BUILDING BRIDGES: LINKING MENTAL HEALTH & WHOLE HEALTH THROUGH PEER INTERVENTIONS AND STRATEGIES FOR BEHAVIORAL HEALTH POPULATIONS
Emma Maki‐Gianani M.S.S, R.N., CACIIIJamie Pfahl B.A.
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Session Objectives
DEFINITIONBehavioral health population:
1) Represents the heterogeneous group of individuals diagnosed with a psychiatric or substance use disorder, as outlined by established medical criteria.
2) Includes mood disorders, anxiety disorders, substance‐induced disorders, or any other brain disease resulting in cognitive and/or psychological changes or decline.
Impact of modifiable health behaviors on behavioral health populations Importance of tailored wellness programming for behavioral health populations How to address tobacco cessation and weight management through DIMENSIONS: Tobacco Free and Well Body Programs
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Our Wellness Philosophy
Leading a meaningful and fulfilling life through conscious and self‐directed
behaviors, focused upon living at one’s fullest potential
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Eight Dimensions of Wellness
Emotional Environmental Financial Intellectual Occupational Physical Social Spiritual
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Making the Case: Linking Mental Health and Whole Health
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
This is a Critical Issue
What is killing the majority of us is not infectious disease, but our chronic and modifiable behaviors.
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Morbidity and Mortality
Modifiable health behaviors
Lack of Physical Activity
Poor Nutrition
Tobacco Use
Excessive Alcohol Consumption
Leading causes of illness and premature death related to chronic disease among U.S. adults:
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Rates of Tobacco Use
Smoking rates by state: Ranges from 9.1% in Utah to 26.8% in West Virginia
Smoking rates by region: Highest in the Midwest (21.8%) and South (21.0%) and lowest in the West (15.9%)
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Burden of Tobacco
443,000 tobacco‐related deaths in the U.S. each year 6 million tobacco‐related deaths worldwide each year
8.6 million people living with tobacco‐related chronic illness 50,000 deaths each year in the U.S. due to second‐hand smoke exposure
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Burden of Tobacco: New York
25,400 adults die each year from smoking
389,000 kids now under 18 living in New York who will ultimately die prematurely from smoking
2,690 adult nonsmokers die each year from exposure to secondhand smoke
Each year, $6.4 billion is spent on treating tobacco related diseases in New York (CDC, 2002)
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Burden of Tobacco: New York
Adults & tobacco use: In New York, the percentage of adults (ages 18+) who currently smoke cigarettes was 18.1% in 2011. New York ranked 8th among the states.
Youth & tobacco use: In New York, the percentage of youth in grades 9–12 who currently smoke cigarettes was 12.5% in 2011. New York ranked 4th among 44 states.
(CDC, 2012)
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Behavioral Causes of Death in the U.S.
8,300 25,70031,700 16,300 33,70043,000 38,400
365,000
443,000
050,000100,000150,000200,000250,000300,000350,000400,000450,000500,000
*
* Persons with Behavioral Health Conditions
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Tobacco & Behavioral Health Populations
Persons with behavioral health conditions: Are nicotine dependent at rates 2‐3 times
higher Represent over 44% of the U.S. tobacco
market Consume over 34% of all cigarettes
smoked
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Persons with behavioral health conditions who use tobacco: Have more psychiatric symptoms; Have increased hospitalizations; Require higher dosages of medications; Are twice as likely to leave against the advice of their doctors, if withdrawal symptoms are not treated.
Tobacco Use Affects Mental Health Care and Treatment
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Impact of Obesity in the U.S.
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
The Burden of Obesity
Approximately 68% of adults in the United States are either overweight or obese. Approximately 17% of youth are obese. Rates of obesity are rising rapidly. Over the past three decades, the percentage of persons who are overweight or obese has increased by approximately 40%.
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Prevalence of Obesity Rates in People with Behavioral Health Conditions
29%
60%
18%
28%
0
10
20
30
40
50
60
70
Men Women
Behavioral HealthConditionsGeneral Population
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On average, persons diagnosed with mental illnesses and addictions have higher rates of
disease and disability, and die up to 25 years earlier
than the general population.
Health Disparities
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People with behavioral health conditions suffer disproportionately more from chronic health conditions and use tobacco at much higher rates
Better health outcomes when behavioral health conditions are treated concurrently Individuals who treat their addiction
to tobacco and other substances at the same time are 25% more likely to sustain their recovery
Where Does Behavioral Health Fit into Wellness?
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Take into account client/patient history, comorbidities, environment, medications, recovery status High rates of poverty Lifestyle factors (e.g., poor health behaviors) Medication side effects and lack of wellness Programming in treatment settings
Behavioral Health Interventions
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
BHWP Toolkits
http://www.bhwellness.org/resources/toolkits
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Peer Advocate/ Mentor – An individual with a history of a behavioral health condition(s) who has received specialized training and supervision to work with others who have a similar history Basic Counseling Skills
Group Facilitation
Supervision
Peer‐to‐Peer Model
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
The Power of Peer‐Driven Services
Adjuncts to formal treatment, involvement in
self‐help groups, and social opportunities in
community and institutional settings
foster empowerment and self‐efficacy.
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
What does someone with a behavioral health condition need to make healthy choices?
Peer‐to‐Peer Model
“…a peer advocate, maybe somebody that’s smoked and quit smoking and they have ideas of how they dealt with stress at that time and how they deal with it now…”‐ Focus group participant
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Behavioral Health and Wellness Program
DIMENSIONS: Tobacco Free and Well Body Programs
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
DIMENSIONS: Tobacco Free and Well Body Programs
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Trainings in New York
Tobacco Free Peer Trainings: NYC Department of Health (2012) NYS Office of Mental Health (2012) NYS Office of Mental Health (2014)
Tobacco Free Provider trainings: Buffalo Psychiatric Center (2009) NYC Department of Health (2012) NYS Office of Mental Health (2012) Bronx Lebanon Department of Psychiatry (2012)
Tobacco Free Policy Trainings: Buffalo Psychiatric Center (2009)
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
DIMENSIONS: Tobacco Free and Well Body Programs
Evidence‐based tobacco cessation and nutrition/weight management programs Initially developed in 2006 The programs support health behavior change through motivational engagement strategies, group process, community referrals, and educational activities
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Role of Program Facilitators
Raise awareness through center in‐services, lunch and learns, and trainings Conduct individual motivational interventions Facilitate groups Make referrals to other healthcare providers and community services Create a positive social network
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
DIMENSIONS: Motivational Intervention
30‐minute semi‐structured interview Work with individuals to increase their readiness for health behavior change Provide brief, personalized feedback Encourage individuals to set concrete and manageable goals Discuss and list the supports they need to reach their wellness goals
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Motivational Intervention
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Plant a Seed
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DIMENSIONS: Tobacco Free & Well Body Programs
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Group Overview
Weekly, 60‐ to 90‐minute, open group
Participants may join at any time
Some information does build on previous sessions
Participants may attend as many sessions as needed
Session topics cycle over a 6‐week period
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Tobacco Free Group
Session A: Creating a Plan Session B: Healthy Behaviors Session C: The Truth about Tobacco Session D: Changing Behaviors Session E: Coping with Cravings Session F: Maintaining Change
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Well Body Group
Session A: Creating a Plan Session B: Healthy Behaviors Session C: The Truth about Nutrition Session D: Changing Behaviors Session E: Coping with Cravings Session F: Maintaining Change
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Participant Eligibility
Participants are eligible to attend group if:
They are interested in learning information about healthy living skills
They are able to actively and appropriately participatein a group
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Who can be Program Facilitators?
The DIMENSIONS: Tobacco Free and Well Body Programs can be led by: Peer Advocates – Persons who are trained and supervised to provide services for people with a similar history or background, for example, a history of a behavioral health condition, a university student, a co‐worker or colleague, among others
Providers – Healthcare providers who have experience with training, facilitation, or direct healthcare services
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
BHWP Program Outcomes
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Program Evaluation
Group evaluation‒ Collection of Peer Personal Progress Forms
Impact Evaluation Protocol‒ Enrollment, 6 months, 12 months
Evaluation Supported by the
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Personal Progress Form
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Group Evaluation
The Findings: Significant tobacco use reduction (52%)
and cessation (7%) rates among persons with serious mental illnesses.
Significant increase in both motivation to quit and confidence to make a quit attempt.
No worsening of psychiatric symptoms.
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
100% Smoke free correctional facilities
DIMENSIONS: Tobacco Free Program implemented statewide
Program evaluation in progress
Case Study ‐ Arkansas
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus© 2012 BHWP© 2012 BHWP
“Have Knowledge”
“Plan Steps”
“Current Steps”
“Confident Ability”
4 3 2 1
4 3 2 1
4 3 2 1
4 3 2 1
“Strongly Disagree”
“Strongly Agree”
Session 1 Session 2 Session 3 Session 4
Change in “Readiness to Quit”
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus© 2012 BHWP© 2012 BHWP
14.112.5 11.8 11.7
0
2
4
6
8
10
12
14
16
Session 1 Session 2 Session 3 Session 4
Number of Tobacco Uses Per Day
Change in Tobacco Uses Per Day
© 2013 Behavioral Health and Wellness Program, University of Colorado Anschutz Medical Campus
Addressing overall wellness in behavioral health populations is vital
Use tailored wellness programming to create a positive social network‒ Integrating care‒ Everyone has a role (providers,
peers, client, staff, community) Systems/culture change
Conclusion
© 2013 Behavioral Health and Wellness Program, CU Denver
303.724.3713www.bhwellness.orgemma.gianani@[email protected]
BHWP_UCDBehavioral Health and Wellness Program
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