system today, it’s still quite siloed and quite separate from one another, even though there are certainly good efforts made to try to bring systems together and integrate them, and especially if those systems aren’t talking with each other, then we’re just missing the mark or maybe we’re hitting lots of marks but missing the big mark of how does all this fit together.

Steven (07:20): What’s interesting to me about that is, a long time ago I was in a training and I remember … This was a street outreach training, and I can remember hearing somebody stating that when you are engaging with somebody who is experiencing homelessness, you’re catching them in basically a snapshot in time. That’s exactly what we do when we head to the ER with our opioid use disorder. Or when I am struggling with an abscess that I got from injecting, and at the ER I’m getting my abscess treated while I’m receiving the nasty lecture from the person stitching me up or cleaning the wound about how terrible it is that I have an opioid addiction.

Steven (08:14): Distilling a person down to the most sort of egregious component of their existence, that single snapshot in time, is pretty much how I think when we come into this medical model, the current model, that’s exactly what happens. I don’t think we want to fault the physician, or the charge nurse, or the staff at the hospital. I think they’re doing a job that is really pushing them to count widgets essentially. So whole-person care requires some time, and it requires getting to know that person to really understand what’s happening to, with, and around that individual. Currently we’re just not set up to do that.

Ken (09:10): Yeah. I so appreciate the fact that it is important to recognize all of the things pressing down on care providers that probably keep them from being the whole-person care practitioners they want to be oftentimes. And they’re forced to work in different, in very narrow ways. Another thing I was just thinking about as I was listening to you. You come in, right, to an ER and whatnot and you want an abscess treated, and of course that’s the immediate focus of attention.

Ken (09:43): But what if then somebody were to have a conversation with you about, “Tell me a bit about your life. What’s going on?” Right? “What are some of your aspirations? What are your hopes? What would you like to see different in your life?” Maybe you would identify something and maybe that person would say, “Well, what would be some reasons to do that? What might be at stake if you don’t make some changes here? Who can support you? How might you go about it?” These are the kinds of things that listeners will recognize come from the practice of Motivational Interviewing, which is one of the best practices in this whole-person care approach.

Ken (10:24): But the tone of how we are with people, and the kinds of things we inquire about, will lead us to very different places than, like you were saying, basically the blaming-shaming method of why are you doing this, and get over it, and get on with your life. I’m curious, Steven, if you don’t mind. You talked a bit about trauma. If somebody were to treat you in a trauma-informed way or a healing-centered way, what does that feel like? What’s that like?

Steven (11:00): Well Ken, that’s a great question because I think it really hinges on the idea of coming at me in the ER in a sort of dignified, respectful, how do I support you, kind of way. That’s pretty rare, and we’ve talked about why that is. But it’s also why we’re seeing more and more recovery coaches and peer specialists, peer workers, in emergency rooms across the country. It’s because those peers have been trained in Motivational Interviewing, a number of other evidence-based approaches, and they do have the time to spend, to share, to talk, and to explore with somebody who may not be particularly thrilled about doing any of that.

Steven (11:57): They may have just overdosed from an opioid, awakened in a hospital, likely having police officers around them. None of that is very comfortable for anybody who uses substances, particularly illegal ones. And being able to spend some time with somebody who cared and somebody who you could tell within the first 60 seconds of a conversation that they had credibility, they had been there, and know their journey wasn’t exactly like mine. But the fact that they were in recovery and able to have this conversation with me in a place like an emergency room where you would never expect something like that, the very thought of that makes me jealous that I didn’t have that opportunity when I was seeking recovery.

Steven (12:55): It’s one of the reasons that the work I do today is focused right there. It’s on really exploring and uplifting the hope and the dignity of individuals, particularly those who have used drugs in their past, and looking at them as a full person and not just distilling them down to the most egregious thing that we can think of, addict. It’s really important that we recognize the individual and not the disease.

Ken (13:31): You mentioned peers and people living in their recovery who are now prepared to also help others in their journey with them in their recovery. How important is that to you? I’ll just preface that by saying that was never part of my world when I worked in the mental health field for a long time, and yet now I’m seeing people with lived experience living with mental health disorders who are I believe making a tremendous difference in people’s lives. Can you just say a bit more about that?

Steven (14:06): Absolutely. I think that the easiest way for me to say that and to really share the value and the importance, maybe the important value, is this. Had I not been exposed to peer workers, particularly recovery coaches, I’m not sure that I would’ve had the courage to step out of my substance use lane and admit, or even acknowledge, frankly, that there might be a mental health condition occurring underneath this. Part of the reason for that is the stigma. Certainly in the culture of addiction that I operated in for decades, frankly, folks would often say, “Well, I might be a dope fiend, but I’m not a crazy dope fiend.”

Steven (15:14): I don’t mean any disrespect to anybody listening, but I do remember that I felt that way, and that stigma was powerful. It was because I had heard recovery coaches and peer specialists talking about their mental health challenges, and their substance use challenges, and their trauma challenges, and their poverty challenges, in a way that normalized that for me. And because it was normalized, I had the courage to bring it up to my physician, to actually my addiction psychiatrist.

Steven (15:57): Not only did I do that, but I asked for a bit of thorough testing. “I’d really like to identify if I’m going to do this, I want to know what’s going on.” All of that arose because of the impact recovery coaches had for me, and today that’s what I do. I normalize this. I wear these things on my sleeves, warts and all, because these are the things that happen to us out there. And if we can normalize the understanding that these are diseases, we can come at treatment a lot more effectively.

Ken (16:38): As you’re talking about all this, I’m thinking about a toolkit that you and I were involved in producing that was released in August of 2021 called “Whole-person Care for People Experiencing Homelessness and Opioid Use Disorder.” In that, you’ve touched on a number of things that I think are critical parts of whole-person care.

Ken (16:59): Including that idea of being trauma-informed, and healing-centered, of being very person-centered, of being recovery-oriented, of helping people think towards the future, and being racially equitable, knowing that discrimination practices are hugely a part of our systems. Being non-stigmatizing, focusing on stable housing for people who don’t have it, and then meeting with people in a way that we partner with them, that we’re accepting, that we are compassionate, that we evoke from them their own wisdom and answers.

Ken (17:35): Those are all component parts it seems to me of all of this. Of course a whole lot more could be said about that. But I think this isn’t about doing stuff to people in terms of treating people by doing stuff to them, so much as finding a way to come alongside them and try to understand their backstory, help them understand where they are, where they were, but also where they want to go. That kind of hopefulness I think is what carries the day for many people. I know you personally are somebody who responded in time, it took time, but to that approach in a positive way.

Steven (18:17): Absolutely Ken. You know, I think a large part of that, honestly, and a large part of the growth in recovery. In fact, I think today I’ve been growing in recovery so long that it doesn’t feel like recovery it really feels like discovery. But through this journey it’s really the cultural humility that I think has helped me shift the lens. In cultural proficiency, cultural competency, the lens is pointed outward, and you’re looking at other people’s cultures, and you’re figuring out how best to fit and to be respectful.

Steven (19:05): With cultural humility, we just turn that lens around and start looking at who we are, how we think about things and the things that we believe. That sort of deep introspection has probably done more for me in terms of growth, maturity, wisdom, adulting, than perhaps anything else that I’ve done. So I think it’s that cultural humility piece, particularly around equitable outcomes, I don’t know how we would get there without that.

Ken (19:46): This term humility I think is so critical. You know, one of the things we know about people who desire to help others is, it’s a wonderful impulse. Right? It’s a wonderful sense of calling. But we also know that helping also ends up looking like imposing upon people what we think they ought to do, and assuming they don’t know what they can do, that’s why they’re stuck where they are. And the humility part, cultural humility and otherwise, is recognizing that we don’t have all the answers. And even the answers we think we have might not be the right ones for that person even if they were right for ourselves or somebody else.

Ken (20:25): And more so, I think just this idea that we fail to realize that people have within them already existing knowledge and wisdom, and aspirations, and hopes, and motivations, that are positive. And people want to live a life of connection, the value of belonging, of happiness. Right? So it’s sort of that’s our beginning, and that’s our end, and that’s the through line. Right? That we assume that people have within them pretty much everything they need in order to be able to make the changes they need, and we’re there as a guide to be with them in that journey in solidarity with them.

Steven (21:07): Ken, another best practice that I’ve been thinking about is harm reduction. Harm reduction has been one of those topics that kind of raises some eyebrows and has some controversy around it. But the truth is that it’s an evidence-based approach, and it has been extraordinarily successful in, frankly, saving lives. I certainly practiced, even in active addiction, practiced some harm reduction when I carried bleach when I was injecting heroin.

Steven (21:44): Harm reduction to me provides the dignity to people who may be out there using drugs and helps keep them alive until they have an opportunity to actually access recovery. That may never happen, but at least we’re giving them an opportunity to do so. There’s one other I think, a really critical piece of this. As we think about whole-person care, one of the other best practices in my mind is around self-care. Can you say a few words about that?

Ken (22:19): Yeah Steven. I’ve been told it’s a good thing to do. I’m chuckling to myself because it’s so critical. We are the vehicle of all of these different practices. If we aren’t of good body, mind, and spirit in the work that we do, we cannot be particularly helpful to others. So I’ll leave it there, but critically important.

Steven (22:47): Exactly Ken. It has been such a pleasure to sit here and chat with you today. Thank you so much for joining.

Ken (22:54): Honored to be here with you Steven.

Steven (22:56): To our listeners, join us next time on Changing the Conversation.

Erika Simon, Producer (23:01): Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.


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