“A simple question about someone’s story can change the whole course, not only for the five percent but all of us.”

On March 29, Lauran Hardin, Senior Advisor of Partnerships and Technical Assistance at the National Center, spoke at TEDxMidAtlantic in Washington, D.C. to a full house at Sidney Harman Hall. She shared the lessons she’s learned as a nurse working with “the five percent” of people in the United States who drive 50% of healthcare costs, a subsection of which are individuals with complex health and social needs, and how we can change our systems to improve their lives.  

“Understanding the five percent is like tapping into the canaries in the coalmine of our social issues today,” Lauran told the audience. Compared with other high-income countries, the United States spends significantly less of its gross domestic product on social services. “That lack of investment then shows up in healthcare, in criminal justice, and other places. One of the gifts of working with [this] population is seeing what makes a difference in that.”

Lauran’s talk was part of TEDxMidAtlantic 2019: Unbreakable!, a two-day event featuring short talks and performances aimed at fostering learning and discussion on a variety of social issues. The event featured an diverse lineup of speakers, including a Holocaust survivor who learned magic tricks to help him survive Auschwitz, and a nuclear policy expert speaking about the need for congressional leadership on nuclear threats, but the overarching theme in the presentations was the same: How can we turn adversity into strength and make our systems and institutions unbreakable?

What matters most to you?

Lauran began her talk with the story of Charles, a man experiencing homelessness, behavioral health issues and a history of trauma in the small California town of Clearlake. Like many individuals with complex health and social needs, Charles was caught in a cycle of incarceration, hospitalization, and hardship. But when a police officer and social worker, working as part of a new collaborative called Project Restoration, approached him in a park to learn about his story, things began to change.

After a few failed attempts to connect, they asked him a key question: “What matters most to you?”

His answer was clear: to get well enough to meet his first grandchild.

Because Project Restoration had brought multiple sectors—police, fire, EMS, social services, behavioral health, and healthcare—to the same table to figure out how to improve what were some of the worst healthcare outcomes in the state, they were able to work together to organize care around Charles’ goals.

He got treatment for his substance use disorder and transitional housing, and then was able to move into the brand new Restoration House, where residents are all equal partners in running the community and are able to become peer mentors to new residents and to bring their experiences and insights back to the Project Restoration collaborative.

Creating belonging and agency at all levels

As Lauran stressed in her talk, Project Restoration’s emphasis on creating a sense of agency and belonging was what allowed Charles and other Clearlake residents to make such dramatic changes in their lives. But the same principle holds on the community level. When the police, nurses, doctors, social workers, and paramedics of Project Restoration came together to answer the exact same question they asked Charles, “What matters most to you?”, they were able to build a sense of agency and belonging for themselves as well.

“As [Project Restoration members] sat at this table and stepped out of their silos, they stopped competing for limited resources,” said Lauran. “They actually walked outside of their buildings and worked together on a shared community problem, and created a sense of belonging with each other.”

The Project Restoration team got a lot done: beyond opening Restoration House, they improved the transportation system for vulnerable individuals and created permanent infrastructure for cross-sector collaboration. But, Lauran said, “the most valuable change that happened for them is they also had a sense of connection. A sense of agency. A sense of ‘We can change this.’ And they did.”

Collaborative Impact by the numbers

As Lauran wrote with Shelly Trumbo, the Community Integration Executive for Adventist Health System, a Project Restoration partner, in an accompanying piece for STAT News, Project Restoration’s person-centered complex care approach has had a measurable impact on their target population’s healthcare utilization and costs. Since they engaged residents like Charles in care that addresses what matters most to them, they have seen:

  • a 44% reduction in hospital utilization
  • an 82% reduction in use of the community response system
  • a 45% reduction in hospital costs among the high-use population

Project Restoration has also secured a $1.6 million grant to develop a center for integrated support services in Clearlake.

With its person-centered, cross-sector and team-based approach, Project Restoration exemplifies many of the complex care principles outlined in the Blueprint for Complex Care.  The collaborative’s dramatic results point to the transformative potential of complex care to bring dedicated individuals and organizations together across a community to create ecosystems of care that address the underlying drivers of poor health outcomes. Lauran identified a number of these drivers in her talk: lack of safe housing, behavioral health needs, social isolation, and trauma.

“The most valuable change is a return to dignity,” Lauran said. “A healthcare system reimagined around what matters most.”

Watch Lauran’s full TEDxMidAtlantic talk here.

Project Restoration was supported in co-design through the  National Center’s technical assistance team. Learn more about how complex care experts like Lauran Hardin from the National Center can help your organization establish or improve complex care programs in your community.