The integrative treatment plan

By Julie Luzarraga

Integrative healthcare is a holistic all-encompassing approach to health and wellness.  Many of us visualize this as a wheel with equally weighted sections representing the many areas of a person’s life that influence their health. These areas include financial, social, environmental, spiritual, physical, and the emotional aspects of our lives. Each of these domains in turn impacts the others in both times of illness and wellness. 

An integrative health assessment is done with ample time, thoughtfulness, and special attention to the patient’s unique experience. Each person’s presentation is different and the path to healing or maintaining health may be hard to map out. An integrative treatment plan maps out the goals, prepares for potential barriers, and creates additional buy-in for patients.  When done mindfully, it is also a tool for ensuring provider collaboration and preventing unnecessary duplication of services. 

Building blocks: The wheel of health

The integrative healthcare assessment relies on the wheel of health: financial, social, environmental, spiritual, physical, and the emotional. These aspects then become the building blocks of the integrative treatment plan. If something is being assessed, it should show up somewhere in the treatment plan.

One of the benefits of an integrative treatment plan is that helps to keep the wheel of health front and center post-assessment. For example, intake and assessment may have included a family history of depression, which can get easily lost in treatment planning. If provider and patient create the goal of “monitor and record mood weekly,” both will continue to be mindful of noting any significant change in mood that could be an indicator of a more serious issue.  Making this part of the treatment plan creates a natural reminder to follow up. 

Each area will also inform the other while creating the plan. A family history of significant depression may change the type of medication or supplement chosen for another condition. I share a patient with one of our medical providers, and, in developing the treatment plan, depressive disorder was included in the emotional health section. The medical provider used this information in making decisions about treatment for the patient’s hypertension, helping to prevent potential decline in mood and energy.

This structure of listing each area of financial, physical, emotional, spiritual, social, and environmental segments will help to identify any gaps that need to be filled with a referral. A new patient at our practice identified feeling a loss of spiritual connection after recently moving to the community. She had not found a place she felt comfortable to worship and she was worried it was affecting her mood and stress level. Obtaining a list of churches that she would identify with became one of the initial treatment goals. This might have been otherwise overlooked if had not been an included section in the treatment plan.

Cocreating an integrative treatment plan

Traditionally, treatment plans have been a means of documenting a provider’s plan for interventions for their patient. Patients rarely saw their own treatment plan and they certainly were not a part of creating the plan. Starting from assessment, patient and provider can cocreate the treatment plan. When we share this responsibility, patients are given the opportunity to tell their story and voice their primary concerns and goals. This is often an organic process that happens over a couple of appointments. What makes it cocreated is the integration of the provider’s assessment and recommendations with the patient’s primary goals, limitations, and strengths. Our recommendations may be shifted by a patient’s goals or limitations. The only way to know is by asking. 

For example, we have a patient who is in a wheelchair. His goals are to maintain his health and improve mood preferably without adding a medication. Together, he and his provider agreed upon a yoga class for him, which would have both emotional and physical benefits. A yoga class would not have been his provider’s first thought, but in spending time talking with the patient, he shared that he really wanted to work on muscle tone and missed being around people. Yoga class became a natural fit for his goals.

Components of an integrative treatment plan

Because the integrative treatment plan is cocreated, it includes both goals and interventions, as well as identifying potential barriers. Like ensuring a prescribed medication is affordable for the patient, if exercise is prescribed, we need to assess if the patient has access to a gym. Other barriers can be work or family commitments that cannot be negotiated. Some barriers can be overcome with the support of a health coach or mental health provider. 

I have worked with many patients who have felt like they have previously failed because their treatment plan was either unrealistic or lacked the support and education needed. This can be eliminated by having a potential barriers section with action steps on how the barriers will be addressed.

Along with the goals and potential barriers, it is helpful to identify action items and timeframes.  Having realistic goals with specific steps and dates for achieving the goals can help to keep a treatment plan manageable. Some treatment plans may consist of a monthly goal of medication compliance and continued exercise that increases in duration each month. Other treatment plans may have scheduled dates for procedures or medication checks. Whatever the goals or interventions are, the integrative treatment plan becomes a living document that gets reviewed and updated frequently. It is a roadmap for both the patient and provider to use at every visit.

Collaborating providers

The living document that is an integrative treatment plan also includes the collaborating providers. Whether it is in an electronic or paper version, the treatment team should be completely represented and share frequently. While one provider may be monitoring mood, another provider may be actively treating it with therapy or medication. Those updates and goals are integrated into the treatment plan. Ideally, a patient can report and inform the treatment plan as a collaborator, but there are often cases in which the treatment plan itself will prompt providers to communicate. In more complex situations, the treatment team may include a case manager or someone who functions in that role. This person may assist the patient in keeping the treatment plan up to date.

Measurements and other assessments

Measurements and other assessments can also be included in an integrative treatment plan.  The most basic measurement is the percentage to which a goal has been met or the completion of an intervention. Recording and reviewing these milestones is empowering for patients. It documents progress and sometimes reveals patterns or informs shifts in the treatment plan. 

Additional assessments are also helpful in showing progress and informing any needed changes.  These may be psychological assessments, lab work, or other physical tests that would help to inform the course of treatment over time. As part of the living integrative treatment plan, patients and collaborating providers remain informed. 

An integrative practitioner treats disease states and provides teaching and coaching on wellness and prevention. Whether it is prevention or active treatment of an acute or chronic condition, an integrative treatment plan is a tool for both the providers and patient. In cocreating the treatment plan and actively reviewing it as a collaborative team, the integrative treatment plan empowers the patient and assists in moving treatment along the path to improved health and wellness.