Integrating Healthy Behaviors as a Routine Part of Team Based Care When Patients are not telling us, and we re not asking

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1 Integrating Healthy Behaviors as a Routine Part of Team Based Care When Patients are not telling us, and we re not asking MODERATOR: Tammy Richards RN, MSN, CPXP, Patient/Clinical Engagement AVP, Intermountain Healthcare PRESENTERS: Scott F. Hansen, MD, Intermountain Healthcare Lori Neeleman, PhD, CBSM, Psychologist, Intermountain Healthcare Bridgette Baker, MSW, LCSW, ACM-SW, Community Care Social Worker, Intermountain Healthcare

2 Objectives Examine best practice approaches for integrating behavior change into clinical workflows Understand the behavior change guidelines for use Execute MHI clinician approach in linking clients with community resources

3 Behavior change just how possible is it?

4 Behavior Change Framework Guidelines for Use

5 Primary Care Physician Scott F. Hansen, MD

6 Attention to the Physical Activity Vital Sign PAVS Clinicians can make a difference in just 3 minutes!

Physician interprets the PAVS and documents that the patient is advised to start, increase, maintain or modify PA based on

7 PAVS Workflow (The Vision) Medical/Clinical Assistant asks the PAVS questions and documents in the EHR. PAVS data is placed as a que for the physician. Physician interprets the PAVS and documents that the patient is advised to start, increase, maintain or modify PA based on PAVS result A 1-3 minute conversation assists the patient to create next step in improved physical activity. Train your team on PAVS Develop your prompt to discuss PAVS Record your assessment and actions Review it each visit

8 Physical Activity Vital Sign (PAVS)

9 PAVS Physician Workflow Ambulatory Comprehensive Intake EMPTY!

10 Live Well, Move More No matter what your current weight or health condition is, being active will give you a better quality of life

11 What do I choose to do?

12 You Can Learn To Move More To make new daily routines, you need to experiment to find what works best for you

13 You ll learn what works for you by trying and creating your own formula. Follow the steps below

14 Complete the task--you need it all: Coding, Billing AND Documentation Coding: ICD-10 Lack of physical exercise + ICD-10 for disease impacted. Billing: minutes of face-to-face time with the patient Documentation: 50% of patient visit spent counseling on physical activity and/or exercise Build your template, icentra upgrades

15 Behavioral Sleep Medicine Specialist Lori Neeleman, PhD, CBSM

16 Sleep: Healthy Behavior versus Problem 100% of people sleep and can benefit from adequate quality sleep. Up to 90% of patients visiting a mental health provider report sleep problems when asked. About 50% of patients attending a primary care visit report trouble sleeping when asked. ASK! Keep sleep on the radar. o o How are you sleeping? Are you tired during the day?

17 PHQ-9/MHI Packet Patient has completed the PHQ9 and item 3 or 4 is >0. Patient has completed the MHI packet and sleep problems are identified. sleeping. Off and on for years 4-6 2

18 Sleep as Problem Type Sleep Related Breathing Disorders Central Disorders of Hypersomnolence Insomnia Disorder Circadian Rhythm Sleep-Wake Disorders Parasomnias Sleep Related Movement Disorders Other Sleep Disorders Standardized Assessment STOP-BANG Epworth Insomnia Severity Index

19 Sleep as Healthy Behavior - Live Well-Sleep Well Fact Sheet Help patient find their why o Able to do more of what you love and feel better doing it o Focus/attention o Relationships less conflict o Mood o Productivity o Memory o Chronic disease o Mental health o Exercise will be more enjoyable/doable o Better food choices o Weight o Sleeping well feels good!

20 Sleep as Healthy Behavior (2) Education o Most adults need 7-8 hours. o Associate your bed with sleep. o Don t try to get more sleep than your body needs. o o o o o Keep a consistent wake time 7 days a week. Minimize screen time and bright lights in the last 2 hours before bed. Caffeine, alcohol, nicotine and some medications can impact sleep if taken close to bedtime. Get adequate bright light exposure and exercise/movement during the day. Establish a regular bedtime routine that includes time to relax.

21 Putting It Together: Using the Behavior Change Framework ASK ABOUT SLEEP KEEP IT ON THE RADAR IDENTIFY PERSONAL WHY/MOTIVATION EDUCATE SET GOALS/ASSESS ABILITY/MAKE A PLAN ACTION OUTCOME CIRCLE BACK

22 Community Care Manager Social Worker Bridgette Baker, MSW, LCSW, ACM-SW

23 Community Care Management: Personalized Help at Home Community Care Management (CCM) is a team-based care program. This outreach program aims to remove obstacles and find solutions so that patients can get well and stay well. The goal is to improve patient s quality of life

24 CCM starts with Person In Environment

25 Maslow s Hierarchy of Needs

26 Patient Advocates Clinic Care Managers Insurance Care Managers Community Care Managers Who s There to Help?

27 Panel Question 1 Questions from the Audience

Discussion Questions Panel Question 1 If a patient describes symptoms of insomnia, should I provide a referral first or try to help them with behavioral changes in the context of MHI/primary care?

28 Discussion Questions Panel Question 1 If a patient describes symptoms of insomnia, should I provide a referral first or try to help them with behavioral changes in the context of MHI/primary care? What specific recommendations have the best chance of helping a patient improve their sleep? When is it appropriate to refer to Community Care Management (CCM)? How can you as a clinician help the patient be successful with a smart goal for increasing physical activity? How can rapid cycle review and treatment adjustment help a patient improve their physical activity habits? How do sleep aids like Ambien fit into a therapeutic regimen for healthy sleep?

29 Intermountain s Behavior Change Framework Thank you for attending this session.

WHEN COUNTING SHEEP FAILS: ADMINISTERING SINGLE-SESSION COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA IN A GROUP PSYCHOEDUCATIONAL FORMAT

WHEN COUNTING SHEEP FAILS: ADMINISTERING SINGLE-SESSION COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA IN A GROUP PSYCHOEDUCATIONAL FORMAT Kristin E. Eisenhauer, PhD. Trinity University San Antonio, Texas I