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Tools to Support Clients with Self-Management

Credit Information If you would like to receive continuing education credit for today’s event via the

Centers for Medicare & Medicaid Service’s Learning Management System, please visit this link for more information: https://resourcesforintegratedcare.com/Behavioral_Health/2017_Self-Management_Support_Webinar_Series/Tools

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https://resourcesforintegratedcare.com/Behavioral_Health/2017_Self-Management_Support_Webinar_Series/Tools


July 26, 2017

Behavioral Health:Tools to Support Clients with Self-

Management

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Overview

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This is the third session of the “2017 Self-Management Support Webinar Series”

Each session will be interactive (e.g., polls and interactive chat functions), with 45 minutes of presenter-led discussion, followed by 15 minutes of presenter and participant discussions

Video replay and slide presentation are available after each session at: https://www.resourcesforintegratedcare.com

https://www.resourcesforintegratedcare.com/


Tools to Support Clients with Self-Management

Developed by: The Lewin Group SAMHSA-HRSA Center for Integrated Health Solutions

Hosted by: The Medicare-Medicaid Coordination Office (MMCO)

Resources for Integrated Care

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Accreditation

The Centers for Medicare & Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET). The Centers for Medicare & Medicaid Services complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, the Centers for Medicare & Medicaid Services is authorized to issue the IACET CEU

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Continuing Education Information

Complete the post-test through CMS’ Learning Management System and score a 80 percent or higher by midnight August 14, 2017

https://www.resourcesforintegratedcare.com/sites/default/files/SMS_Webinar_3_CMS_CEU_Guide.pdf

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Support Statement

This webinar is supported through the Medicare-Medicaid Coordination Office (MMCO) in the Centers for Medicare and Medicaid Services (CMS) to ensure beneficiaries enrolled in Medicare and Medicaid have access to seamless, high-quality health care that includes the full range of covered services in both programs. To support providers in their efforts to deliver more integrated, coordinated care to Medicare-Medicaid enrollees, MMCO is developing technical assistance and actionable tools based on successful innovations and care models, such as this webinar

To learn more about current efforts and resources, visit Resources for Integrated Care at: https://www.resourcesforintegratedcare.com

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Introductions

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Alexis EstominConsultant, The Lewin Group

Larry FricksDeputy Director, Centers for Integrated Health Solutions

Matthew FedericiExecutive Director, Copeland Center

Ellen HochbergCertified Recovery Support Specialist,WRAP facilitator, Thresholds, Inc.


Webinar Outline/Agenda

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Polls Action Plan Selection Guide Whole Health Action Management Action Planning

(WHAM) Model Wellness Recovery Action Plan (WRAP) Model Implementing Action Planning with Clients RIC Self-Management Support Resources Q&A


Webinar Learning Objectives

Upon completion of this webinar, participants will be able to:1. Define the key elements of action planning with clients to

promote self-management

2. Identify different evidence-based action planning selectionguides, including the Wellness Recovery Action Plan(WRAP), Whole Health Action Management (WHAM) Plan

3. Define supportive conversations with clients on the self-management of chronic conditions and mental illness usingRIC client handouts

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Action Plan Selection Guide

Alexis Estomin, Consultant, The Lewin Group

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https://www.ResourcesForIntegratedCare.com12

Action Planning in Self-Management Support

What is Self-Management Support (SMS)? Long-term, continuous process toward recovery Systematic provision of educational and supportive interventions Goal to improve client skills in managing their own health issues

Action Planning is 1 of 6 Skills that Promote Successful SMS1:1. Problem solving2. Decision making3. Resource utilization4. Formation of a patient-provider partnership5. Action planning6. Self-tailoring

1. Lorig, K.R., & Holman, H.R. (2003). Self-Management Education: History, Definition, Outcomes, and Mechanisms. Annals of Behavioral Medicine, 26(1).


Understanding Action Planning

Goal-setting through action plans Working with clients and natural supports to develop

short-term objectives for health Developing specific steps for crisis management Facilitating the provider-client discussion Creating a reference document for providers,

clients, and other members of the clinical care team

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RIC Action Plan Selection Guide

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Key Features of Action Plans

Client Population The client population the action plan focuses on

Intervention or Method Structure and context for how the action plan is of Implementation delivered to clients

Estimated Time per Estimated amount of time to complete each module of Session the action plan

Frequency of Action How often clients are expected to update their action Plan Updates plans

Approach to Goal- Steps involved in achieving the clients’ goals, which may Setting include the level of client effort, frequency of client

engagement, or timing of the goal-setting activity

Identification of Whether the action plan prompts providers and clients to Triggers/Warning Signs identify potential triggers or warning signs for the client

Client Self-rated Scales Whether the plan uses a client self-rated scale to determine client’s confidence in their ability to meetaction plan goals


RIC Action Plan Selection Guide (cont.)

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The Action Plan Selection Guide includes peer-reviewed studies demonstrating the effectiveness of each action plan. Some of the action

plans have been formally evaluated.

Aspects of studies evaluating the action plans are included in the guide:

Evidence of Effectiveness

• Study design • Measures and instruments

• Study population • Description of findings

• Length of study • Citation

• Study replication



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The Action Plan Selection Guide also includes information related to operationalizing action plans:

Key Details for Implementation

• Staff training options • Available manuals or tools to assess fidelity

• Licensing and certification • Available technical assistance requirements resources

• Cost of training, licensing, and certification



Action plans featured in the guide (alphabetical order): Brief Action Planning (BAP) CHCF Team Up for Health Action Planning Form Harlem Family Action Plan for Better Health Health and Recovery Peer (HARP) Program Illness Management and Recovery Program Individual Recovery Plan (Council of Southeast Pennsylvania, Inc.) IHI Action Plan MaineHealth Self-Care Plan New York State Wellness Self-Management + (WSM +) Penn Foundation Integrated Wellness Recovery Plan Stanford Chronic Disease Self-Management Program (CDSMP) Wellness Recovery Action Plan Whole Health Action Management (WHAM) Plan

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Whole Health Action Management (WHAM) Action Planning Model

Larry Fricks, Deputy Director, Centers for Integrated Health Solutions

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What is WHAM?

Designed for behavioral health peer workforce by SAMHSA-HRSA Center for Integrated Health Solutions

Whole Health Action Management (WHAM) training is a peer-led intervention to activate whole health self-management to create and sustain new health behaviors

“The secret of change is to focus all of your energy, not on fighting the old, but on building the new” -Socrates

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What is Included in a Two-Day WHAM Training?

Two trainers

All materials to implement WHAM (participant manual, weekly action plan booklet, implementation manual, and link to all training handouts)

Technical assistance

National listserv

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WHAM 5 Keys to Success

A person-centered goal focused on 10 science-based whole health and resiliency factors

A weekly action plan that breaks the goal into small, achievable successes

A daily/weekly personal log One-to-one peer support A weekly WHAM peer support group

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WHAM 10 Science-Based Health and Resiliency Factors

1. Stress management2. Healthy eating3. Physical activity4. Restful sleep5. Service to others6. Support network7. Optimism based on positive expectations8. Cognitive skills to avoid negative thinking 9. Spiritual beliefs and practices10. A sense of meaning and purpose

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Self-Management Skills

Engage in person-centered planning to identify strengths and supports in 10 science-based whole health and resiliency factors

Write a whole health goal using the IMPACT process Create and log a weekly action plan Participate in peer one-to-one and peer support groups to create

new whole health habits

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Self-Management Skills (cont.)

Engage in cognitive skills to avoid negative thinking

Know basic whole health prevention screenings and how to prepare for them

Use shared decision-making skills for more engaging meetings with doctors

Elicit the relaxation response to manage stress

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Whole Health Goal

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Sample Weekly Action Plan

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Week…1…....……………..………………………………….....

What?...Walk..........................................................................

How much?...1 mile................................................................

How often?...3 days...............................................................

When?...In the evenings.........................................................

Confidence level?...8..............................................................


WHAM Resources

For more information on WHAM, contact Sarah Flinspach

[email protected]

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mailto:[email protected]


Wellness Recovery Action Plan (WRAP®) Model

Matthew Federici, Executive Director, Copeland Center

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WRAP® Co-Facilitation

An evidence-based practice promoting activation of personal self-agency

WRAP guides people through the process of identifying their personal wellness resources, and then how to use those resources as a guide to daily living, dealing with triggers, early warning signs, indicators that things are breaking down, and developing crisis and post crisis plans

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WRAP® Co-Facilitation (cont.)

The curriculum is delivered in a peer-support group context that has been widely used with people of all ages, including those with varying mental health diagnoses and other disabilities, those from varied economic circumstances, and diverse cultural backgrounds

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Learning to Use WRAP®

The evidence-based practice that showed positive impacts of learning WRAP® was through a peer based self help group

How you document, share and continue to work on your wellness action plans can take many forms but…

YOU AND ONLY YOU CHOOSE HOW TO USE WRAP®!

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WRAP® Co-Facilitation Values and Ethics

Based on self-determination Rooted in the belief in equality A mutual learning model Avoid medical and clinical language No limits to recovery Focus on person’s strengths and away from perceived deficits

It is a way of approaching daily living!

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The Keys to Unlock the Implementation is Peer Support & Self-determination

The Copeland Center facilitates a process that evolved out of two fundamental values upon which the mental health field was historically built:

1. People are experts in their own recovery and wellness

2. People with shared experience can support each other effectively

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Learning to Use WRAP®

The evidence-based practice co-facilitated 8-12 sessions through the following areas of wellness and recovery action planning: 5 Key Concepts of Wellness and Recovery: Hope, Personal

Responsibility, Education, Self Advocacy and Support Building a Wellness Toolbox 3 Part Daily Maintenance Planning Identifying Triggers and Action Plans Identifying Early Warning Signs and Action Plans Describing When Things are Breaking Down and Action Plans Describing Crisis and support plans such as names of

individuals willing to help, & types of assistance preferred. Plan for Post-Crisis support, retooling WRAP® plan after a

crisis, Graduation ceremony

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The Implementation Science of WRAP® Co-Facilitation Programs

Randomized control trial level research demonstrated …

1. Overall positive outcomes and overall quality of life

2. Significant decrease in service utilization and self reported need for services

3. Increase in patient self-advocacy

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1. Cook, Judith et al., Initial Outcomes of a Mental Illness Self-Management Program Based on Wellness Recovery Action Planning, Psychiatric Services 60:246–249, 2009

2. Cook, Judith, Jonikas J A..,et al. Impact of WRAP on Service Utilization and Need in a Randomized Control Trial, American Psychological Association Vol, 36, No 4, 250-257

3. Jonikas, Jessica A., et al. Improving Propensity for Patient Self-Advocacy Through Wellness Recovery Action Planning: Results of a Randomized Controlled Trial, Community Mental Health Journal DOI 10.1007/s10597-011-9475-9


WRAP® Tested in This Study

Lasted for 8 weeks

Met for 2 and ½ hours every week

Followed a highly standardized curriculum: Facilitator Training Manual: Mental Health Recovery Including

Wellness Recovery Action Plan Curriculum (Mary Ellen Copeland, 2012)

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WRAP® Tested in This Study

Co-facilitated and Facilitator curricular departures discouraged

Co-facilitators gave illustrations from their own use of WRAP®

Followed and reviewed a checklist of values and ethics. (i.e. medical and clinical language by the facilitators is avoided.)

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Fidelity Implementation: Train-the-Trainer Model of WRAP®

Three-part model:

1. Introduction to mental health recovery and WRAP®

2. WRAP® facilitation certificate course

3. Option Advanced Level WRAP® Facilitator Training certificate course

Listing and directory of people trained in this model is available at www.copelandcenter.com

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http://www.copelandcenter.com


The Way WRAP Works

https://copelandcenter.com/resources/way-wrap-works

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https://copelandcenter.com/resources/way-wrap-works


Implementing Action Planning with Clients

Ellen Hochberg, Certified Recovery Support Specialist,WRAP facilitator, Thresholds, Inc.

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Introduction

Action plans empower people to create an improved sense of wellbeing.

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My Story

Background: 58 years-old with a diagnosis of Bipolar II illness

Early warning signs (identified by client): Loss of interest in friends and family and lower energy level

Goal: to feel better during depressive episodes

Action plan: Check-in with self to evaluate whether symptoms are progressing Permit self to cut back on social activities Spend time in nature Practice mindfulness

Results: Reduction in stress over depression

What I learned: I could take steps to create a better sense of wellbeing

in my life – WOW!

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Brian’s Story

Background: 48 year-old man with a 25 year history of schizophrenia. As a result of his illness he has periods of hearing voices – voices that only Brian hears

Early warning signs (identified by client): voices getting louder and saying negative things

Goal: reduce distress brought on by hearing voices saying negative things

Action plan: Listen to music Color Talk to his social worker Get a PRN medication

Results: Over time Brian’s voices have been less disruptive in his life and he has needed less PRN medication

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Mary’s Story

Background: 49 year-old woman with a history of manic episodes – these episodes have put her personal safety at risk; in the past, she has been out at night walking long distances and has had involvement with the justice system

Early warning signs (identified by client): Days of minimal to no sleep

Goal: to reduce chances of a severe manic episode

Action plan: Do everything on her daily maintenance list Work to create a regular sleep routine Keep track of her sleep patterns Talk to her social worker or psychiatrist should she notice any changes in sleeping Exercise during the day Read a book/listen to music to wind down before bed

Results: Mary feels empowered and is proud that she is developing a plan for self-care

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Debra’s Story

Background: 59 year-old woman who has had several episodes of depression

Trigger: Being alone for Thanksgiving

Early warning signs (identified by client): feelings of hopelessness, negative thinking, difficulty getting out of bed

Goal: to manage depression during the Thanksgiving holiday

Action Plan: Do everything on her daily maintenance list Remind herself that “It is just another day” Call a friend or family member to chat for a little while Volunteer to serve meals to those who may be less fortunate

Results: Debra had a fine Thanksgiving. Her WRAP plan helped her to restructure her thinking about expectations for the day.

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Key Takeaways

We are the experts on ourselves

Symptoms/triggers are unique to individuals

Action plans should be tailored to individuals’ goals

Action plans are living documents – they evolve over time as the individual goes through his or her recovery journey

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RIC Self-Management Support Resources

Alexis Estomin, Consultant, The Lewin Group

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Self-Management Support First Person Stories

Six client handouts featuring success stories of individuals who have used self-management techniques to effectively manage their behavioral health and substance use conditions

Available in English and Spanish: https://resourcesforintegratedcare.com/concept/client-handout/2016/self-management-stories

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https://resourcesforintegratedcare.com/concept/client-handout/2016/self-management-stories


What To Expect When You’re Self-Managing

Client handout designed to support conversations with clients on the self-management of chronic conditions.

Includes information on: The purpose of self-management What the client should expect from the care team What the client may ask for from natural supports Resources available to support client efforts to self-manage

Available in English and Spanish: https://resourcesforintegratedcare.com/behavioral_health/self_management_support/client_handout

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https://resourcesforintegratedcare.com/behavioral_health/self_management_support/client_handout


SMS Organizational Assessment Tool (SMS OAT)

Self-assessment tool to help administrators, providers, or other service delivery staff in organizations serving individuals with serious mental illness or substance use conditions assess the capacity for implementing self-management services

The SMS OAT can be found on our website: https://resourcesforintegratedcare.com/behavioral_health/self-management_support/tool/organizational_assessment_tool

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https://resourcesforintegratedcare.com/behavioral_health/self-management_support/tool/organizational_assessment_tool

https://www.ResourcesForIntegratedCare.com51

Questions


Evaluation Form and Post-test

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Thank you for joining our webinar. Please take a moment to complete a brief evaluation on the quality of the webinar

For more information about obtaining CEUs via CMS’ Learning Management System, please visit: https://www.resourcesforintegratedcare.com/sites/default/files/SMS_Webinar_3_CMS_CEU_Guide.pdf

Video replay and slide presentation are available after each session at: https://www.resourcesforintegratedcare.com

Questions? Please email [email protected]



mailto:[email protected]

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