if G lLife GoalsCollaborative Care

Life Goals Collaborative Care (LGCC)Life Goals Collaborative Care (LGCC)Life Goals Collaborative Care (LGCC)Life Goals Collaborative Care (LGCC)

AmyM Kilbourne PhD MPHAmy M. Kilbourne, PhD, MPHDept. of Psychiatry University of Michigan

VA Ann Arbor Health Services Research and DevelopmentU i i f Mi hi D i CUniversity of Michigan Depression Center

Life Goals Collaborative Care

• LGCC is an evidence‐based psychosocial intervention designed toLGCC is an evidence based psychosocial intervention designed to improve medical and psychiatric outcomes for persons with mood disorders through personal goal‐setting aligned with wellness and symptom coping strategies and supported through ll b ticollaborative care. 

• Consumer‐centered program based on the Chronic Care Model shown to improve physical and mental health outcomes for persons with bipolar disorder in 3 randomized controlled trialspersons with bipolar disorder in 3 randomized controlled trials

• Closes the gap between physical and mental health by integrating tailored psychosocial sessions with collaborative care g g p ymanagement

• Recently expanded to serious mental illness, and found to be effective for those with co‐occurring substance use disorders

LGCC DescriptionLGCC Description

LGCC h l i t i i i t d• LGCC helps persons maintain a vision towards achieving their personal goals while providing practical day‐to‐day support in working on specificpractical day to day support in working on specific health‐related objectives that help them  achieve these goals over time

• LGCC focuses on prevention of adverse medical outcomes through a unique combination of health g qbehavior change, psychotherapy, and motivational enhancement

The Life Goals Collaborative Care ModelThe Life Goals Collaborative Care Model

Integrated ProviderSupport

Life Goals:Symptoms & WellnessSupport Wellness

MedicalSelf‐management

Medical & Psychiatric 

Care Management

Medical and psychiatric care decision support

focused onpersonal goals

Care Management

Enhanced access/continuitysupported by registry

Bauer MS et al. Psych Serv 2006; Kilbourne AM et al. Psych Serv 2008

Life Goals Collaborative Care Life Goals Collaborative Care DevelopmentDevelopment

1996 2006 LGCC d l d b d f db k1996 - 2006 LGCC developed based on consumer feedbackTested in two large randomized controlled trials nationwideManual (v.1.0) published (translated in Spanish, French)

2006 - 2008 2nd Generation randomized clinical trial adapted LGCC to address improving medical and psychiatric outcomes

Manuals (v. 2.0) and intervention packages for ( ) p gproviders, administrators, and consumers

2009 - present Publication of Overcoming Bipolar Disorder (LGCC workbook) for providers & consumersworkbook) for providers & consumersSeveral provider trainings implemented (e.g., for MSW, nursing psychiatry, psychology, international scholars) Manuals developed for mood disorders, SMI

LGCC Consumer Workbook Published by New HarbingerLGCC Consumer Workbook Published by New Harbinger

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Slide 6

hf5 Add description and details about text to supplement image. heidi frankenhauser, 11/3/2010

Life Goals Collaborative Care:Life Goals Collaborative Care:Life Goals Collaborative Care:  Life Goals Collaborative Care:  The The Consumer’s ExperienceConsumer’s Experience

Session 1 Session 3WEEK ONE      WEEK THREE             SIX MONTH FOLLOW‐UP WITH 

WEEK TWO WEEK FOUR HEALTH SPECIALIST

Following the session work the HealthSession 4Session 2

Following the session work, the Health Specialist will initiate contact with the consumer at agreed upon monthly scheduled times, for 10‐15 minute intervals for the following:

Assist with wellness goalsReview medicationsCollaborate on careCollaborate on careAssist with mood monitoring Review of lessons learned

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Slide 7

hf6 Might be helpful to break down and re-create into two slides that describe sessions and follow-ups separately (to simplify and reduce text). That- or perhaps a more simplified timeline followed by one r two slides that break down session content. heidi frankenhauser, 11/3/2010

Life Goals Session ContentLife Goals Session Content

• Depression overview and • Self management & C ll b i C

Session 1 Session 3

symptoms• Triggers to depressive episodes

• “What’s Your Experience”?A ti l f d i

Collaborative Care• Understanding Mood Symptoms •Identifying Core ValuesM d Di d & W ll • Action plan for depression

Session 3• Mood Disorders & Wellness

Session 1

Session 4Session 2• Your Wellness Plan• Building and Strengthening Collaboration of CareR l P ti

• Mania/anxiety  overview & symptoms• Triggers to episodes“Wh t’ Y E i ”? • Relapse Prevention• “What’s Your Experience”?

• Action plan for symptoms

Session 2 Session 4

Why Implement LGCC in your Setting?Why Implement LGCC in your Setting?

• LGCC was originally developed for bipolar disorder one• LGCC was originally developed for bipolar disorder, one of the most costly mental disorders and is part of the Collaborative Care Model family

• LGCC addresses the “unwanted co‐travelers” associated with mood disorders, including cardiovascular disease, diabetes, anxiety, and substance use

• LGCC is manual‐based, scalable, and practical to implement

• LGCC can be adapted to other mental disorders commonly seen in primary care settings

LGCC ReferencesLGCC References

1.Kilbourne AM, Post EP, Nossek A, Drill L, Cooley S, Bauer MS. Improving medical and , , , , y , p gpsychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial. Psychiatr Serv. 2008 ;59:760‐8.

2. Bauer MS, McBride L, Williford WO, Glick H, Kinosian B, Altshuler L, Beresford T, Kilbourne AM, Sajatovic M; Cooperative Studies Program 430 Study Team. Collaborative , j ; p g ycare for bipolar disorder: part I. Intervention and implementation in a randomized effectiveness trial. Psychiatr Serv. 2006;57:927‐36.

3. Bauer MS, McBride L, Williford WO, Glick H, Kinosian B, Altshuler L, Beresford T, Kilbourne AM, Sajatovic M; Cooperative Studies Program 430 Study Team. Collaborative Kilbourne AM, Sajatovic M; Cooperative Studies Program 430 Study Team. Collaborativecare for bipolar disorder: Part II. Impact on clinical outcome, function, and costs. Psychiatr Serv. 2006;57:937‐45.

4. Simon GE, Ludman EJ, Bauer MS, Unützer J, Operskalski B. Long‐term effectiveness and cost of a systematic care program for bipolar disorder. Arch Gen Psychiatry.and cost of a systematic care program for bipolar disorder.  Arch Gen Psychiatry. 2006;63:500‐8.

5. Kilbourne AM, Biswas K, Pirraglia PA, Sajatovic M, Williford WO, Bauer MS. Is the collaborative chronic care model effective for patients with bipolar disorder and co‐occurring conditions? J Affect Disord. 2009;112: 256‐61.occurring conditions? J Affect Disord. 2009;112: 256 61.