copyright © 2009, 2011, 2012, 2013, 2014 patricia a. fennell albany health management associates,...

Copyright © 2009, 2011, 2012, 2013, 2014 Patricia A. Fennell

ALBANY HEALTH MANAGEMENT ASSOCIATES, INC.

Patricia A. Fennell, MSW, LCSW - R, PresidentJon S. Rice, LCSW-R, Sr. Clinician / OMH Program Specialist 2

Web site: www.albanyhealthmanagement.com_____________________________________________________

Re-Integrating Care: Applying Fennell’s Four Phase (FFPT™)

Chronic Illness Management System to Achieve Desirable

Outcomes

New York State Care Management CoalitionMay 13, 2015

Agenda

• Paradigm Shift in Healthcare: Acute to Chronic Illness

• Physical and Mental Health: False Dichotomy

• Chronic Illness (CI) and the Four Phases

• The Need for Applying the Phase Model

Copyright © 2009, 2011, 2012, 2013 ,2014 Patricia A. Fennell

Paradigm Shift in Medicine

• 20th century: focus on acute illness;21st century: focus on chronic illness

• Chronic vs. acute care• Necessity of chronic care models• Chronic comprehensive care management

vs. clinical treatment


Chronic vs. Acute Illness

• Chronic illness can be difficult to define, measure and treat

• Medicine has not adapted to a CI model of care - Pts. often fare poorly in acute care

• Client needs vary over the duration and phase of the illness

• Clients suffer from social stigma, economic losses, and lack of knowledge and understanding about their conditions

• Everyone becomes frustrated with the unpredictability and chronicity of symptoms


Increased Prevalence of Chronic Illness Worldwide

• Advances in public health• Advances in medical care • Aging population

Copyright © 2009, 2011, 2012, 2013,2014 Patricia A. Fennell

4 Groups of Chronically Ill

• Acute illness survivors with managed symptoms (cancer, cardiovascular disease, post-viral syndromes)

• Traditional chronic (depression, MS, FM, asthma, lupus)

• “Persistent acute” (HIV/AIDS, stroke)• Natural consequences of aging in an aging

population


Soma or Psyche? Yes

• Physical and mental health – A false dichotomy

• Physical health problem-look for the psychological components

• Psychological/Situational problem-look for the physical components


Why use an Integrated and Phase Approach with Chronic Illness?


Just the Facts


• About ½ of all adults (117 million) have one or more chronic conditions.*

• One out of four adults has two or more chronic conditions.*

• Seven of the top ten causes of death in 2010 were chronic diseases (heart disease and cancer accounted for 48% of all deaths)**

* Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:130389. DOI: http://dx.doi.org/10.5888/pcd11.130389

**Centers for Disease Control and Prevention. Death and Mortality. NCHS FastStats Web site. http://www.cdc.gov/nchs/fastats/deaths.htm. Accessed December 20, 2013.

http://dx.doi.org/10.5888/pcd11.130389

http://dx.doi.org/10.5888/pcd11.130389

http://www.cdc.gov/nchs/fastats/deaths.htm

Kids and Chronic Illness?


• Among adults, half of all mental, emotional and behavioral disorders were first diagnosed by age 14 and three-quarters by age 24.8*

• 2009-2010: Nearly one of five youths, aged 2-19, was obese (Body Mass Index equal or greater than 95th percentile)**

* Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6):593-602.

** Centers for Disease Control and Prevention. NCHS Data on Obesity. NCHS Fact Sheet Web site. http://www.cdc.gov/nchs/data/factsheets/factsheet_obesity.htm. Accessed December 20, 2013.

http://www.cdc.gov/nchs/data/factsheets/factsheet_obesity.htm

The Bottom Line

• The costs of chronic illness account at least 78% of all healthcare spending.

• Cost is over a trillion dollars per year.

Anderson, G. 2004. “Medicare and Medicaid are programs for people with chronic illnesses…but do not know it.” Presentation. General Accounting Office, February 5, 2004.


Soma and Psyche - Example


Terri Dome, a successful international business executive for a major movie studio in California, had it all, until her heart was ravaged by the effects of treatments she had received years before for a childhood cancer...

We used the latest advancement in treatment and technology... and our doctors’ vast knowledge and experience. In February 2009, Terri had a heart transplant...

Terri is now making the most of her new life, reaching out to counsel other women with heart disease...

Chronic Mental/Physical Illness and the Fennell Four Phase Model


Philosophy of the Phase Method

• A Systemic Approach• False Dichotomies• The Phenomenon of Chronicity• Traumatization and Chronicity• The Integration Assumption • Palliation • Clinician as Active Equal Participant


Trauma Types

• Disease/Syndrome Trauma• Iatrogenic Trauma• Cultural Trauma• Vicarious Trauma

• Pre-Morbid / Co-Morbid Trauma


Socio-Cultural/Quality of Life Factors

• Cultural Intolerance of Suffering• Cultural Intolerance of Ambiguity• Cultural Intolerance of Chronic vs. Acute

Syndromes• Pre-existing Cultural Climate Toward

Chronic Syndromes• Media • Initial Syndrome Illegitimacy and

Subsequent EnculturationCopyright © 1998, 2011, 2012, 2013, 2014

Patricia A. Fennell

Traditional Disability vs. Chronic Conditions

• Chronic conditions on a continuum• Static vs. dynamic disability/illness

– Fixed disability– Relapse and remission– Waxing and waning

• Legal definitions of disability/chronic illness• Social or colloquial definitions

– Disability– Illness– Disease/condition/syndrome


The Four Phases of Chronic Change

The Smith Family’s Story: Survivors of Mental and Physical Illness


Phase I – Trauma / Crisis•Physical/Behavioral Domain

– Coping stage– Onset stage– Acute / emergency stage

•Psychological Domain– Loss of psychological control / ego loss– Intrusive shame, self-hatred, despair– Shock, disorientation, dissociation– Fear of others, isolation, mood swings

•Social/Interactive Domain– Others experience shock, disbelief, revulsion– Vicarious traumatization– Family / organizational maturation– Suspicion / support continuum


Phase II –Stabilization/ Normalization

Failure•Physical/Behavioral Domain

• Plateau• Stabilization

•Psychological Domain• Increased caution/secondary wounding• Social withdrawals, social searching• Service confusion / searching• Boundary confusion

•Social/Interactive Domain• Interactive conflict / cooperation• Vicarious secondary wounding• Vicarious traumatic manifestation• Normalization failure


Phase III – Resolution• Physical/Behavioral Domain

– Emergency stage diminishment / improvement– Continued plateau / stabilization– Relapse

• Psychological Domain– Grief reaction / compassion response– Identification of pre-crisis – “self”– Role/identity experimentation– Returning locus of control– Awareness of societal effects– Spiritual development

• Social/Interactive Domain– Breaking silence / engulfment in stigma– Confrontation– Role experimentation – social, vocational– Integration / separation / loss of supporters


Phase IV – Integration• Physical/Behavioral Domain

– Recovery stage– Continued plateau / improvement / relapse

• Psychological Domain– Role / identity integration– New personal best– Continued spiritual / emotional development

• Social/Interactive Domain– New / reintegrated supporters– Alternative vocation / activities


Integrating the Four Phases in today’s system of care


Gearing Up for Change


Managed Care

DSRIP

Health Homes

For What are We Gearing Up?

• Physical and behavioral health to be integrated*

• Clients’ recovery goals will be supported* • Cross-systems communication/case

planning**

* Medicaid Redesign Team Behavioral Health Managed Care Update, Webinar, May 18, 2013

**Children’s MRT Behavioral Health Subcommittee : Performance Measure Recommendations, 2011


Adapted from Concepts presented by Medicaid Redesign Team Behavioral Health Managed Care Update, Webinar, May 18, 2013Copyright © 1998, 2011, 2012, 2013, 2014

Patricia A. Fennell

Fewer Hospitalizations &

Cost Savings

Recovery

Integrated Care

Community

Supports

How to put the Four Phase Model to work?

• Assess and diagnose mental and physical health

• Phase Placement Assessment• Consider and tailor interventions based on

diagnosis and Phase Placement• Match psych and physical interventions to

Phase• Multidisciplinary Phase-based application

Medicaid Redesign Team Behavioral Health Managed Care Update, Webinar, May 18, 2013


The Chronic Illness WorkbookUsing her extensive experience with chronic illness clients, Patricia Fennell has created an original, comprehensive, research-validated approach that brings clarity and order to what feels like an unmanageable and isolating experience.

For more information or to order, visit:www.AlbanyHealthManagement.com

or contact: [email protected]

Availablefrom

Albany Health Management Publishing

ISBN: 13 978-0-9796407-1-1© 2012 Copyright ©2012, 2012, 2013. 2014

Patricia A. Fennell

http://www.keepcalm-o-matic.co.uk/p/who-you-gonna-call-ghostbusters-2


For More Information:For further information on the following please contact

AHMA at---

communications@albanyhealthmanagement.comwww.albanyhealthmanagement.com

• certification in the FFPT™ approach• instrumentation/ CHAI, Pcat, Fennell Phase

Inventory™ • research projects• books and related articles• clinical services• consulting• education and trainingCopyright ©1998, 2011, 2012, 2013, 2014

Patricia A. Fennell

copyright © 2009, 2011, 2012, 2013, 2014 patricia a. fennell albany health management associates,...

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