Stanfords CDSMP in Behavioral Health Presented by: Claudia Sloan, - - PowerPoint PPT Presentation

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Stanfords CDSMP in Behavioral Health Presented by: Claudia Sloan, - - PowerPoint PPT Presentation

Sep 08, 2022 266 likes •669 views

Healthy Living: Implementation of Stanfords 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

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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

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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 –
  • utcomes, successes, challenges, and lessons

learned.

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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.

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Health and Wellness for all Arizonans

SHARED VISION

  • CDSMP provides a professional development
  • pportunity 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.

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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
  • r 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.

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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.”

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Health and Wellness for all Arizonans

Why CDSMP?

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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
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Health and Wellness for all Arizonans

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Health and Wellness for all Arizonans

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

ARIZONA LIVING WELL INSTITUTE

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Health and Wellness for all Arizonans

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

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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

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Health and Wellness for all Arizonans

Healthy Living Stanford University’s CDSMP

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

Healthy Living

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Health and Wellness for all Arizonans

Disease Tense Muscles Pain Stress/ Anxiety Difficult Emotions Shortness

  • f Breath

Depression Fatigue

Symptom Cycle

Stanford Chronic Disease Self Management, 2006

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Health and Wellness for all Arizonans

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
  • English & Spanish
  • Diabetes & Chronic Pain

www.wittysparks.com/2007/05/26/15-tips-to-manage-yourself-better/

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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
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Health and Wellness for all Arizonans

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.

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Health and Wellness for all Arizonans

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
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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

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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.

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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.

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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.

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Health and Wellness for all Arizonans

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

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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
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A Bit About NARBHA

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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)

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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.

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Health and Wellness for all Arizonans

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

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Health and Wellness for all Arizonans

OUTCOME MEASURES

THE STANFORD UNIVERSITY CHRONIC DISEASE SELF-MANAGEMENT PROGRAM (CDSMP)… …WHAT DOES THIS LOOK LIKE IN NORTHERN ARIZONA?

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Health and Wellness for all Arizonans

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

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Health and Wellness for all Arizonans

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 from interfering? Keep Pain from interfering? Keep Emotions from interfering? Keep Other Symptoms from interfering? Do Tasks and Activities? Do things besides take medication to help?

Confidence in Doing Things Pre & Post Survey Comparison n=92

Pre Mean Post Mean

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Health and Wellness for all Arizonans

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 or strengthening exercises? Walking? Swimming or aquatic? Bicycling? Other aerobic? Other exercises?

Physical Activity Pre & Post Survey Comparison n=92

Pre Mean Post Mean

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Health and Wellness for all Arizonans

Workshops September 2011 through March 2014

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't understand? Discuss personal problems related to your illness?

Medical Care Pre & Post Survey Comparison n=92

Pre Mean Post Mean

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Health and Wellness for all Arizonans

Workshops September 2011 through March 2014

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

Pre Mean Post Mean

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Health and Wellness for all Arizonans

Workshops September 2011 through March 2014

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 by Health Problems? Fearful About Future Health? Worried About Your Health? Frustrated with Your Health? Level of Fatigue 0- 10? Level of Pain 0-10?

Health Distress Pre & Post Survey Comparison n=92

Pre Mean Post Mean

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Health and Wellness for all Arizonans

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
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Health and Wellness for all Arizonans

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)

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Health and Wellness for all Arizonans

It WORKS!

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Health and Wellness for all Arizonans

Questions?

Veronica Wilson

Medical Systems Analyst/Acute Health Plan Coordinator Certified Stanford University CDSMP Master Trainer

NARBHA 928-774-7128 Veronica.Wilson@narbha.

  • rg

Melanie Mitros

Director

AZ Living Well Institute A division of Empowerment Systems Web: www.azlwi.org mmitros@azlwi.org Claudia Sloan, MBA

Division Chief of Communications

ADHS Division of Behavioral Health Services Blog: bhsblog.azdhs.gov Web: www.azdhs.gov/bhs Claudia.Sloan@azdhs.gov

THANK YOU!