health - arizona state university › sites › default › files › session-17-pdf... ·...
TRANSCRIPT
Health and Wellness for all Arizonans
Healthy Living: Implementation of Stanford’s CDSMP in Behavioral
Health Presented by:
Claudia Sloan, MBA, ADHS Division of Behavioral Health Services Melanie Mitros, PhD, Arizona Living Well Institute
Veronica Wilson, Northern AZ Regional Behavioral Health Authority
Health and Wellness for all Arizonans
Outline
• Overview of CDSMP implementation for AZ public behavioral health system – goals & impact.
• Background information about CDSMP – key elements, planning process, resources to implement.
• A closer look: NARBHA’s implementation – outcomes, successes, challenges, and lessons learned.
Health and Wellness for all Arizonans
Implementing the CDSMP Program for Behavioral Health Service Recipients
A workforce development program to train the behavioral health peer-support specialists, and peers and their family members to self manage chronic illnesses, with priority given to persons with SMI.
Health and Wellness for all Arizonans
SHARED VISION
• CDSMP provides a professional development opportunity for peers (members employed at provider sites) which uses a low-cost, psycho-educational group model with demonstrated efficacy with both the Medicare and Medicaid populations.
• Outcomes have proven that CDSMP reduces visits to Emergency Departments, preventable hospitalizations and health care distress while improving personal efficacy.
Health and Wellness for all Arizonans
Why CDSMP?
• At least 75% of individuals with a serious mental illness (SMI) have a chronic medical illness.
• Medical illnesses are more likely to go undiagnosed or misdiagnosed in individuals with SMI.
• To address these disparities and improve the overall quality of life of people with serious mental illness in the public behavioral health system.
Health and Wellness for all Arizonans
Why CDSMP?
• Self-management programs help individuals gain self-confidence in their ability to control symptoms and manage the progression of several long-term and chronic age-related illnesses.
• “It is unreasonable to expect people to change their behavior when so many forces in the social, cultural, and physical environment conspire against such change.”
Health and Wellness for all Arizonans
How did we do it?
• Federal grant from SAMHSA/NASMPHD
• Partnership with the Arizona Living Well Institute
• Partnership with our contracted Regional Behavioral Health Authorities (RBHAs)
• Partnership with Peers and Family members
Health and Wellness for all Arizonans
Health and Wellness for all Arizonans
The mission:
to advance evidence-based programs for Arizona communities through structured communication, multi-level coordination and systematic coaching.
ARIZONA LIVING WELL INSTITUTE
Health and Wellness for all Arizonans
Empowerment Systems, Inc.
AZ Living Well Institute
Greater Valley AHEC
Community Outreach
Health Informatics
AZ Coalition for Military
Families
Funds to launch the Arizona Living Well Institute were made available by grant funds from St. Luke’s Health Initiatives and the Arizona
Department of Health Services through a grant from the Administration on Aging.
Arizona Living Well Institute
Health and Wellness for all Arizonans
How AZLWI Provides Support
Coordination and leveraging of resources to create greater impact
A systematic approach to data collection and management
Coordination of training opportunities throughout the state, including coordination of self-management workshops
Educate employers, health care providers and community services organizations about the benefits of self-management programs and evidence-based health promotion programs
Health and Wellness for all Arizonans
Healthy Living Stanford University’s CDSMP
http://med.stanford.edu/patienteducation/
Healthy Living
Health and Wellness for all Arizonans
Disease
Tense Muscles
Pain
Stress/ Anxiety
Difficult Emotions
Shortness of Breath
Depression
Fatigue
Symptom Cycle
Stanford Chronic Disease Self Management, 2006
Health and Wellness for all Arizonans
Workshop Design
• 6 weekly sessions that meet 1 day per week for 2.5 hours each
• Introduces tools needed in day-by-day life with chronic conditions
• Practices using self-management skills
• Focuses on goal setting
• Shared experiences, emphasizes mutual support
• Workshops Available
o English & Spanish
o Diabetes & Chronic Pain
www.wittysparks.com/2007/05/26/15-tips-to-manage-yourself-better/
Health and Wellness for all Arizonans
Topics Covered • Action Plans • Feedback/Problem Solving • Getting a Good Night’s Sleep • Managing difficult emotions • Falls Prevention • Physical Activity/Exercise • Nutrition & Food Labels • Weight Management • Mind-Body Connection • Informed Treatment Decisions • Working with Health Care
Health and Wellness for all Arizonans
Ideal Abilities of a Leader
Arizona Living Well Institute
• Possesses good listening skills, is non-judgmental
• Understands the importance and purpose of fidelity (following the curriculum)
• Possesses good communication and interpersonal skills
• Exhibits enthusiasm
• Is dependable and consistent
• Comfortable in front of a small group
• Possesses life experience resulting in empathy to the needs and abilities of older adults.
Health and Wellness for all Arizonans
Process to Implement
1. Develop a recruitment strategy – Scholarship process
– Training calendar – 9 Leader Trainings
2. Comprehensive Scholarship Application
3. Select Recipients
4. Mentorship & Technical Assistance
5. Facilitator Incentives
6. Data Management
Health and Wellness for all Arizonans
Results
• Successfully trained – 2 CDSMP Master Trainer - Both are active
– 58 CDSMP Leaders • Had 126 applicants
• Currently have 28 active Leaders – 30 recipients are no longer able to facilitate workshops.
• 24 Leaders have co-facilitated workshops. Many have facilitated multiple workshops.
• 40 workshops with 456 participants, 65% completion rate
Health and Wellness for all Arizonans
Lessons Learned
• Even with an application process that is reviewed by multiple, it is HARD to identify leaders who will be able to commit the time.
• Must be a priority of the organization.
• Every organization is structured different, so standardized processes were challenging.
• Challenging to track participants in different systems.
Health and Wellness for all Arizonans
Partnership Opportunities
• Partnering with CBOs to broaden the array of non-clinical services
• New models of care delivery provide flexibility for service design and payment to include self-management programs
• Greater focus on patient motivation and engagement
• Growing awareness of effectiveness of self-management programs and value of partnering with community resources
Lachenmayr, S. National Council on Aging “Patient Self-Management As a Strategy to Reduce Hospital Readmissions”, September 2012. Slides 19-22.
Health and Wellness for all Arizonans
Community-Based Referral Network
• A comprehensive system of evidence-based wellness programs – Promoted and integrated with primary and behavioral
health outpatient providers of service for those living with or at risk of developing chronic conditions.
• In order to sustain and expand the impact of self-management programs, AZLWI is further developing, supporting and promoting a structured provider membership system to ensure quality evidence-based wellness services are provided at affordable prices.
Health and Wellness for all Arizonans
Community-Based Referral Network
• Community Outreach Navigators
• Health & Human Service Providers
• Insurance Providers • AHEC Interns • Self-Referral
Referrals
• Evidence-based Self-Management Workshops
• Referral to other needed services (e.g. ASHLine, WIC, etc.)
• Assistance completing health & human service applications (e.g. AHCCCS)
• Referral to potential Medical Home
• Database Management • Invoicing & Billing
Services
Services
• Response to referral source of services provided to include: • Participation in Self-
Management Workshop
• Other completed referrals/services
Outcomes
Health and Wellness for all Arizonans
NORTHERN ARIZONA REGIONAL BEHAVIORAL HEALTH AUTHORITY (NARBHA)
• Founded in 1967 • Geographic Service Area: 62,000 square miles • About 12% state population • 19,000+ members • 10 Responsible Agencies (Behavioral Health
Homes) • Memorandums of Understanding with 10
tribes • Collaborative projects
Health and Wellness for all Arizonans
A Bit About NARBHA
Health and Wellness for all Arizonans
We’re Different
Vision and Innovation…
• Since 2009, NARBHA Board has funded >$1,000,00 in community reinvestment grants to establish integrated care programs (Recover Wellness):
– On-site primary care required in contract
• North Country Healthcare (FQHC) partnership provides on-site primary care at 4 BH Health Homes
• 3 of our BH Health Homes are fully integrated
– Since 2011, Stanford CDSMP taught by peers
– Project ECHO, a tele-mentoring chronic pain program (7 PCPs and 3 pain management specialists)
Health and Wellness for all Arizonans
NARBHA STATISTICS
• In 2011 NARBHA was the first Regional Behavioral Health Authority in Arizona to implement the Stanford Chronic Disease Self-Management Program (CDSMP) for individuals enrolled in our system of behavioral health care diagnosed with a Serious Mental Illness.
• CDSMP aligns with recovery principles and the Triple Aims of the Affordable Care Act – better health, better healthcare and improved quality, while reducing cost.
Health and Wellness for all Arizonans
NARBHA’S CDSMP IMPLEMENTATION AS OF April 2014
• NARBHA Master Trainers = 3
• NARBHA Peer Lay Leader = 1
• NARBHA RA Master Trainer = 1
• NARBHA RA and community Lay Leaders = 102
• NARBHA RA peer Lay Leaders = 37
• NARBHA staff who took 6 week course = 22
• NARBHA RA members who took 6 week course = 273
Health and Wellness for all Arizonans
OUTCOME MEASURES
THE STANFORD UNIVERSITY
CHRONIC DISEASE SELF-MANAGEMENT
PROGRAM (CDSMP)…
…WHAT DOES THIS LOOK LIKE IN
NORTHERN ARIZONA?
Health and Wellness for all Arizonans
OUTCOMES September 2011 and March 2014
Improved
Better than Stanford Outcomes
Stanford Post- Workshop
NARBHA Pre-Workshop
NARBHA Post-Workshop
Confidence Managing Chronic Disease (6 Items) 10 is "Totally Confident" 5.17 5.03
5.98
Health Distress (4 Items) 0 is "none of the time" 2.04 3.00
2.61
Fatigue (1 Item) 0 is "no fatigue" 4.89 6.01
5.67
Pain (1 Item) 0 is "no pain" 4.36 6.70
6.14
NARBHA CDSMP Outcome Measures ~ Veronica Wilson Master Trainer
30
Health and Wellness for all Arizonans
Workshops
September 2011 through March 2014
4.89 4.72 4.94 4.85 5.42 5.40 5.85 5.92 5.88 5.76 5.89
6.60
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
Keep Fatigue frominterfering?
Keep Pain frominterfering?
Keep Emotionsfrom interfering?
Keep OtherSymptoms from
interfering?
Do Tasks andActivities?
Do things besidestake medication to
help?
Confidence in Doing Things Pre & Post Survey Comparison n=92
Pre Mean
Post Mean
Health and Wellness for all Arizonans
Workshops September 2011 through March 2014
1.30
1.80
0.02 0.52 0.23 0.33
1.52
2.45
0.30 0.57 0.43 0.45
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Stretching orstrengthening
exercises?
Walking? Swimming oraquatic?
Bicycling? Other aerobic? Other exercises?
Physical Activity Pre & Post Survey Comparison n=92
PreMean
PostMean
Health and Wellness for all Arizonans
Workshops September 2011 through March 2014
1.92
3.12 2.95
2.24
3.22 3.11
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Prepare a list of questions? Ask questions about things you don'tunderstand?
Discuss personal problems related toyour illness?
Medical Care Pre & Post Survey Comparison n=92
PreMean
PostMean
Health and Wellness for all Arizonans
Workshops September 2011 through March 2014
2.13 2.31
2.51 2.35
1.92 2.00 2.18
2.01
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Normal Social Activities? Hobbies? Household Chores? Errands and shopping?
Interference in Daily Activities Pre & Post Survey Comparison n=92
PreMean
PostMean
Health and Wellness for all Arizonans
Workshops September 2011 through March 2014
2.86 2.99 2.83 3.33
6.01
6.70
2.49 2.46 2.49 3.01
5.67 6.14
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
Discouraged byHealth Problems?
Fearful AboutFuture Health?
Worried About YourHealth?
Frustrated withYour Health?
Level of Fatigue 0-10?
Level of Pain 0-10?
Health Distress Pre & Post Survey Comparison n=92
PreMean
PostMean
Health and Wellness for all Arizonans
IT’S ALL GOOD!
• Response to the CDSMP workshops has been positive. Some participants repeat the workshop because they have gained so much.
• Participants create new wellness networks and stay connected to each other.
• Partnerships in integrated care have expanded.
• Adding Diabetes Self-Management Groups
Health and Wellness for all Arizonans
Coding for Prevention/ Health Promotion
Education and training in single or multiple sessions to individual, family or group using a standardized curriculum to increase knowledge of a health-related topic, such as nature of illness, symptom management, stress management, medication management and healthy lifestyles. Individual must be licensed/ certified/ trained in the topic. (ADHS/DBHS Covered Services Guide)
• H0025 - Behavioral Health Prevention Education Service Billing Unit: 30 minutes
• H0038 – Self-Help/Peer Services Billing Unit: 15 minutes (up
to 2 ¾ hours)
Health and Wellness for all Arizonans
Questions?
Veronica Wilson Medical Systems Analyst/Acute Health Plan Coordinator Certified Stanford University CDSMP Master Trainer
NARBHA 928-774-7128 [email protected]
Melanie Mitros Director
AZ Living Well Institute A division of Empowerment Systems Web: www.azlwi.org [email protected]
Claudia Sloan, MBA Division Chief of Communications
ADHS Division of Behavioral Health Services Blog: bhsblog.azdhs.gov Web: www.azdhs.gov/bhs [email protected]
THANK YOU!