Depression & Anxiety Intervention

Christine Garcia, BA, Research Assistant

Rachael Meir, PsyD, Director of Health and Wellness Services

Rachel Speer, LCSW, Behavioral Health Clinician

Marisa Taylor, LPC, Behavioral Health Clinician

Collaborative Family Healthcare Association 15th Annual ConferenceOctober 10-12, 2013 Broomfield, Colorado U.S.A.

Session # B4b October 12, 2013

Faculty Disclosure

We have not had any relevant financial relationships

during the past 12 months.

Learning Assessment

A learning assessment is required for CE credit.

Presenters Will:Incorporate audience interaction through a

brief Question & Answer period during or at the conclusion of our presentation.

Objectives

• Identify benefits of telephonic counseling as an adjunctive treatment for depression and anxiety

• Explain specific skills and techniques taught by this counseling intervention

Overview

•Introduction to Telephonic Counseling

•Past Research

•Current Practice

•Specific Interventions

•Case Presentation

•Conclusion & Future Directions

•Q & A

Telephonic CounselingIntervention Benefits:Intervention Benefits:

•To provide adjunctive treatment for the reduction of anxiety and depression symptoms

•To provide counseling to populations that may experience many barriers to participating in traditional treatment

•To be a cost-effective intervention

Benefits: Enhancing Treatment

Our overall aim is to enhance PCP’s treatment of depression and anxiety by:

(1) Providing evidence-based psychotherapy

(2) Improving adherence to antidepressant medications

(3) Improving depression and anxiety outcomes

(4) Identifying previously undiagnosed psychiatric comorbidities

(5) Providing feedback to PCPs on depression and anxiety

outcomes, skills learned, and other recommendations

Benefits for Patients

Telehealth benefits patients by:

☺Eliminating need for transportation and childcare

☺Increasing access to care through lower costs, provider availability, extended coverage to underserved populations and underserved geographical regions.

☺Reducing stigma associated with being seen in a mental health clinic

☺Facilitating willingness to disclose personal information

Benefits for Healthcare Institutions

Telehealth allows institutions to offer more cost-effective care by:

•Lowering costs of administrative and reception personnel, waiting areas, and patient care rooms.

•Reducing problematic no-show rates

Psychiatric assessment 3 outcomes monitoring calls

Psychiatric assessment 3 outcomes monitoring calls Behavioral Activation Therapy Medication adherence monitoring Relapse prevention counseling

Control Group:Control Group:Enhanced Usual Care (EUC)Enhanced Usual Care (EUC)

Experimental Group:Experimental Group:Telephone Counseling (TC)Telephone Counseling (TC)

DH conducted a depression study from 2009-2013, including 300 participants…

Findings:

*TC had statistically significant reductions in levels of depressive symptoms at 6, 12, and 24 weeks

*TC had increased depression remission rate at 24 weeks

Research

Steps in Treatment

1. Referrals & Outreach2. Consent, Disclosures, Initial Assessment3. Patient chooses 3 module topics4. Complete module calls5. Final call: Self-Care Plan6. Update providers about patient’s progress 7. Research assistant tracks progress

Referrals & Outreach

Referrals: Referrals: •Self•PCP•Other Staff•Pharmacy

Outreach: Outreach: Highlights include:•free service•how it benefits the patient•module choices•can opt-out at any time• monetary incentive.*English and Spanish

Initial Assessment

PHQ-9 to assess Depressive Symptoms

GAD-7 to assess Anxious Symptoms

Mini International Neuropsychiatric Interview (M.I.N.I.) to assess additional diagnoses

Module Choices

Patients can chose at least 3 call topics

Getting Going Grief and Loss Healthy Eating Healthy Relationships Improve Sleep Patterns Manage Stress Better Mind Tricks for Pain Overcoming Illness Physical Activity Positive Thinking Problem-Solving Worrying Less

Our Database

Anxiety Module: Call 1

Anxiety Module: Call 1

Anxiety Module: Call 1

Belly Breathing Activity(Audience participation recommended!)

More Skills

Guided Imagery

CBT

DEAR MAN

Self-Management Action Plan

Gate Control Theory

Progressive Muscle

Relaxation

Pacing

Motivational Interviewing

Sleep, Eating,

Exercise Habits

Last Call: Self-Care Plan

Updating the PCPOur practices:– Emails to PCPs at initial enrollment, and 6, 12, and 24 weeks,

including symptom severity, medication recommendations, and comorbidities

– Enter notes into medical records• 80.5% of PCPs noted reviewing our emails and/or medical

record notes– Provide recommendations for PCPs to reinforce patient

goals/skills learned – Encourage three-way communication between PCP, telehealth

clinician, and patient– Schedule follow-up appointments with PCPs if needed

Tracking Progress:Reduction in Depression Scores

Tracking Progress:Reduction in Anxiety Scores

Patient Testimonials“I feel she really cares. When you have a sickness like cancer, everybody cares about you but when you have a mental illness, people flee and run away. So when you find somebody who really cares, it gives you that positive boost. I’m a private person so how she got me to talk about my feelings is a miracle.” “If it wasn’t for her, I don’t know where I’d be.”

“I’ve met with other people before and they were so stuffy and used big words and I didn’t feel comfortable. It’s hard for my feet to get goin’ and I like that I don’t have to go anywhere to talk with her.”

“I don’t know if it’s the deep breathing exercises or the medication or talking with her but I have noticed a definite positive change.”

Case Study

•Demographic•Presenting problem

• PHQ-9/GAD-7 scores

•Module work• Skills learned

•Outcome• PHQ-9/GAD-7 scores

Future Directions

FUTUREFUTURE

Trauma workInteractive

videosMotivational

texts/emailsSustainability

Conclusions

♥ Enhances depression and anxiety treatment

♥ Benefits to patient & healthcare institution

♥ Evidenced-based treatment

♥ Future developments & applicability

Questions & Comments

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!