Penn State Altoona Integrated care model Health services Counseling Services Disability Services Health Promotion

Transcription

1 Penn State Altoona Integrated care model Health services Counseling Services Disability Services Health Promotion 4,000 undergraduates SAMHSA grant

2 Topics Introduction Outcomes Statistics Screening In Primary Care Gatekeeper Training Early Alert Program

3 Challenges Significantly depressed students are often unidentified on campuses, refuse formal counseling, or drop out of treatment- Less than 10% seek help at their counseling center; Almost 80% of students that commit suicide aren t seen by a counselor Accuracy of recognition of depression in primary care is low; up to 69% may present only with physical symptoms; only 22% accurately diagnosed depression when symptoms were physical Short term models, separation periods from care and tracking of very high risk students is difficult. Collaboration between Medical and Counseling systems often is not ideal Kisch, Leino & Silverman, 2005; American College Counseling Association s 2007 National Survey of Counseling Center Directors; J. Gen Intern Med Jan, 23(1):25-36; Simon,GE, et al. N. Engl. J Med. 1999, 34(18):

4 PSU Altoona NCHA 2012(fall) 49.9% felt overwhelming anxiety 29.5% felt so depressed that it was difficult to function 44.6% felt things were hopeless 85.2% felt overwhelmed 80% felt exhausted (not from physical activity)

5 1 out of 10 report being diagnosed or treated for depression in the past 12 months American College Health Association. American College Health Association- National College Health Assessment II: Reference Group Executive Summary Fall Hanover, MD: American College Health Association; 2013

6 AUCCCD REPORT 2013 The average percent of students seeking counseling services is 9-12% at small colleges and 6-7% at larger colleges/universities. 21% of counseling center students present with severe mental health concerns 31.5% of centers have a waitlist at some point during the year.

7 Mental Health Outreach Initiatives at PSU Altoona Since the GLS Grant

8 Penn State Altoona Outreach Initiatives Mandatory Gatekeeper training for first year students- completion rate (80%) Gatekeeper training for faculty/staff - faculty (63%), staff (83%) Public Health Model- population based screening through Health Services Early Alert Program- Early Identification and Intervention Program

9 Student TRAINING

10 At-Risk Gatekeeper Training 30-minute, online Includes simulated conversation with atrisk student avatars Utilized to train all freshmen, RA-s, high risk groups SPRC Best Practices Demos can be viewed at os.

11 . Learning Objectives 1. Recognize common signs of psychological distress 2. Manage a conversation with an at-risk student and how to effectively motivate them to seek help & refer them to the counseling center 3. Avoid common pitfalls such as attempting to diagnose the problem or giving unwarranted advice during the conversation 4. Know what to do if the friend refuses to seek help or you feel uncomfortable to engage in the conversation 5. Learn about own college specific counseling center and referral process

12 Penn State Altoona Results AT-RISK How prepared participants are to engage in gatekeeper behaviors The likelihood or behavioral intent to engage in gatekeeper behaviors How confident (self efficacy) are participants in their ability to engage in gatekeeper behaviors

13 Measures Pre-test Post-test Three month follow-up using the GLS- The 11- item GIS is a validated tool that has been shown to predict gatekeeper behaviors

14 Outcomes Post-Training measures of Preparedness, Likelihood and Self Efficacy all significantly increased (p<.05) when compared to Prebaseline levels. At the 3-month follow-up all measures decreased as anticipated yet they remained significantly higher when compared to Pre-baseline measures. This demonstrates that the learning was sustained.

15 Student Skills- Based Outcomes Preparedness Liklihood Self-efficacy n=2467, 41 matched pairs Pre-test Post-test Follow-up

16 Student Results 120% n= % 80% 60% 40% n= % 0% Satisfaction Recommend Likely to Help

17 Bonus Results As a result of this course I may be more likely to recognize the signs of psychological stress in myself 58.6% Agreed or Strongly Agreed As a result of this course I may seek help from the counseling center myself when feeling stressed 51.2% Agreed or Strongly Agreed

18 Faculty and Staff Training

19 AT RISK- Faculty/staff Faculty/Staff Product: In Prof. Hampton s class, there are six students he s concerned about.

20 Three are at risk. - Users must approach them & refer them to the Counseling Center. The others are not at risk. They can be approached. (optional) Users should realize their problems are not psychological. Users can refer them or implement other solutions (e.g., setting boundaries and expectations for future behavior).

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22 Faculty/Staff Skills Outcomes Preparedness Liklihood Self-efficacy n=379; 36 match Pre-test Post-test Follow-up

23 Faculty/Staff Satisfaction Part of the role of faculty, staff and administrators is to connect students experiencing psychological distress with mental health support services 100% either Agreed or Strongly Agreed Overall, how would you rate this course? 97.2% from Good to Excellent. Would you recommend this course to your colleagues? 91.7% - Yes

24 Early Alert WHAT: Web-based system to submit a concern regarding a student s health, safety or academic progress unresolved through other venues. WHO: Faculty/Staff, Students WHY: Early Intervention: Identify, intervene, refer

25 Early Alert Committee has representation from Police Services, Student Affairs, Residence Life, DUS, Faculty, Student Conduct, HWC. Weekly meetings Initial Outreach by the Coordinator, then others as appropriate

26 Referrals to CAPS Based on Percentage who completed AT-RISK 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Spring 2012 Fall 2012 Spring 2013

27 Referrals to Counseling due to Early Alert 53% were referred to Counseling Services 82% of faculty/staff respondents believe that the program is essential in our efforts to help students. Number of submissions have increased by 158% from 2009 to 2013 (130 submissions last year) 82% retention rate

28 GATEKEEPERS IN PRIMARY CARE

29 BEST PRACTICES National guidelines (US Preventative Services Task Force) and Healthy Campus 2020 strongly recommend screening for depression among adults and teens in general medical care as an evidence based approach (when practices are prepared to provide treatment).

30 Improving Depression Identification Early Detection: Maximize existing health and mental health resources to identify and treat depression WHY? Under detection must be addressed aggressively. During a 1 yr. study (Young, 2001)- 83% with Dep/Anx. saw a PCP- < 30% received appropriate care. Primary care physicians assess for suicide in patients with depression in only about 1/3 of visits Young, A., et al. Arch Gen Psychiatry ;2001:58:55-61 Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); May p. [244 references] Feldman MD, et. Al MedCare 2006:44 (12):

31 HOW WE HAVE CHANGED Previous Model Screening only through annual medical history form If not in CAPS- no MH meds in Primary Care Lack of guidelines for follow-up CAPS- limited use of objective monitoring tools Evidence based approach Screening at each visit in primary care Treatment protocols based on objective measures Collaborative care related to follow-up and treatment- MDT Objective measures for monitoring outcomes Self-management and Case management

32 PHQ-2 During the past two weeks, have you been bothered by: Little interest or pleasure in doing things? No Yes Feeling down, depressed or hopeless? No Yes

33 PHQ-9 Symptom Checklist Over the last 2 weeks, how often have you been bothered by the following problems? Not at All Several Days More Than Half the Days Nearly Every Day a. Little interest or pleasure in doing things b. Feeling down, depressed, or hopeless c. Trouble falling or staying asleep, or sleeping too much d. Feeling tired or having little energy e. Poor appetite or overeating f. Feeling bad about yourself, or that you are a failure... g. Trouble concentrating on things, such as reading... h. Moving or speaking so slowly... i. Thoughts that you would be better off dead... PHQ-9 = Patient Health Questionnaire-9. Kroenke K, et al. J Gen Intern Med. 2001;16: Subtotals: TOTAL: 16

34 Improve individual outcomes by assisting in treatment planning; highlights the urgency for improved function in semester based schedules. Group level outcomes can serve as benchmarks and goals that can be used as critical information to confirm or address effectiveness of service model changes. Creates a common language across disciplines and providers to promote effective integration Just like taking vitals Why Measurement?

35 Depression Screening Workflow from Primary Care to Counseling Streamline referral process Utilize PHQ 9 scores as a guideline PHQ 9 score < 10 : follow-up 11 14: Consideration for treatment initiation and/or referral to counseling services 15 19: Clear plan of care with appointment in counseling ASAP (within 2 wks.); consideration of medication > 20: same day mental health assessment Suicidal ideation protocol- question #9

36 Delivery System Redesign Link depression screening to vision, mission, and goals of primary care Integrate depression screening into QI program Make the depression screening a standing agenda item at treatment team meetings Ensure senior leaders actively support improvement effort by removing barriers and support with incremental incentives/resources (TIME)

37 Outcomes % screened positive in primary care Referrals to CAPS increased 13%, visits increased 38% System Re-Design: Development of Triage, Bio-feedback program and Case management services

38 Lessons Learned Ensure senior leaders actively support improvement effort by removing barriers and providing support with resources (TIME) Mandatory suicide prevention training Make your initiatives/positions indispensable Create a campus and community web- type structure: Health Advisory Board