Download SBIRT Governor`s Policy Subcommittee

SBIRT Governor’s Policy Subcommittee
Co-Occurring Conditions
October 21, 2008 11am-1pm
I.
Introductions: Laura Saunders (WIPHL), Chanda Belcher (WIPHL), Mia
Croyle (WIPHL), Susan Bush (Aurora Mayfair), Kerri Weberg (Marshfield),
Shel Gross (MHA), Rebecca Cohen (DHS), Susan Endres (Project
Freshlight), Rob Adsit (CTRI)
II.
Review/Approval of the minutes from September
 Need to move forward with tobacco protocols, Rich will write and work
on the protocols
 Did check the CTRI website, good launching point and will build upon it
within the next couple of months
 Tobacco is billable, can be worked out with WIPHL contract to share
with WIPHL time
 Upon review of minutes many clinics want change quickly; tobacco is
high on Rich’s list to move to sustainability
 Will give the clinics 2 choices to implement tobacco protocols: want to
start quickly – can decrease WIPHL time; want to start slower – option
to roll out slowly to fill HE time
III.
Review analysis plan for additional data
 Laura had no time to compile
 Evaluation team has whole data sets, once the charts are done the
information should come quickly
 Mary Beth volunteered to help
 Chart of clinics and what they screen for was passed out for review: 9
clinics screen for depression and 6 screen for domestic violence,
almost all screen for tobacco
 May be able to cross tab AODA with all data, can also cross tab
depression with weight or nutrition
 Adolescent update: pilot protocols are finished, 7 clinics are set for
implementation, services may be set at beginning of new year
 Adolescent screen is strictly AODA – some clinics decide to add or use
as a stand alone screen
 In the future may add more mental health issues
IV.
Review, discuss and provide feedback on the depression protocols –
presented by Mia Croyle
 Mia handed out 2 booklets: Overview of Depression Self-Management
Protocol and the Depression Workbook
 Mia and Teri Woods are creating/editing depression protocols
 Mia would like very honest feedback – is very much in draft form
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V.
Very small ICTR grant pilot study using 5 clinics that will max at 20
patients
The objective is to use a similar process with Depression screening as
we do with AODA
Will be using PHQ-2, if get positive response get patient consent and
then administer PHQ-9 (depression inventory) and SF-12 (MH
symptom inventory)
Training will be at WIPHL Coordinating Center 11/17-11/19
SF-12 (short form 12 questions)
o Health survey developed by health institute
o Will send out for review
o Physical health
o Emotional problems
o Pain
Will be administered at intake and at 3 month follow-up
If have a positive Brief Screen (BS) but no consent – will get usual care
through Primary Care Physician
PCP will also have PHQ results for their review
Guideline to all clinics; if choose to screen - your clinic is responsible to
respond not the HE
Scoring delineates follow-up
Special note on suicidality (might want to specify it)
Score of 5-14 still get PCP care; add to scoring and procedure pages
Include suicidality training for adults and adolescents
Beyond the HE scope to assess – if someone voices thoughts or
intentions refer back to clinic for further assessment
Must be licensed and have specific training to deal with suicidality
Toolkit will be given outlining the bare bones on how clinic must
respond (what the clinic “might” do if issue comes up)
Most protocols are scripted for HEs
If patient has overlapping AODA issues will not be in Depression study
Overview of Depression Self-Management Protocol
 On page 1 under procedure, add refer to doctor
 Normalize & Reassure:
o Don’t use word “normal”
o Many women present as anxiety, men present as angry = not
“sad”
o Maybe include a range of emotional states: feeling down,
anxious, angry, overwhelmed etc.
o Take out sentence “It’s not pleasant…
o Add to end of script can “help you feel better”
o Don’t use word recover
o Some issues may present as “symptoms” upset stomach,
headaches
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Educate:
o Take out “normal”
o Take out sentence starting “We wouldn’t want your symptoms
to get any worse. Sometimes symptoms….”
o Some patients may be coming in already clinically depressed
o “Painful” can be physical or emotional pain again use a range
of emotions.
o Add paragraph 3 first sentence: can come on quickly in
response to any major stressor
o Take out missed a meal, overdone with exercise, re-charge
our batteries – maybe add financial stressors
o Paragraph 4 remove 2nd sentence and last sentence
o Use “triggered” not kicked off
o Don’t use word “suffer”
o Panel has never heard of “Anti-depressant behavior” or
“program of self-care”
o Add “an important part of treatment is wellness management”
o There are many treatments for depression: medication, talk
therapy, combinations….
o Situational and clinical depression can overlap
o Leave out “I’m” statements – no judgments
o Encourage “You know yourself best”
o Can modify treatment to fit patient’s needs
Assessment of Self Care
o Basic Nutrition:
1. Ask “since feeling symptoms have you been eating the
same or have there been changes”
2. Do people really know what is good eating or not?
3. Hard to self-assess; might be too hard on yourself
4. Patient needs to choose what to target
5. Assessment doesn’t guide: “tell me where you think you
are at”
6. Need more dialogue on what is best vs. worst
7. Have benchmark: fruits, veggies
8. Appetite vs. nutrition – do importance scale
9. Take out “worst possible diet and person could eat” and
“best possible…”
o Sleep
1. Use terms “feel rested”, “fall and stay asleep”, “restful
sleep”
2. Change first sentence to “It can often be difficult to get
sleep that leaves us feeling rested”
3. Again remove “worst possible” and “best possible”
o Exercise
1. Looks better
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2. Open it up more and give a benchmark on how to
exercise
o Social Support
1. Take out first sentence “human being benefit from …”
2. Remove “we’re better off physically, etc”
3. Remove “total isolation” and “rich and well rounded”
4. Change to “Do you have satisfying relationships?”
o Having Fun
1. Add “Are you satisfied”
2. Also add “Activities that are meaningful”
o Relaxation
1. 2 types of relaxation: active and passive
2. Take out recharging our batteries
3. Take out scale “I’m so tense I can’t…”
4. Add take time to do something relaxing
Mia will check on spirituality pieces to aid in treatment, can add prayer,
yoga, tai-chi etc.
Develop Self Management Plan
o Remove “in order to help us with our mood” and “Six is a lot to
think about…
o Add “what 3 should we focus on first”, “which one do you want
to do 1st”
o Prompt the patient
o Add do you want to work on another?
Schedule Follow Up
o Take out 100% successful
o Add: “It will be great if you experience success with this plan.
Either way I want to see you back and we will look at things that
worked well and what didn’t”
VI.
Overview of Depression Workbook
 Will have a binder feel, can add pages as go
 Will have a weekly log patient will write in
 Include a menu of options for activities: some goals might be…
 On Nutrition page take out: “even if you have to force yourself…”
 Sleep page looks good
 On Exercise page add affirmation, “it is great that you chose…”
 On Social Support page remove “it is natural to want to isolate…”, just
go right into “We know that being around people…”
 Relaxation page looks good
 On Having Fun page, remove 1st sentence. In 2nd sentence change to
“can make the things that used to be enjoyable…”, take out “if we have
to force ourselves…”
 Overall Workbook looks good and well thought out
VII.
Other Announcements/Next Steps/Next Meeting
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Mia will make changes and forward to Co-Occurring Conditions
committee to review again
By next meeting Depression training will have occurred
Next meeting 11/24/08 11am-1pm