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glambitions-a · 4 years

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falling, but i thought that you would need me.

“yes, gil, i promise they won’t make you drop out even if you don’t do your chores. you don’t even have to do chores anymore. you know that don’t you?”

audrey rose was trying her damn best to keep that god-forsaken snark out of her tone. she was trying because honestly, she did care. she cared so much, in fact, that the blonde had taken it upon her self to see that every single villian kid on that damned isle would be happily situated in healthy and safe homes. because she owes it to them, doesn’t she?

doesn’t she owe it to them after the half-ass apology she got from her royal highness, lady of the court, daughter of maleficent? because she almost destroyed everything, which is enough for her to almost start screaming because she didn’t really mean to.

but, it’s not right to dwell on the past, (she can still hear those words coming out of her own grandmother’s mouth, seated in the formal living room on golden detailed sofas, praying the lesson would end so she could go see her future husband ben.) she can think of old audrey, who’s snarky words were all that she had and held her tongue until one day it slipped loose of her hold. and now she’s lost everything, chad won’t look her in the eye (as he should, best friends don’t curse each other) but then she was queen, dark and incredibly regal so much so that she no longer had just her words, oh no, she had magic then, and she had made them pay (something still whispers that it’s not enough, they haven’t paid their dues, that it was only a fraction of the cost. she had been cheated)

sometimes, when those words get too loud, she goes away. for days at a time, its only gone over a week once, which got her in so much trouble with her family, so she’ll never do that again. audrey never seems to remember where exactly she goes, which is certainly nightmarish in every way all things considered. (by all things she really means her little incident not so long ago)

god forbid she actually feel something out of line, the world would turn upside down should she ever be angry, or passionate. even mal is walking on eggshells around her, the daughter of an effing villian scared of sweet little audrey rose. it would be laughable if audrey wasn’t scared of herself too.

“are you sure? i can..” the boy looked around their surroundings, the calm chatter of the cluster of picnic tables near them drowning out the birds chirping (which audrey has come to find out, uma hates the noise, harry’s indifferent; though his captain disliking it makes him hate it too, and gil just adores it, which makes the other two say that they don’t care even though they were hellbent on making gil happy. this kind of behavior audrey may or may not be jealous of. nobody wants to make her happy, they just want to keep her from exploding, it sounds so tempting to let her emotions run free, however dangerous it is.)

audrey doesn’t let him finish, putting a soft hand over top his own the table, like ben does. “i’m very sure.” she says with finality, which makes him beam gratefully causing the princess to smile in return. (”it’s a super power of his” harry had said. “uma coulda’ just lost a battle to mal and if he smiled, we were all doin better already.”)

but of course all so suddenly, disaster strikes. she can spot dark purple (a new establishment after several critiquing comments from council members about the blue she had sported) out of the corner of eye and she can tell she visibly pales because even oblivious sweet gil looks at her with concern. her hand leaves gil’s and goes to push herself off and up the table, heart pumping so loud it thunders through her.

gil’s face flashes briefly with alarm, before he turned around to discover the almost-queen laughing and waving at familiar faces and he turns back to her, his face soft with understanding (which fires up rage in her heart because he doesn’t understand, no one does. nobodies ever kissed his boyfriend in front of everybody with no apology.)

she wants to snap at him, her mind reeling in a response as soon as he looked at her. but she couldn’t. that was the old audrey, now she is kind and forgiving and gracious. (and jealous)

so instead she ignores him, (arguably not the best choice, but whatever) and picks up her purse from where it had been laid on the bench. audrey offers a smile, “i’m not feeling too well, must’ve been something i ate.” she laughs to cover up her bundled nerves but she’s not fooling anybody.

but then, gil stands up with her and goes over to where she stands, she’s in shock but tries to keep a neutral face on, her eyes following him. normally he always lets her leave because he’s such a pushover sweet friend. are they friends? or is he just here to tell mal she’s not losing her fucking mind? because she is, but if you can convince everybody you’re not falling apart of anger but of sadness, nobody has to tell that your therapist is really just somebody you vent to, and that they don’t actually make your gnawing anxiety go away.

“audrey, you haven’t eaten anything.” she wants to cry at the way he says her name, like he’s fucking disappointed when he really doesn’t have any right to be. it’s none of his business, but she really can’t think about it too much because she doesn’t want mal to see her and she doesn’t want to pretend to talk to her.

“oh,” the little noise she makes is pathetic and she immediately wishes she never made it she can’t let her guard down. “well i have to go talk to uh..” she tries to think of a name, any name that’s not mal bertha almost florian. audrey realizes how unsure she sounds and she tries again, “i have to go talk to freddie, she wanted me to help her with her goodness 101 homework, it’s funny sometimes i forget i’m in that class too.” i don’t belong there tries to force it way out of her mouth which surprisingly would’ve gone perfectly with that bitter tone the last part was uttered in.

she tugs her arm out of his grip (she hadn’t even noticed that he had touched her in the first place isle instincts would’ve gifted her so greatly.) “so, i should go. i’m sorry, i’m such a ditz i can’t believe i forgot!” she offers an apologetic smile and goes to turn but his arm is back, tighter this time, and she knows she isn’t getting away.

gil purses his lips like he’s in thought, before looking back at her. “i don’t believe for one minute that freddie needs help, mal helps her with her homework.” audrey opens her mouth to say something, whether an apology or an excuse she isn’t sure. “but --” her mouth abruptly closes with the look he gives her. “-- we are going to go with harry and uma and the four of us will do our homework together” he finishes with passion and a firm nod of his head, leaving no room for argument.

audrey wants to snarl and say something clever and fiendish like how he is dumb as rocks and really won’t be able to do the homework which isn’t true. she almost sobs at how easy it is to be mean, how quick she would’ve been had she not thought.

instead, she nods mournfully, like a pathetic pitied princess scolded toddler. she tries to regain her dignity by standing up straighter, which gil adorably tilts his head at.

the princess looks over her shoulder to still spot purple hair causing her to frantically drag gil away from the inevitable scene she could’ve caused. face paced heeled feet carry her far away from the anxiety inducing area and back to the comfort of her own dorm where she could wrap herself up in a blanket and just forget.

unfortunately, as she tries to make a break for it, gil notices and he tugs gentle as could be her back in the direction of uma’s dorm. normally audrey would argue that the library would be better suited, if it was somebody else. but harry hook is not well known for being quiet or getting along with other students.

and then she’s sitting on a lazily thrown teal comforter on top of uma’s bed, her book propped up against the foot board and her binder in her lap on top of uma’s feet.

the princess had finished her homework for the class the sea witch was currently groaning about a long time ago, it was simple and the questions were phrased in such a way you’d think that they were for kindergartners.

a pillow hits her shoulder and she is quickly startled out of her studies. “harry!” she cries, throwing it back at him. it misses, making him burst out laughing as uma leans back off of the side of the bed, causing audrey to grab her ankle in attempt to keep her from falling. uma punches harry on his knee from where he sits next to the bed, and that’s when gil starts to laugh.

and it stays like that for awhile, audrey trying to study while the so called ‘sea three’ goof off. it’s so sweet audrey almost doesn’t notice the prickling burning thoughts that start to bubble to the surface after gil says something offhandedly about taking over auradon that even uma doesn’t catch.

they laugh it off, although audrey’s laugh is a lot less convincing and her face is screwed up, she’s sure it looking absolutely disgraceful but they don’t notice so she lets it be.

and then she messes up because she lets the thoughts ravage her mind until that’s all she can hear. so much so she almost doesn’t realize that uma, who had taken a notice at her silence and brown eyes boring into the paper, is calling her name and now sitting up.

at least, until she does see and then she’s met with fierce eyes and a fiercer face laced with concern which makes her feel angry and comforted at the same time.

and that’s where things start to worsen for audrey because she could blow off and fake everybody else in the world, but not uma, and not her pirates. so really, it shouldn’t of surprised her when she tried to make up an excuse and got off the bed when uma pulled her back down.

“what is going on?” uma’s voice goes in one ear and out the other, truly, because she continues to try and leave.

“uma, please let me go. i’m serious i have to go.” she tugs backwards only to find a pale hand on her shoulder, and she looks up to meet blue eyes that tell her she’s not going anywhere until she answers them.

which is fine, because she scoffs and pushes harry’s hand off, squirming through uma’s tight grip on her hand. “i’m fine, please i have to go.”

her words don’t seem to affect uma at all because she’s still looking at her so sternly that audrey can feel herself shrinking back. “i’m sorry, but i’m fine.” she purses her lips to look up at uma. “ i don’t want you to pity me, i told you i’m not playing this game with you.” she sneers, and it’s accidental, but uma’s gaze only narrows.

she remembers the first time they met, when harry had conveniently disappeared and left her alone prime time for pirates ganging up on her, she supposed. she remembers uma telling her she wasn’t alone. and that was all she had said before taking her back to harry.

they were not friends, but they were not cruel to each other. they were kind, even. it was a mutual respect kind of deal (but did mutual respect include calming audrey down when she’s about to burst or letting her play with her fingers under the desks in goodness 101?) it was nothing more, really. audrey doesn’t owe her anything. (which is maybe why they get along so well.)

uma’s glare had turned cold as she let go of audrey’s arm, crossing her own over her chest. “i’m not going to pity you, princess.” uma’s tone matches her gaze and audrey feels as if her heart would shatter. and it’s especially ridiculous that her heart feels so broken because she wants this, doesn’t she. all she really wants is to be left alone, away from people who make guilt stir deep in her stomach because it hurts.

audrey’s is at a loss for words, her thoughts spinning her head around. “good,” she states, tilting her nose up only slightly (a habit) uma hates when she does that, because it makes her look entitled. but why not hide what is already there. “can i go now? or are you going to interrogate me some more?” interrogation, like when the kidnapped ben for the wand, because they’re pirates. every pirate’s a villian in the end, her grandmother had taught her that at least, maybe this is something she’s right about.

she can tell she did something because there’s a trace of sadness on uma’s face before it’s gone, she can see uma disappointingly wave her hand at harry and suddenly audrey’s free to go. (it’s pathetic how much she wants to dive into uma’s lap and never leave, to hold on tight to something, anything would be so lovely.)

she pretends she does not think about staying and collects her things quietly, imagining like she can not feel the three other teens’ eyes burning through her. her heart is stinging and she’s about to cry. (she can’t cry, she cannot cry in front of pirates, in front of villians.) but, she would rather be bitter than cry in front of people so instead she gathers her pride and leaves. audrey imagines in her head that they’re running after her, that somebody still wants her even after she’s been a bitch.

it’s a ridiculous hope, she wouldn’t want to be friends with herself after all she’s done and continues to do. she always finds herself alone and mean at the end of the day. her nightmares are always the same, her lying dead in a room full of adults she once was adored by, her cursing an entire kingdom (and abusing her best friend) and nobody ever saves her, nobody wakes her up.

the princess has always had nightmares, she had always imagined it was her mother’s curse, and her own curse had only heightened the fear and realism of them. once a week turned into every other night, which turned into never having a single dreamless night.

princess audrey rose never had any peace.

ʚĭɞ | hi there! i hope you enjoyed this lil bit of audrey angst. i’m not sure if i’ll continue this, it was very fun to have a break of writing my oc fic. it felt nice to write something new. i hope i gave audrey justice i really love her as a character and i recently did a ‘study’ on her outfits you can find here! let me know what you think! - rory

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yallreddieforthis · 5 years

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My Summer From Hell: A Tale of Friendship

Fandom: It (2017)

Pairing: Eddie Kaspbrak/Richie Tozier (minor mentions of Richie’s crush on Eddie)

Rating: T (for language)

Words: 2.9k

Movie canon-compliant. Also posted on AO3. This is that summer experience essay Richie warned us about.

“Richie Tozier?”

Richie takes a reluctant break from the sick-ass game of MASH: The Wonder Years Edition he’s playing by himself in his algebra notebook to look up at his teacher, who is waving a blue note and glaring expectantly at him.

Blue note. That means Neil wants to see him. Damn, only five days into the school year! New—actually, not a new record. Richie feels like he and the principal should be on a first-name basis by now; Richie’s in his office a lot. He rarely gets punished because most of the things he does toe the line of punishable offenses magnificently—he usually just gets told to stop doing whatever it is he’s doing and then gets sent back to class. If he was down there getting detention every other day, he’d understand what the problem was. But alas, Neil shot down the suggestion of being called Neil right away. So they can only be on a first-name basis in Richie’s head. Too bad.

The Math and Science building is as far away from the Administration building as you can get without leaving Derry Junior High, and Richie takes his time during the walk to Neil’s office, stopping outside the computer lab until Eddie catches sight of him through the window. He makes a gesture that causes Eddie to give him a surreptitious middle finger, hidden from his teacher by the monitor, but his cheeks also bloom cherry red, so Richie counts it as a win because it’s the cutest goddamn thing he’s seen all day. It feels like every other day now Richie’s being hit in the face with how adorable Eddie really is. He’s torn between wanting to pinch his cheeks and kiss him on the mouth, and frankly he’s mostly still straddling the fence on that issue only because he doesn’t want to deal with the answer.

In contrast to having a pretty good idea deep down what direction things are headed in regarding his general feelings about Eddie, Richie has not the slightest clue why he’s being called to the principal’s office the Friday after school started. None of the things he’s done should have been discovered yet. It makes no sense.

Bill is in the computer lab too, and Richie can’t see him from where he’s sitting, so he heads over to the staircase at the end of the hall. Pausing to make sure no teachers are lurking around to give him shit for it, he sits down at the top of the railing and slides down. Actually, he slides about a fourth of the way down before falling off and sort of rolling the rest of the way, but no one saw that so it still counts as a success.

He walks past the yard to watch Stan and Ben running the mile in P.E. Stan is fucking booking it, and Richie dawdles long enough to figure out that he’s a lap ahead of everyone else. Running away from Bowers for a few years will do that to ya. Well, at least it will if you’re Stan. Richie still can’t run an 8 minute mile, so his P.E. grade has stagnated at a B-.

Richie stops in the middle of the hallway in the Language Arts Building, glancing into Mr. Tremblay’s French 1 class. Bev was planning on taking that this year, and she’d be in there if she hadn’t moved to Portland. Sometimes—and Richie hates thinking about this because there’s no use in dwelling on it—but sometimes he really wants to kick himself for not getting to know her sooner. She’s the best bro he’s ever had that’s a girl, and it just really sucks ass that they only got to hang out for like one summer.

Before he even realizes it, he’s walking into the front office. Bertha glances up at Richie through her horn-rimmed reading glasses.

“Mr. Tozier! What’d you do this time?” she asks brightly. Ah, Bertha. She and Richie have a rapport. Richie might go so far as to say she even likes him, at least a little. He’s made her laugh at least seven times, and once in sixth grade she told him he had a real gift after he showed her his best Rick Moranis impression. She doesn't bullshit him, and he doesn’t bullshit her. Well, not very much at least.

“I have no idea,” he tells her honestly, resting his elbows on her desk, which is decorated with a rubber band ball, a Hoberman sphere, several pictures of her nieces and nephews, and the biggest Hershey’s Kiss Richie has ever seen in his entire life. Seriously, it’s almost as big as his goddamn face. Apparently, she got it on a trip to New York, and she’s had it at least as long as Richie has known her. He has never wanted to eat a thing so badly in his entire life, regardless of how old it is. It’s a fucking Hershey’s Kiss. Do those things even go bad? Either way, it’s Richie’s number one goal to take a big fucking bite out of that thing before he culminates at the end of the year. He’s a thousand percent sure it will taste like sweet victory.

“Neil?” Bertha calls over her shoulder. “Did you send for Richie Tozier?”

Neil’s voice floats back through the open door behind Bertha. “Oh, yes. Thanks, send him on back.”

Neil’s desk always starts the year looking pristine, and by the last day of school it is filled with stacks of pure chaos. Richie admires him for trying again at the beginning of each year. It’s like how his mom buys him a binder for each class and book covers and sets up an organizational system for his homework and notes despite knowing that it won’t last a month. It’s nice of her to try, but Richie is pretty sure they both go into it with the understanding that it’s kind of a hail Mary situation.

So right now Neil’s just got like three pictures of his wife, a snowglobe with GREETINGS FROM ST. PAUL written on the base, and a manageable-looking stack of papers in file folders. Godspeed, sir.

“Mr. Tozier,” Neil says by way of greeting, “please have a seat.”

“How was your summer, Ne—Principal McCormack?” Richie asks, plopping down into the chair directly opposite Neil.

Neil’s eyebrows raise. “Not as interesting as yours, based on what I heard from Ms. Pfarrer this afternoon,” he says, reaching into his desk and pulling out two pieces of lined paper stapled together. “Care to explain?”

He places it directly in front of Richie. Richie peers at it. The top right corner reads: Richie Tozier, English 8A, Period 4, September 3, 1989. It wasn’t stapled when he handed it in, he’d just sort of folded the corners over together and hoped for the best, but Ms. Pfarrer must have gone ahead and stapled it for him.

“That would be yesterday’s English homework.”

“Correct,” says Neil. “I want you to read this entire essay out loud to me, and then I’m going to ask you some questions. Okay?”

Richie’s not sure if the questions are about the contents of the essay, or if Neil just can’t read his handwriting. Then again, that sounds like a Ms. Pfarrer problem; he’s not sure why she’d bring it to the principal if she just couldn’t read it. Normally she just hands it back to him and tells him to rewrite it when that happens, or at least that’s what she did last year. If his teachers have suddenly decided to send him to the principal every time he turns in an illegible assignment, it’s going to be a very long year.

But whatever.

My Summer From Hell: A Tale of Friendship

If you had asked me at the end of last year what the worst thing about my summer would probably be, I would have bet a hundred bucks it was going to be the trip I took down to Augusta to see my grandma two weeks ago, which sucked. All we did was watch Matlock all week and she made me get a really shi bad haircut, just like last year. It’s going to take me months to grow it out. But compared to what went down in July and the beginning of August, eating soup at Grandma Dottie’s house was NOTHING.

You know how kids just disappear off the face of the earth all the time here in Derry? If you didn’t, that’s a fun fact from me to you that I learned from my new friend Ben (he’s in your 5th period class). Well, while we were looking for my other friend Bill’s missing brother, we found out where they all went.

Underneath our feet, down in the sewers, there lives a killer clown. That’s right, you heard it here first. Like John Wayne Gacy, but 100000x worse because it’s for sure not human. Sometimes It’s a clown, sometimes not. Depends. On what? I have no idea. It was usually a clown when I saw it but one time it started turning into maybe a werewolf. It can turn into anything it wants and it eats kids.

Anyway, It almost killed all of us on the fourth of July. We Bill decided to go try and fight It at the creepy ass house on Neibolt street, and that was an absolute shit show disaster. Ask Ben to show you the sick scar on his stomach if you don’t believe me. Eddie fell through a giant hole in the floor and broke his arm. I got mad at Bill for bringing us all there and he punched me in the face, and then I didn’t talk to him for a month.

Then It dragged Beverly Marsh into its nasty sewer lair and we all went down the grossest well in Derry to get her back. Henry Bowers followed us because he just has to ruin everything, even things that are already the worst. There’s this giant cistern that has a huge pile of broken toys and crap and the clown lives in there. There were hundreds of dead kids floating in the air.

It’s a long story but I beat the shit crap out of It with a baseball bat and we fought it back. We swore to each other that we’d all come to fight It again if it returns. Anyway, the moral of this summer is that you can achieve anything if you work together and also that there is no way Henry Bowers could have caused an explosion during the 1800’s. I want to see him go to jail for taking a dump in my backpack for sure, and I guess for killing Belch, Vic and his dad too, but I know for a fact that he didn’t kill Georgie Denbrough or Betty Ripsom or Ed Corcoran. This town is just cursed.

Richie looks up brightly at Neil when he finishes reading. Neil takes a deep breath and rubs his temples with his fingers.

“I’m not sure you understood what the assignment was, Richie,” he says. “This is an inventive—and deeply disturbing—story, but this was supposed to be about what you actually did over the summer, not—”

“Yeah,” says Richie. “It is. I mean, I didn’t think Ms. Pfarrer was going to actually read them all. But—”

“This was a nonfiction assignment though.”

Neil’s being real slow on the uptake. Maybe his brain is still on summer break.

“Yeah,” says Richie, nodding. “As in, this is what actually happened to me. Here’s where we swore we’d come back and fight again when we’re old. If It comes back.” Richie holds out his left hand so Neil can see the freshly healed scar.

“Ouch,” Neil winces. “How did you get that?”

Richie rolls his eyes. “I cut it on glass. On purpose. Go get the others—they’ll tell you. Eddie Kaspbrak, Stanley Uris, Bill Den—”

“Please stop with the games,” says Neil. “Just—I’ve had a long week. We all have. Ms. Pfarrer wanted me to look into sending you to the school psychologist. I know you like to, you know, do what you do, but this is taking it too far.”

“Why would I lie to you about this?” Richie asks. He puts both elbows on the desk and leans forward. “Seriously. Why?”

“Attention-seeking behavior is common after the kind of trauma we’ve all experienced over the past year,” Neil says. Super patient, like he’s quoting a textbook and speaking to a preschooler. “I know what happened with Henry was a surprise to—”

“Wait, wait wait,” Richie interrupts. “You think I wrote this to get attention?”

Neil sighs and throws up his hands. “I can’t think of any other reason. If there is one, I’d love for you to give me some insight.”

Honestly? How fucking dare he. It strikes Richie in that moment how goddamn unfair this is. They had to do this with everyone—from explaining those nasty bites on Stan’s face to Eddie being grounded for the rest of the summer, to knowing exactly why there were so many more bodies in the sewer than missing kids from this past year and no one believing them…

“How about this for insight? ” Richie says. “I’ve been through too much trauma this year to come up with another bullshit story that all you adults will eat up. None of you care what actually happened; you just want me to tell you something that means you don’t have to do anything about it. Well, you’re gonna have to come up with your own lie to tell yourself. I’m not doing it for you.”

Neil is gaping. But Richie keeps going.

“I thought it was Bowers before this summer and honestly, I wish I’d been right. And it’s not like I’m sorry that he’s getting all this shit pinned on him even though he didn’t do it. My life is a million times easier without him around—he can get strung up by his ballsack for all I care.”

“Richie, there’s a mountain of evidence against—”

“I don’t give a shit about evidence,” says Richie. “I know what I saw. I know what happened. I know, and Bill knows, and Stan knows, and Bev… What do you care though? You’ll probably be dead anyway by the time It comes back.”

“Is that supposed to be some kind of threat?” Principal McCormack asks. His face has gone hard and stony like Richie’s never seen before; like Richie has crossed a real line this time. Somewhere in the back of his mind, he knows there’s going to be nasty consequences for this, but he can’t find it in himself to give a shit.

“You wouldn’t believe me even if it was,” Richie mutters. “Just… Fuck it. Send me to the school shrink or whatever. Give me detention; flunk my essay. None of this shit matters anyway.”

“You can bet you’re getting all three of those things,” says Principal McCormack with a mirthless chuckle. “And I’m not sure what’s gotten into you this year, but I feel like—”

“Do I sound like the grownups in Charlie Brown when I talk?” Richie demands. “Seriously, am I making like, actual words to you? Or are you just hearing wah wah wah when I—”

“I’m calling your parents,” Principal McCormack says over him. “Is something going on at home?”

Richie feels blood pounding through his veins. Like it could melt his skin. He looks Principal McCormack dead in the eye, reaches for his essay and tears it to shreds, standing slowly.

“In the end,” he says, his voice shaking and frustrated tears threatening to overpower him, “it’s not going to make any difference if you don’t believe me. We’ll come back, all of us. Me and Eddie. Ben, Beverly, Mike. Bill. Stan. What you think doesn’t change that.”

And as suddenly as it came, the anger evaporates. Just...poof. Gone. It clears, and there’s fucking gobsmacked Principal McCormack sitting there like a lump, staring at Richie. Maybe he heard the individual words, but one thing Richie know for sure: he still doesn’t get it. And he never will. And not just him; Ms. Pfarrer. Even Bertha, whether she thinks Richie is gifted or not. And his parents…

There’s a sick loneliness that kind of creeps in to fill up where his anger was, colder than a January wind. Every time his dad comforted him as a kid, when he’d check under the bed and in the closet for monsters, was a lie. When his mom told him he’d be safe sleeping in their bed. That nothing was coming to get him. That they’d never let him get hurt. Lies, all of it. And it’s not like the adults in his life are lying to him on accident. The truth is right there in front of their stupid fucking faces and they just refuse to look at it.

The chill settles into a stony sort of resolution. Richie has stared the truth in the face and didn’t flinch. Even getting suspended is fucking nothing compared to… Whatever. He’s getting detention anyway. Might as well make it memorable. He turns on his heel and walks out of the office.

“If you’re still alive in 2016,” Richie calls over his shoulder, “I’ll hit you up at your nursing home and let you know I was right all along.”

#It (2017)#richie tozier #Stephen King's IT

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technicaldr · 6 years

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Connecting the Dots: Referrals between Medical Care and Community Resources

Policymakers and providers all agree that addressing patients’ non-medical needs will be critical to improving health, health care, and health care costs, but little progress has been made towards integrating traditionally segmented services. What can and should a health care organization do? Realistically, most health care organizations will not build new lines of social services into their core clinical operations. Instead, leading organizations are connecting the dots by optimizing referrals to existing community resources. Based on phone interviews and site visits with executive leadership, frontline providers, and community partners, we highlight the work of nine innovative health care organizations. Here, we offer practical steps to reflect upon where your organization stands and where it might look to be in a referral model for community resources.

Starting point: Does your team have a useful resource library?

Useful is the key word here: we’re not talking about a static laundry list that simply names local community resources on a website or a print out. Useful resource libraries not only catalog existing community resources but also include pertinent details such as eligibility criteria. For example, at one organization we interviewed, health coaches use their electronic resource library to match the patient’s age, income, and residence profile with available community resources. To create the most useful resource library for your organization, we suggest querying your care team about what essential pieces of information would help them effectively and confidently refer patients to community resources.

Importantly, a resource library is only as useful as it is accurate and up-to-date. Organizations will need to identify who will monitor and update the resource library at regular intervals by visiting program websites, calling program contacts, or surveying providers about their experiences with listed community resources. For example, one organization we interviewed created a dedicated committee to appraise over 300 community resources that engage with their providers. Clearly, modifications to the resource library are to be expected, so electronic resource libraries (e.g. in a cloud-based platform or in the EHR) will be more dynamic than binders. Two organizations we interviewed are even using or contracting with companies that have created web-based resource libraries (e.g. Aunt Bertha, NowPow).

Next step: Who is responsible for referring patients?

Remember, the resource library is a tool not the solution. Organizations must lay out what roles will best enable referrals to community resources. Depending on your unique organization, referrals to community resources might be done through an entire team, an individual, or outsourced partners. For example, one larger organization we interviewed developed multidisciplinary teams of nurses and social workers, making specialized referrals and handoffs for particular social service domains (e.g. a housing team, transportation team, and nutrition team). In contrast, another organization used a single, centralized point person to make all referrals into the local community. Alternatively, two organizations we interviewed piloted with external partners (such as Health Leads) whose staff executes the referrals to specific community resources.

In addition to defined roles, organizations must not forget to develop associated workflows. What is the workflow to identify the patients with social service needs? What is the provider’s workflow to connect with whomever will make the community resource referrals? Are there workflows in place to follow-up regarding the referrals made to community resources? While developing these workflows, organizations need to consider what the preferred modes of communication are and which documentation platforms will facilitate the workflows. For example, one organization we interviewed built workflows into their EHR by tailoring the existing social service pathways of the Pathways Hub Model to fit the organization’s particular patient needs, staffing structure, and provider network. By strategically designing roles and workflows that support patient referrals to community resources, your organization shares responsibility for the success of the referral model.

Final move: Are you evaluating the impact?

Evaluating your referral model is crucial not only to intelligently decide what to keep, drop, or adapt but also to assess the impact of your work. All of the organizations we interviewed found it challenging to demonstrate that referrals to community resources directly influenced larger outcomes such as total costs of medical care. More immediately, data points that organizations may want to capture include the number of patients with different types of social service needs and the number of complete and incomplete referrals made to each community resource. For example, one organization we interviewed is tracking their rate of unsuccessful referrals to community resources in order to reveal where gaps in the community persist and subsequently inform advocacy efforts.

Furthermore, evaluating your referral model sets the foundation to build a business case for social service partnerships. A few organizations we interviewed were interested in entering financial arrangements with a curated network of community partners based on quality and other performance metrics, although these were generally still in the early stages of development. As organizations look to harmonize data collection and evaluation efforts, partners will need to agree upon the types of data, preferred reporting formats, and interval of reporting requests. In fact, based on interviews with community partners, we learned that many community partners are motivated to collect and exchange data on shared patients in order to improve their value proposition with grant funders and secure future funding.

Following the lead of innovative organizations, there are valuable opportunities for health care organizations to use a referral model with community resources. Health care organizations that leverage their local communities can more effectively match patients with comprehensive services critical to improving health status. Improving the referral model is a key sPolicymakers and providers all agree that addressing patients’ non-medical needs will be critical to improving health, health care, and health care costs, but little progress has been made towards integrating traditionally segmented services. What can and should a health care organization do? Realistically, most health care organizations will not build new lines of social services into their core clinical operations. Instead, leading organizations are connecting the dots by optimizing referrals to existing community resources. Based on phone interviews and site visits with executive leadership, frontline providers, and community partners, we highlight the work of nine innovative health care organizations. Here, we offer practical steps to reflect upon where your organization stands and where it might look to be in a referral model for community resources. Starting point: Does your team have a useful resource library? Useful is the key word here: we’re not talking about a static laundry list that simply names local community resources on a website or a print out. Useful resource libraries not only catalog existing community resources but also include pertinent details such as eligibility criteria. For example, at one organization we interviewed, health coaches use their electronic resource library to match the patient’s age, income, and residence profile with available community resources. To create the most useful resource library for your organization, we suggest querying your care team about what essential pieces of information would help them effectively and confidently refer patients to community resources. Importantly, a resource library is only as useful as it is accurate and up-to-date. Organizations will need to identify who will monitor and update the resource library at regular intervals by visiting program websites, calling program contacts, or surveying providers about their experiences with listed community resources. For example, one organization we interviewed created a dedicated committee to appraise over 300 community resources that engage with their providers. Clearly, modifications to the resource library are to be expected, so electronic resource libraries (e.g. in a cloud-based platform or in the EHR) will be more dynamic than binders. Two organizations we interviewed are even using or contracting with companies that have created web-based resource libraries (e.g. Aunt Bertha, NowPow). Next step: Who is responsible for referring patients? Remember, the resource library is a tool not the solution. Organizations must lay out what roles will best enable referrals to community resources. Depending on your unique organization, referrals to community resources might be done through an entire team, an individual, or outsourced partners. For example, one larger organization we interviewed developed multidisciplinary teams of nurses and social workers, making specialized referrals and handoffs for particular social service domains (e.g. a housing team, transportation team, and nutrition team). In contrast, another organization used a single, centralized point person to make all referrals into the local community. Alternatively, two organizations we interviewed piloted with external partners (such as Health Leads) whose staff executes the referrals to specific community resources. In addition to defined roles, organizations must not forget to develop associated workflows. What is the workflow to identify the patients with social service needs? What is the provider’s workflow to connect with whomever will make the community resource referrals? Are there workflows in place to follow-up regarding the referrals made to community resources? While developing these workflows, organizations need to consider what the preferred modes of communication are and which documentation platforms will facilitate the workflows. For example, one organization we interviewed built workflows into their EHR by tailoring the existing social service pathways of the Pathways Hub Model to fit the organization’s particular patient needs, staffing structure, and provider network. By strategically designing roles and workflows that support patient referrals to community resources, your organization shares responsibility for the success of the referral model. Final move: Are you evaluating the impact? Evaluating your referral model is crucial not only to intelligently decide what to keep, drop, or adapt but also to assess the impact of your work. All of the organizations we interviewed found it challenging to demonstrate that referrals to community resources directly influenced larger outcomes such as total costs of medical care. More immediately, data points that organizations may want to capture include the number of patients with different types of social service needs and the number of complete and incomplete referrals made to each community resource. For example, one organization we interviewed is tracking their rate of unsuccessful referrals to community resources in order to reveal where gaps in the community persist and subsequently inform advocacy efforts. Furthermore, evaluating your referral model sets the foundation to build a business case for social service partnerships. A few organizations we interviewed were interested in entering financial arrangements with a curated network of community partners based on quality and other performance metrics, although these were generally still in the early stages of development. As organizations look to harmonize data collection and evaluation efforts, partners will need to agree upon the types of data, preferred reporting formats, and interval of reporting requests. In fact, based on interviews with community partners, we learned that many community partners are motivated to collect and exchange data on shared patients in order to improve their value proposition with grant funders and secure future funding. Following the lead of innovative organizations, there are valuable opportunities for health care organizations to use a referral model with community resources. Health care organizations that leverage their local communities can more effectively match patients with comprehensive services critical to improving health status. Improving the referral model is a key step in connecting the dots between medical care and community resources, a small move toward systematically caring for the whole person rather than the discreet set of problems bringing a patient into a given provider’s office.tep in connecting the dots between medical care and community resources, a small move toward systematically caring for the whole person rather than the discreet set of problems bringing a patient into a given provider’s office.

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isaacscrawford · 6 years

Text

Connecting the Dots: Referrals between Medical Care and Community Resources

By JOELLE JUNG & VALERIE LEWIS

Starting point: Does your team have a useful resource library?

Next step: Who is responsible for referring patients?

Final move: Are you evaluating the impact?

The authors are health services researchers at Dartmouth.

Article source:The Health Care Blog

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