Mental Health Peer Support in Primary Care

Transcription

1 Mental Health Peer Support in Primary Care Successful Implementations Mental Wellness Recovery 1

2 Faculty/Presenter Disclosure Faculty: Magda Czegledi Relationships that may introduce potential bias and/or conflict of interest: No relationships to declare.

3 Disclosure of Commercial Support This program has received NO COMMERCIAL financial support. This program has received NO COMMERCIAL in-kind support.

4 Faculty/Presenter Disclosure Faculty: Susan Miller Relationships that may introduce potential bias and/or conflict of interest: Other: The Litebook Company

5 Disclosure of Commercial Support This program has received NO COMMERCIAL financial support. This program has received NO COMMERCIAL in-kind support. Potential for conflict(s) of interest: Profit: Susan Miller has shares from the Litebook Company.

6 Mitigating Potential Bias This presentation will focus on peer-led support groups and will NOT discuss products from The Litebook Company.

7 Who s in the room? PCN? AHS and AH? Physicians? Other direct patient care providers? Support and Management? Other? 7

8 What is your situation now? Once patients diagnosed with depression, anxiety or bipolar II, what support is your team able to offer in addition to medication? Do you refer patients to 1-1 counselling or groups? What are the challenges to providing this support? 8

9 What information would you like from this session? 9

10 Learning objectives: How can Mental Health Peer Support: address the service gap for patients diagnosed with a mental illness? be successfully added to an existing collaborative mental health care model? What are patient outcomes in primary care and outpatient settings? What is the cost of this model compared to others? 10

11 Peer Support Definition Those with lived experience of mental illness recovery helping others recover from mental Illness 11

12 The image part with relationship ID rid3 was not found in the file. The image part with relationship ID rid2 was not found in the file. Professional Peer Support Effective treatment - reduces overall healthcare costs Studies have found that peer support services : Decrease morbidity and mortality rates Improve self-care skills, including medication adherence Reduce use of urgent care and emergency services by up to 50% Reduce hospital re-admission rates by up to 70% Kathol, Melek, and Sargent: Mental Health and Substance Use Disorder Services and Professionals as a Core Part of Health in Clinically Integrated Networks. (2015) Druss, B.G., and Walker, E.R. (February 2011). Mental Disorders and Medical Comorbidity 12

13 Alberta Gap Report on Mental Health About 10,000 Alberta adults per 100,000 population have unmet service needs these individuals are most in need of counselling and information" pg191 13

14 The image part with relationship ID rid3 was not found in the file. The image part with relationship ID rid2 was not found in the file. Goal of Peer-Led Mental Wellness Recovery Groups We provide information and facilitation that enables participants to understand and practice methods that have been proven to support resilient recovery, and reduce likelihood and severity of relapse 14

15 Unique model for adding Peer Support Primary Care: South Calgary Primary Care Network (SCPCN) 227 Family Physicians at 55 clinics Outpatient: The Carnat Centre day hospital for schizophrenia & psychosis Community: Canadian Mental Health Assoc. Peer Support provide by: Mental Wellness Recovery Groups (MWRG) 15

16 Mental Wellness Recovery Groups Interactive, recovery-based program 2 hrs/week x 10 weeks 8-12 participants diagnosed with mental illness Evidence-based methods taught and practiced facilitated by trained Certified Peer Specialists 16

17 Integration with Existing Services Clinical Scenarios: Diagnosed & symptoms sufficiently managed to enable group participation GP & self-referral for anxiety, depression, BPII After discharge from hospital Follow-up after day hospital program While wait-listed for other services Added to outpatient services 17

18 The picture can't be displayed. The image part with relationship ID rid2 was not found in the file. Syllabus Mental Wellness Recovery Groups Compilation of evidence-based, recovery-oriented modalities to help participants: Maximize the benefits of treatment Practice self-care & address negative self-talk Find hope & purpose Exercise connection & control Develop a personal action plan 18

19 Client Outcomes Overview Participant Data 240 sessions in clinical and community settings: 229 registered, 180 grads, 79% retention Aged 20 to % women Diagnoses: mood disorders & psychosis What is your overall rating of the program? 9.2/10 Would you recommend this program to other people who have mental illness? 100% YES 19

20 The picture can't be displayed. Participant Data Client Outcomes SCPCN & Carnat Outcomes from 170 sessions facilitated: 168 registered, 128 grads, 76% retention Aged 20 to % women Diagnoses: mood disorders & psychosis Overall rating of the program? 9.3/10 Would you recommend this program to other people who have mental illness? 100% YES 20

21 The picture can't be displayed. Participant Data Client Outcomes For SCPCN Participants rate their ability and knowledge in areas research has shown to be significant for recovery and reduced incidence of relapse. Beginning of the 10 week program End of the program 5 point scale % Improvement denominator: beginning score % Increase denominator: 5 21

22 The picture can't be displayed. Participant Data Client Outcomes For SCPCN 115% improvement and 43% increase in ability to change unhelpful thinking and negative self-talk 120% improvement and 46% increase in ability to plan for my personal wellness & recovery 98% improvement and 43% increase in knowledge and understanding of recovery 99% improvement and 46% increase in the understanding of the importance of self care 22

23 100s of Positive Participant Comments This program has forever changed my life in a positive way most helpful thing I have ever done for my mental health This program made me love myself again! shows you how to grow and make necessary changes I am more focused and content... working on recovery Awesome group. Learned a lot Inviting/accepting atmosphere. Feeling of community nurtured 23

24 South Calgary Primary Care Network View of MWRG Peer Implementation Sheena K. Clifford, MSW RSW Program Manager, SCPCN: At a zone-wide education day, 3 patients shared their experience of the health care system (from offices, to clinics, to outpatient and inpatient services) MWRG was at the top of their list. We have found that this intervention is stand alone for some of our patients, reducing the burden on additional resources 24

25 South Calgary Primary Care Network View of MWRG Peer Implementation Penny Borghesan MD, Mental Health Physician Champion, SCPCN: I would recommend this to my patients and fellow physicians very valuable addition to our services... impressed with the group dynamic... led them through the recovery process together... Very impressed. 25

26 Carnat Centre View of MWRG Peer Implementation Dr. Tim Ayas MD FRCPC CCFP MPH BSc Consultant Psychiatrist - Carnet Centre Clinical Medical Director Claresholm Centre for Mental Health and Addictions... been extremely helpful to be able to refer to this program... I as their psychiatrist... and the case managers have noticed quite a benefit in patients outcomes and in patient progress and quality of life. 26

27 Carnat Centre View of MWRG Peer Implementation Ellen Au-Mulder BSc (OT), Case Manager, Occupational Therapist Carnat Centre Case managers have spoken very highly about the group and... Clients finding it very useful to speak to people with lived experience. 27

28 South Calgary Primary Care Network View of MWRG Peer Implementation Sheena K. Clifford, MSW RSW Program Manager, SCPCN: enables us to be truly patient-centred Mental Wellness Recovery Group enabled us to offer this to our patients in a very quick way Very smooth efficient collaborative process getting recovery groups up and running. A pleasure to work with. Not only from the business side of things also do things that are outcome-based and sustainable and patient- focussed. PCN took on the logistics the peer facilitators did the rest 28

29 What was unique about MWRG Peer implementations? Contract with established group of Certified Peer Specialists An evidence-based 10-week recovery program Facilitators trained, managed, paid and supported by MWRG Self referral as well as physician referrals MWRG does all participant fit interviews & registration, delivers the program Outcomes are measured, reported & monitored 29

30 How MWRG Peer Groups Intro d Quote from S. Clifford - Program Mgr SCPCN: MWRG rounded out our continuum of services In addition, we were able to offer MWRG to all our member clinics with reasonable access... Posters created and distributed to all clinics Created a list of patients who could benefit, and referrals increased. Having facilitators present to our PCN teams has been really powerful, offering both mental health and non-mental health providers a trusted option that can really make a difference. 30

31 Mental Wellness Recovery Groups Peer-Led Team Strong group of Certified Peer Specialists (CPS) dedicated to helping address the gap in mental health services by providing Peer-Led Mental Wellness Recovery Groups Led by two successful peer leaders 31

32 The picture can't be displayed. The image part with relationship ID rid2 was not found in the file. MWRG Peer Facilitators Have Lived Experience of Recovery Plus Certified Peer Specialist (Georgia Method) training in Alberta Must pass certification exam well- recognized in USA growing in Cda Medicaid reimbursable in 30 States In Georgia, no reimbursement without a Certified Peer Specialist 32

33 The picture can't be displayed. The image part with relationship ID rid2 was not found in the file. Facilitator Training Mental Wellness Recovery Groups In addition to Certified Peer Specialist training & exam each MWRG facilitator must complete: Practicum 20 weeks Co-facilitation with experienced MWRG facilitator Learning Materials Support: Participant Guide 125 pages Facilitator Manual 112 pages 33

34 Quality Assurance Session Statistics monitored & reported to Partners (attendance, feedback, outcomes) Session Observation by partners Quality Monitoring by senior facilitators 2-3 sessions per group. Backup Facilitator for every group Facilitators supported & developed 34

35 Cost In Alberta as per Gap Report Avg Cost Hospital Psychiatric $16,239 Hospital Outpatient $2,629 Community MH Services $3,961 Cost of Peer-Led Mental Wellness Group $430 Cost of Peer-Led Virtual Group $260 35

36 The image part with relationship ID rid4 was not found in the file. The image part with relationship ID rid2 was not found in the file. Telehealth High Patient Satisfaction Users of Telehealth Patient Satisfaction millions % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 92% to 96% Use of telehealth is exploding - 20x growth forecast by 2018 Independent Studies: Alliance for Connected Care Anthem MD Live Teladoc Peer Support Solutions 36

37 The image part with relationship ID rid3 was not found in the file. The image part with relationship ID rid2 was not found in the file. Combining Telehealth with Professional Peer Support is a transformative treatment option Online professional peer support is a convenient, accessible, low cost treatment option that substantially reduces the need for additional expensive care 2015 Survey of Online Depression Recovery Group Participants (N=142) Evaluation Criteria Before After Moderately to severely depressed Urgent care for depression, bipolar or anxiety Emergency room visit for depression or related issue Hospitalized for depression or other related issues 73.2% 48.6% 24.6% 12.7% 28.2% 14.4% 32.4% 9.9% Professional peer support improves effectiveness AND lowers cost addresses a broad set of behavioral and chronic conditions is better than face-to-face: value access convenience at equal outcomes 37

38 Mental Wellness Recovery Virtual PSS Groups 8-week interactive, recovery-based program 90 minutes /week 8 participants diagnosed with depression, anxiety or bipolar II Evidence-based recovery tools taught and practiced facilitated by MWRG Certified Peer Specialists Pilot Cost: $500 setup fee + $260 per participant 38

39 The image part with relationship ID rid3 was not found in the file. The image part with relationship ID rid2 was not found in the file. Benefits More consistent service delivery Quick and easy implementation Expanded reach and accessibility Target by region, PCN physicians Systematic capture of usage and outcome data Completely scalable solutions Professional MWRG Peer Staff Better value, no need to use limited PCN space and resources for registration & administration 39

40 Mental Wellness Recovery Groups Increase peer support, information and services Proven outcomes in primary care & outpatient settings. Independently managed and collaboratively delivered Qualified Facilitators - hired, trained and managed Provide budget flexibility without HR burden Capacity available for rapid expansion 40

41 Questions? Comments? Sue Miller