Doing What Works - Effective Brief Strategies for Care Managers - PowerPoint PPT Presentation

w w w . T h e N a t i o n a l C o u n c i l . o r g Doing What Works - Effective Brief Strategies for Care Managers Suzanne Daub, LCSW The National Council for Behavioral Health suzanned@thenationalcouncil.org C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Webinar Goals > Improve our effectiveness when providing care management services. > Expand our repertoire of brief strategies by considering evidence based methods. > Integrate into treatment planning > Apply brief strategies to challenging case examples. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Does Care Management Ever Feel Like This? C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Effective and Brief Strategies  The 5 As  Motivational Interviewing  Transtheoretical Model: Stages of Change  Behavior Change Strategies C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

What are the 5 A ’ s? > Sequential steps designed to facilitate behavior change and self- management of symptoms > First applied to smoking cessation but found to have utility with other behaviors > Consumer-centered approach that engages consumer in process > Not a theory but a set of “ how to ” guidelines that can be used by all team members Whitlock, Orleans, Pender & Allan, 2002 Karmody, K.A. 2008, The 5As of Self-Management (healthcarecommunities.org) C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

ASSESS : ADVISE : Beliefs, Behavior & ARRANGE : Provide specific Knowledge Information about health Specify plan for risks and benefits of follow-up (e.g., change 1. List specific goals in visits, phone calls, behavioral terms mailed reminders) 2. List barriers and strategies to address barriers 3. Specify follow-up plan 4. Share plan with consumer, team and consumer ’ s social support network ASSIST: AGREE: Identify personal barriers, Collaboratively set goals based strategies, problem-solving on consumer ’ s interest and techniques and social/ confidence in their ability to environmental support change the behavior C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Benefits of 5As Approach > Consistent with Motivational Interviewing, Stages of Change, CBT interventions, etc. > Also models for consumer and team members a way to “ think ” about behavioral change that demystifies our work > Identifies areas for feedback in consultation with PCP and care team > Components of model are important at all stages of care C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Motivational Interviewing (MI)  Collaborative vs. expert approach  Person centered  Elicit consumer ’ s motivation for change (the consumer ’ s reasons)  Ambivalence- two (or more) conflicting views about behavioral change (think about what the consumer will have to give up to do what we are asking) C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Motivational Interviewing Increasing Change Talk  Desire: Why would you want to make this change?  Ability: How would you do it if you decided?  Reason: What are the three best reasons?  Need: How important is it? and why?  Commitment: What do you think you ’ ll do? C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Transtheoretical Model Stages of Change:  Precontemplation  Contemplatiion  Preparation  Action  Maintenance  Relapse Major Contributors: Prochaska & DiClemente C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Stages of Change  Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation  Be aware of your (and team members) reactions at each stage of change  Stage-Matched Interventions C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Matching Intervention to Stage of Change > Neutrality NOT READY: > Build rapport Pre-contemplation > Raise awareness > Tailor psychoeducation to Contemplation readiness level > Indicate readiness to help > Identify benefits/costs of change > Praise previous efforts Karmody, K.A. 2008, The 5As of Self-Management (healthcarecommunities.org) C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Matching Intervention to Stage of Change READY > Collaborative problem solving Preparation > Identify and reinforce small steps taken (be a Action cheerleader!) > Develop action plan > Encourage support networks > Look for ways to increase self-efficacy C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Behavior Change Strategies C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 13 2 0 2 . 6 8 4 . 7 4 5 7

Symptom Monitoring Use a Rating Scale: “ On a scale of 0 – 10 where 0 = no symptoms and 10 = worst symptoms ever, where are you now ” ?  Helps the consumer develop a sense of self efficacy over symptoms C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Establish Importance Use an Importance Ruler: What goals are important to the consumer NOW? (may differ from PCP ’ s goals) 1 2 3 4 5 6 7 8 9 10 Not Unsure Somewhat Very Important Important Important C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Establish Readiness Use a Readiness Ruler: how ready is the consumer to take action? 1 2 3 4 5 6 7 8 9 10 Not Unsure Somewhat Very Ready Ready Ready & Trying C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Establish Confidence Use a Confidence Ruler: how confident is the consumer that he or she can change the behavior? 1 2 3 4 5 6 7 8 9 10 Not Unsure Somewhat Very Confident Confident Confident C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Mood Monitoring Form www.tiny.cc/moodmonitor C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Teach The Relaxation Response The Relaxation Response is a state of deep rest that changes the physical and emotional responses to stress. When the Relaxation Response is elicited:  Metabolism decreases  Breathing slows down  Heartbeat slows down  Blood pressure decreases  Blood vessels open up  Stress hormones decrease If practiced regularly, it can have lasting effects C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Two Essential Steps to Elicit the Relaxation Response 1. Repetition of a word, sound, phrase, or muscular activity. 2. Passive disregard of everyday thoughts that inevitably come to mind and a return to repetition. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Fostering Strengths and Resiliency > Consumer ’ s strengths provide a foundation that interventions can be built upon and helps build rapport > Are we being less effective by primarily focusing on consumer ’ s deficits, symptoms, and/or chief complaint? > Positive Psychology: Focus on strengths may have a lasting impact on mood, self-perception, perceived control, and coping. C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Practical Ways to Foster Strength and Resiliency  Make a checklist of strengths  Make a list of Pleasurable Activities  Strengthen social ties and “ service to others ”  Promoting positive thinking/optimism (personal hope that one ’ s life can be better)  Catch it! Check it! Change it!  Connecting With that Which Is More than Self  Promoting restful sleep, exercise, healthy diet C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7