Advancing Standards of Care for People with Bipolar Disorder Overview

Bill Schmelter PhD Willa Presmanes M.Ed., M.A.

Quick Reminders Your Participation Open and hide your control panel Join audio: •Choose “Mic & Speakers” to use VoIP •Choose “Telephone” and dial using the information provided Submit questions and comments via the Questions panel

Note: Today’s presentation is being recorded and will be provided within 48 hours.

2

Asking Questions Your Participation • Please continue to submit your text questions and comments using the Questions Panel

• Please raise your hand to be unmuted for verbal questions.

3

Participating Behavioral Health Organizations Organization

City and State

AltaPointe Health Systems Inc.

Mobile, Alabama

AtlantiCare Behavioral Health

Egg Harbor Township, New Jersey

Cobb/Douglas Counties Community Services Board

Smyrna, Georgia

Family Guidance Center for Behavioral Healthcare

Saint Joseph Missouri

Gallahue Mental Health Services

Indianapolis, Indiana

Hill Country Mental Health Services

Kerrville, Texas

Mental Health Centers of Central Illinois

Springfield, Illinois

Recovery Resources

Cleveland, Ohio

Seminole Behavioral Healthcare

Fern Park, Florida

Spokane Mental Health

Spokane, Washington

Advancing Standards of Care Core Components: – Engaging consumers in their own Wellness Self Management through the implementation of the evidence based Wellness Self Management Curricula – Tracking functional outcomes through implementation of the DLA-20 functional assessment – Publicizing the program to the community

Wellness Self Management and Wellness Self Management Plus Curricula • WSM and WSM + were developed as a collaborative effort among the NYS Office of Mental Health (OMH), the Urban Institute for Behavioral Health in NYC, the OMH Bureau of Recipient Affairs, and the Center for Practice Innovations at Columbia Psychiatry (CPI) • CPI received a 2010 “Science to Service” award by The Substance Abuse and Mental Health Services Administration (SAMHSA) for development of the Wellness Self Management Program

Curricula Elements WSM and WSM + Personal Workbooks – WSM : 57 Lessons organized into 19 Topic Areas – WSM+ : 57 Lessons organized into 18 Topic Areas – Each Lesson includes: • • • •

Important Information Discussion Points Personalized Worksheets Action Steps

WSM and WSM+ Workbooks • The Workbook and Supplemental Materials are available on the Center for Practice Innovations Website: – WSM Page: http://practiceinnovations.org/CPIInitiatives/WellnessSelfManagementWSM/ tabid/189/Default.aspx – WSM + Page: http://practiceinnovations.org/CPIInitiatives/WellnessSelfManagementWSM/ WellnessSelfManagementWSMPlus/tabid/184/Default.aspx – Storefront: (To Register and Download or Purchase Workbooks) http://practiceinnovations.org/PurchaseCPIProducts/tabid/108/Default.aspx

DLA-20 • The Daily Living Activities (DLA) Functional Assessment is a functional assessment, proven to be reliable and valid, designed to assess what daily living areas are impacted by mental illness or disability. The assessment tool quickly identifies where outcomes are needed so clinicians can address those functional deficits on individualized service plans. • The DLA is intended to be used by all disabilities and ages. Developmental Disabilities and Alcohol/Drug Abuse forms are personalized for daily functional strengths and problems associated with those diagnoses. An Adult form exists for for SMI and SPMI consumers over the age of 18 and a Youth form for consumers between the ages of 6 and 18.

DLA-20

DLA-20 • The DLA-20 is copyrighted and its use requires training by MTM consultant Willa Presmanes • Subsequent to training there is no cost for materials or ongoing use for those trained

Project Process 1.

Train Teams in WSM and DLA-20

2.

Teams recruit 50 + individuals with bipolar disorder to participate in groups

3.

Teams and MTM Consultants monitor implementation of groups, DLA-20 administration and participant attendance using project data system

4.

DLA-20 administered every 60 days

5.

Monthly GoToMeetings with MTM consultant and each team to review data integrity, trends, attendance, and to provide coaching and problem solve.

6 Month Outcomes

6 Month Outcomes

Implications for Shift to “Pay for Value” Models • Behavioral Health organizations should be preparing for the shift from “Pay for Volume” to “Pay for Value”

• The “Advancing Standards of Care” project demonstrates how, in a short time, organizations can begin to tackle three important aspects of this shift: – Reliable implementation of an effective EBP – Implementation of a valid and reliable outcome measurement system – Demonstration of statistically significant functional outcomes for a specified population

Highland Rivers Health Beth Vice, LPC Regional Manager Natalie Davis, CPS Lead Certified Peer Specialist Peer Support

Advancing Standards of Care Implementation • • • •

Implemented within current Peer Support Programs 6 Programs in 6 locations 15 Staff Participated Recruitment of current consumers within Peer Support Program in addition to consumers recruited from Outpatient Program participated • WSM was implemented into the current structure of program one (1) day per week for three (3) hours

Advancing Standards of Care Lessons Learned • Utilizing a current Peer Support Program proved successful with recruitment and retention • Promoting as a “Class” in which participates would receive a certificate during a ceremony at the end of the Program was effective • Do not underestimate time to allow for data collection • To increase effectiveness/efficiency having one person per program administer DLA 20 to ensure they were completed in a timely and consistent manner • Coaching sessions assisted in the progression of the program • The data program was instrumental in finding missing or inconsistent data

Advancing Standards of Care Struggles • Coordination of 6 programs and 15 staff • Data collection from 6 programs/15 staff in 6 locations • Promotion of Program to Outpatient Staff in short amount of time • Structuring WSM to fit into 3 hour time period (incorporated activities and covered 1-4 lessons per class) • DLA 20 implementation / training of staff • All staff completing DLA 20

Advancing Standards of Care Successes • • • • • •

Retention of 38 participants Recruitment (57 initially started group) Support from Leadership and Outpatient Clinical Staff Facilitators enjoyed the program. Renewed sense of pride in Peer Support. Participant engagement Participants reported: – – – – – –

Decreased Hospitalizations Increased self-confidence Reconnection with Family Re-entering the work force Increase in social relationships Increased leadership skills

Advancing Standards of Care Tips on Implementation • • • • • • • • • •

Utilizing a current group/program structure Promoting as a class/course Collaboration with participants Clear communication regarding timeframe of data collection Incorporate activities within the curriculum (art, role playing, sharing recovery stories, games) Ensure staff support and “buy in” of program by sharing the WSW and DLA 20 Share success stories with participants, staff, and facilitators Allow for time to make up lessons that were missed Provide outreach to participants that missed classes Sustainability: Highland Rivers Health has been able to continue utilizing the WSM within Peer Support and other groups throughout the agency

Robert Young Center

Lessons Learned Using Different Language • We described it as a “project” in all of our marketing. • We encouraged people to “enroll” and “sign up.” • This generated some additional “buzz” and word of mouth with our consumers. • Historically, our new groups are called “groups” • We described the ASC project as a “class” instead.

Lessons Learned Keep It Simple • We wanted to mobilize WSM and WSM+ initially • Difficulty separating population: • • • • •

High # of co-occurring substance abuse Some active users, some episodic, in remission Didn’t want to create a stigma with a “substance use group” Logistics – some people with SA problems were only available at certain times Didn’t want to intermingle WSM and WSM+ in the same group

• Short timeline led us to select WSM as the only curriculum we used in all of the groups

Lessons Learned Ask About Scheduling • We initially asked people who signed up to select from 6 different times/ days that we had obligated for this class. •

This helped us determine multiple issues: • • •

One facilitator vs. two How many total groups we needed Where to fit the groups into our existing group schedule

• Most consumers signed up for four of the times. A handful of consumers signed up for one other time. • Classes were a mix of days and times for convenience • Final result –we added four WSM groups to our existing psychosocial rehabilitation group schedule.

Struggles Scheduling • Finding times that would work for consumers and allow them to attend regularly. • We worked around all of the other important things (Dr. Clinics, Lab days, other groups on the schedule, etc.) as much as possible. • We had to incorporate a way to make up a missed class.

• Since we had four groups, it took about 60 days for consumers to really settle into their “home group.” • A lot of movement between groups as people found what really fit their schedule the best. • This impacted the group dynamics.

Struggles DLA’s • Completing the DLA’s proved consistently challenging. • Some consumers would no show appointments for DLAs, but attend groups. • We worked with case managers to catch people. • We looked at who was scheduled with other providers. • We made time directly before and after classes.

• A real team effort to get the DLAs completed consistently

Struggles Knowledge of the Consumer/ DLA • Facilitators completed the DLAs in the project. • They were not always the case manager. – DLA Scores were initially higher in the beginning of the project and we had to re-calibrate after: – Staffing with other providers – Reviewing the record – Spending more time with the consumer.

• First use of the DLA instrument. • Developing an understanding of the DLA was necessary also.

Successes Recruitment •

•

Mailed invitations out to all consumers with a qualifying diagnosis, inviting them to “Information Sessions” on this project. At the Info Session, possible participants were given: • • • • •

The WSM manual The DLA A broad overview of the project Potential days and times of the class The opportunity to ask questions or clarify anything

Successes Recruitment (continued)

• At the Info Sessions, clients could “opt out” on the spot. • For those who were interested in participating: • Informed consent was obtained • They were asked to choose a first, second and third choice of days or times from our available list.

• For those who did not sign up, instructions on how to get involved if they changed their mind were handed out.

Successes Retention • We were very persistent • People who missed class got a phone call. • We informed them which groups they could attend to “make up” a session. • We informed case managers about a miss or a couple misses in a row. • Offered to make up a session individually in some cases. • Really tried hard to stay engaged with people once they signed up.

Successes Retention (continued) • We had some goodies • We obligated small gift cards to reward perfect attendance. • Coordinated with a local grocery store. • No cash value – could only be used there and no change was given. • These were a big hit! • Group facilitators also had “grab bag” type door prizes during each group session to keep it fun.

Successes Group Composition – We identified at sign up that some people might more quickly or slowly through the curriculum for various reasons. – We talked with their case managers and the consumers to get them all in the same group. – We ended up with the following types of groups: • Fast track • Two moderate speed groups • One group that moved more slowly through WSM

Tips on Implementation Recruitment • Information sessions worked really well for us. • It helped engage consumers from the start. • Gave consumers something tangible to see and feel before they signed up. • Was great for collecting Informed Consent.

Tips on Implementation Team Approach • From the beginning, we got the facilitators involved in problem solving issues. • They worked closely together when it came to unravelling some logistical problems. • Having both male and female facilitators assisted with finding just the right spot for consumers.

Tips on Implementation Incentives • We had incentives for perfect attendance. The team could only identify one consumer that they felt was “just in it for the card.” But still, that consumer sat through all the sessions and had a DLA increase! • The facilitators had a grab bag style incentive during groups where folks could win a small item for participation.

Mean Calculated GAF Over 4 Administrations - RYC 46.0

45.4 45.0

44.0

43.4 43.0

42.0

GAF

42.3

42.0

41.0

40.0 1

2

3

4

Project Outcomes – RYC Only • Eliminating potential participants who dropped out in the first two months yielded an adjusted 6 month attrition rate of 35%. • RYC had 22 withdraw from the project.

Initial Starting Group 44

Final Active Group 22

Withdrew from Project

Never Attended

22

10

Adjusted Starting Group 34

Adjusted Attrition Number 12

Adjusted Attrition Rate 35%

Project Attrition Rate 50%

Project Outcomes – RYC Only • 8% increase in GAF for cohort • 35% adjusted attrition rate • 33% lower healthcare utilization (combined psychiatric crisis and psychiatric admissions) for cohort in the six months of the project when compared to the six months prior to the project.

Payment/ Delivery Reform Readiness • Using the DLA-20 can: – Assist in establishing medical necessity – Be used as an outcome measure

• Moving toward value based purchasing scenarios, groups can be a population health tactic. • Using WSM for population health management – Reduce Emergency Department utilization – Reduce readmissions – Decrease length of stay