BUILDING BRIDGES: LINKING MENTAL HEALTH WHOLE …nyspha.roundtablelive.org/Resources/Documents...building bridges: linking mental health & whole health through peer interventions and

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


Our Wellness Philosophy

Leading a meaningful and fulfilling life through conscious and self‐directed

behaviors, focused upon living at one’s fullest potential


Eight Dimensions of Wellness

Emotional Environmental Financial Intellectual Occupational Physical Social Spiritual


Making the Case: Linking Mental Health and Whole Health


This is a Critical Issue

What is killing the majority of us is not infectious disease, but our chronic and modifiable behaviors.


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:


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%)


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


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)


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)


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


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


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


Impact of Obesity in the U.S.


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%.


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


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


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?


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


BHWP Toolkits

http://www.bhwellness.org/resources/toolkits


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


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.


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


Behavioral Health and Wellness Program

DIMENSIONS: Tobacco Free and Well Body Programs




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)



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


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


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


Motivational Intervention


Plant a Seed


DIMENSIONS: Tobacco Free & Well Body Programs


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


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


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


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


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


BHWP Program Outcomes


Program Evaluation

Group evaluation‒ Collection of Peer Personal Progress Forms

Impact Evaluation Protocol‒ Enrollment, 6 months, 12 months

Evaluation Supported by the


Personal Progress Form


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.


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


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