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
Why CDSMP? 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
ARIZONA LIVING WELL INSTITUTE The mission: to advance evidence-based programs for Arizona communities through structured communication, multi-level coordination and systematic coaching. Health and Wellness for all Arizonans
Arizona Living Well Institute Empowerment Systems, Inc. AZ Coalition AZ Living Well Greater Valley Community Health for Military Institute AHEC Outreach Informatics 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. 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 Healthy Living Stanford University’s CDSMP http://med.stanford.edu/patienteducation/ Health and Wellness for all Arizonans
Disease Tense Fatigue Muscles Symptom Shortness Pain of Breath Cycle Stress/ Depression Anxiety Difficult Emotions Health and Wellness for all Arizonans 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/ 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 • 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 Arizona Living Well Institute
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 Services Providers • Insurance Providers • AHEC Interns • Self-Referral • Evidence-based Self- • Response to referral Management Workshops source of services Referrals • Referral to other needed provided to include: services (e.g. ASHLine, • Participation in Self- WIC, etc.) Management • Assistance completing Workshop health & human service • Other completed applications (e.g. referrals/services AHCCCS) • Referral to potential Medical Home Outcomes • Database Management • Invoicing & Billing Services 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
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