Health - Arizona State University › sites › default › files › session-17-pdf... · 2019-12-19 · Health and Wellness for all Arizonans Empowerment Systems, Inc. AZ Living

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


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.


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.


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.


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.


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.”


Why CDSMP?

http://youtu.be/10HjGv7KDfw


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



The mission:

to advance evidence-based programs for Arizona communities through structured communication, multi-level coordination and systematic coaching.

ARIZONA LIVING WELL INSTITUTE


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


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


Healthy Living Stanford University’s CDSMP

http://med.stanford.edu/patienteducation/

Healthy Living

http://med.stanford.edu/patienteducation/


Disease

Tense Muscles

Pain

Stress/ Anxiety

Difficult Emotions

Shortness of Breath

Depression

Fatigue

Symptom Cycle

Stanford Chronic Disease Self Management, 2006


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/


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


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.


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


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


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.


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.


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.


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


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


A Bit About NARBHA


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)


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.


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


OUTCOME MEASURES

THE STANFORD UNIVERSITY

CHRONIC DISEASE SELF-MANAGEMENT

PROGRAM (CDSMP)…

…WHAT DOES THIS LOOK LIKE IN

NORTHERN ARIZONA?


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


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


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



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



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



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


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


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)


It WORKS!

http://youtu.be/msdX66iCBZ0


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!

mailto:[email protected]


http://www.azlwi.org/


http://www.azdhs.gov/bhs


Documents

Health - Arizona State University › sites › default › files › session-17-pdf... · 2019-12-19 · Health and Wellness for all Arizonans Empowerment Systems, Inc. AZ Living