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Marketing CDSMP to Specific Populations

• 10:00 -10:30 Pain ClinicsKathy Medford, SE WA ALTC

• 10:30-11:00 Rural Health SystemsJessie Stopsen, Olympic AAA

• 11:00-11:30 Large Health Care SystemsAnne Whigham, ALTC of Eastern WA Nancy Ludwick, Community Health Association of Spokane

• 11:30-Noon Tribes Shelly Zylstra, NW Regional Council

CDSMP and working with a Pain Management Clinic

SE Washington Aging and Long Term Care February 9, 2012

A Quick Look at the DataA Quick Look at the Data• The number of Americans with chronic conditions

is expected to increase from 125 million in 2000 to 157 million by 2020.

• The number of people with multiple chronic conditions will rise from 60 million to 81 million.

• Care for people with chronic conditions accounts for 77 percent of Medicaid spending for beneficiaries living in the community.

• (Mollica and Gillespie, 2003)

Chronic Illnesses per the CDCChronic Illnesses per the CDCChronic diseases cause 7 in 10 deaths each year in the

United States.

About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness, including chronic pain.

More than 75% of health care costs are due to chronic conditions.

Approximately one-fourth of persons living with a chronic illness experience significant limitations in daily activities.

CDSMP Symptom Cycle and CDSMP Symptom Cycle and Pain Pain

CDSMP demonstrating how symptoms may progress in a circle or

cycle, each exacerbating the next

Waters Edge Yakima Memorials Pain

Management Clinic

Connecting With Our Community Partner

•Educating the staff about workshops and curriculum•Making referrals•Follow up communication and coordination

Getting Started

•Early Challenges•Early Wins •Responses from clients and clinicians

Learning our lessons

Evaluations/Life ChangesEvaluations/Life Changes• Evaluations from CDSMP Workshops held at the Pain Clinic

– This class is very helpful. Glad to know that there is a brighter side to this chronic pain. It will not control me, I will have better control of it. Making an action plan and find someone to be supportive of these plans, like a friend, group or your family.

– ……..It has really helped me to see what others do to deal with their chronic pain issues.

– I was surprised to find the class more relevant to my personal issues (kidney transplant recipient) than to my issues as a caregiver.

•Future plans – workshops (schedules, leaders, and locations)•Funding sustainability (grants and Medicaid)•Community uptake with other pain specialists, primary care or others.•Recommendations for other communities

Planning for next steps and sustainability

For additional information please contact:Melissa Schafer SE WA Aging and Long Term Care 509-965-0105schafml@dshs.wa.gov

Questions

Olympic Area Agency on Aging presents

Marketing CDSMP to Hospitals

Olympic Area Agency on Aging Olympic peninsula service region - entire west coast of

Washington Extremely rural, rugged with difficult access Home to 7 Hospitals Home to nine registered Indian Tribes Native Americans have the highest prevalence & mortality

rates for preventable diseases and conditions. Four rural service counties with higher proportion of older

adults Two service counties (Grays Harbor & Pacific) lead the state

in ‘counties with the greatest chronic disease burden.’ Limited access to public health resources and health care

services, compared with chronic disease burden of service population

About Tableau maps: www.tableausoftware.com/mapdata

Willapa Harbor Hospital

Whidbey General Hospital

Valley Medical Center

St Joseph Medical Center

St John Medical Center

St Anthony Hospital

Providence St Peter Hospital

Providence Centralia Hospital

Olympic Medical Center

Ocean Beach Hospital

Morton General Hospital

Mason General Hospital

Mark Reed Hospital

Jefferson Healthcare

Harrison Medical Center

Grays Harbor Community Hospital

Forks Community Hospital

Capital Medical Center

Western Washington Coast Hospital Locations

Strategies to open door

• Know your hospitals mission and vision• How does your hospital provide education to

their patients ( investigate)• Know your potential key contacts• Be prepared to briefly explain CDSMP• Be prepared to know what you can potentially

offer the hospital to make it easy to refer.

Strategies to open door

1. Know your hospitals mission and vision• Most hospitals are committed to preventive

care and community wellness through education.

Strategies to open door

2. How does your hospital provide education to their patients ( investigate)

• Face to face • Internal media system on local network• Portable media system • Handouts

Strategies to open door

3. Know your potential key contacts • Hospital-based Health Educator • Discharge Coordinator • Diabetic Health Educator • Chief Nursing Officer / Administrator• Other community contacts

Strategies to open door

4 . Be prepared to briefly explain the evidence- based program

• How CDSMP can support their mission or vision with the challenges their patients face

• Keep staff presentations under 15 minutes• Develop a variety of approaches (show the dvd; give

them a brochure; CDSMP in 3 minutes)

Why refer patients to CDSMP?• Evidence-based; numerous studies confirm results• Adopted by national health systems in many countries

(UK, Australia, others)• Shown effective across multiple cultures• Gets results! Participants experience

– Increased exercise – Improved self-reported health indicators– Diminished health distress– Increased energy– Decreased disability– Fewer hospital & ER visits

• Appears to work for the long run…

CDSMP supports patients after discharge:The Self Management Tool Box: • Disease-related problem-solving • Managing emotions /Fatigue • Exercise / Breathing techniques/fall prevention • Cognitive symptom management

– (relaxation, distraction, self-talk, visualization, pain management )

• Communication skills • Developing patient/physician partnership • Use of community resources • Nutrition • Managing medications • Advanced directives

Strategies to open door 5. Be prepared to know what you can potentially offer the

hospital to make it easy to refer. Use available resources:

“Healthier Living: Managing On-going Health Conditions” – 10 minutes – Patient version

“Chronic Disease Self-Management Program [The Healthier Living

Program]” – 11.35 minutes - Professional Bull Publishing Co. P.O. Box 137 Boulder, CO 80306

Strategies to open door

• Fall Prevention DVDs FREE “Fall Reduction through Exercise and Education” w/ hand outs

• Go4Life Everyday Exercises From the National Institute on Aging at NIH

Be prepared to know what you can potentially offer the hospital !

• Portable DVD Player 9”• CDSMP brochures

Rx stamp: makes it easy for PCPs to recommend CDSMP to patients

Living Well TV Series

• North Beach Community TV• Ten 30” programs on a healthy aging topic

featuring interviews w/ local health providers• Program topics include exercise, mental

health, community resources, advanced directives ……

CDSMP Resource Links

• Stanford University CDSMPhttp://patienteducation.stanford.edu/programs/cdsmp.html

• National Council on Aginghttp://www.ncoa.org/

• Olympic Area Agency on Aging http://www.o3a.org

Presentation: Jessie Stopsen RN stopsja@dshs.wa.gov Director of Nursing 360-538-2456

Olympic Area Agency

Marketing to Large Health System

Nancy Ludwick Community Health Association of Spokane

Anne WhighamAging and Long Term Care of Eastern Washington

• Area Agency on Aging - ALTCEW • Cover north eastern portion of Washington

State with five counties, mostly rural• Contract with 27 agencies to provide in-

home social services that help people remain in their homes

• State and Older American Act Funding

Aging and Long Term Care of Eastern Washington

• Spokane is the Medical Hub for the Inland Northwest with Health Care as the primary employer

• We have four hospitals in Spokane County and 7 smaller hospital in the five surrounding communities.

• We have two federally funded health centers• And two major medical practices throughout the

county, including Group Health

Connecting With Our Community Partners

• Started March, 2011 with a small grant for books and supplies and support from our Director

• Attend a quarterly Medical Clinics Committee with flyers and enthusiasm for the program

• Determined who might listen to me and called them

• Set up a lay leader meeting with CHAS and Group Health

Getting Started

• We are developing on-going working relationships with one of the major hospitals, meeting with staff from the emergency and social work departments

• Incorporating into our Care Transition Program

• Incorporating into our Chronic Care Management Program

• AND working with CHAS

What Is Working At ALTCEW!

• Federally funded health clinic• 6 clinics with more than 80 providers• Urgent Care across from one of the major

hospitals in Spokane• Averages 360 patients per day• Medical, Dental, & Behavioral Health

Community Health Association of Spokane

• Started CDSMP in 2009 • The Medical Director took the Master Training

at Stanford • Program fits the mission of CHAS to bring

quality health care and wellness to the community

• CEO involved the Board of Directors

Community Health Association of Spokane

• 2 workshops in 2009• 10 workshops in 2010• In 2011, provided training for 9 new lay-

leaders and facilitated 19 workshops• Graduated approximately 225 participants• Contract with ALTCEW to expand program

in Spokane County

Community Health Association of Spokane

ALTCEW received a grant from ADSA for program expansion

Contracted with CHAS for Spokane CountyAlso contracted with our case management

agencies to expand the program in four rural counties

Reaching out to medical and social services staff to develop more lay-leaders

Moving Forward

• Getting to the right people at the right time• Getting the doctors and the medical clinic staff to

see the benefits of the program• Finding the time to keep going to their offices, the

hospitals with updated program schedules• Health Care Reform• And of course, funding to keep the program going

Challenges

• Find a Champion within the healthcare organization

• Present to staff at monthly meetings• Utilize the benefits of Health Care Reform

that is bringing social and medical services together – find the various meetings and be pushy

• Have flyers always updated and available

Recommendations

Wisdom Warriors:Living Long, Living Strong

Shelly ZylstraNorthwest Regional Council

zylstra@dshs.wa.gov

A Disparate Culture• Indian lands were

exchanged for treaty promises, most of which have not been upheld– Food, medical care,

education were primary and common to most treaties

– Commodity foods, IHS on the non-entitlement budget, and Indian Boarding Schools were what the tribes received

• Years of poverty, poor medical care and loss have left tribes in a vulnerable position

Disparities

• Infant mortality +33%• Accidental death +38%• Diabetes death +54%• Cirrhosis death +126%• Alcohol death +178%• CVD unheard of 40

years ago!• Diabetes unheard of in

1900!

Socioeconomic Characteristics

Chronic Disease Rates

Health in Indian Country

• Great emphasis on all aspects of person—emotional, spiritual, physical, and community

• “Tolerated Illness”—based in importance of community; acceptance

• Traditional practices• Require connectedness

between healer and self

• Self-care is viewed as a complement to the care of family members– “I cannot care for them

unless I care for myself.”

The Classes• Tribal people get their

information from a number of sources—usually word of mouth– Doctors– Social Service Directors– Health Clinic Staff– Elders’ Program

Coordinators– Tribal Breakfasts or

Newspapers

• Connect your class with another event—a congregate meal or another well-attended activity

• NOTHING beats a personal invitation!

CDSMP Dissonance• Is a self-efficacy model• The answer is inside

yourself and you hold the power to overcome and manage your symptoms

• How to encourage self-efficacy in a community where it is considered rude to think of yourself first?

• How to promote self-reliance and empowerment in a culture where family and community are more important than self?

Requires Incentives

• Patterned after the Wisdom Steps program in Minnesota

• Very population with tribal elders there

• Provides incentives for health behaviors learned in CDSMP

Plan So Far

• When elders complete CDSMP, they are given a medicine bag with the owl pin on it

• It is the beginning of the new behaviors

• Elders can earn beads for continuing healthy behaviors

All Tribes are not Created Equal

• Each tribe will work with their health center to determine which health behaviors they need to emphasize

• Tasks must fit under the same category for the color of the bead

• Blue Beads—medical check ups

• Black Beads—self care• Red Beads—exercise• Green Beads—nutrition• Yellow

Beads--Spiritual/cultural• Orange Bead—

intergenerational activities

Blue Beads—Medical Checks

• Physical examination• Mammogram• Prostate• Colonoscopy• Dental check• Whatever the tribal

clinic is wishing the elders would do!

Black Beads—Self Care

• Blood Sugar checks• Regular foot care• Weight gain or loss• Keeping a current list of

medications• Keeping meds in a locked

box• Again, ask tribal programs

about areas they wish elders would improve.

Red Beads--Exercise• Elders should have a

pedometer—check with your clinic—to count steps

• For elders who cannot walk, alternate activities are available

• We use the Wisdom Steps equivalents, but there is no reason not to make it up!

Green Beads--Nutrition

• Eating fruits and veggies• Attending the Title VI meal

regularly• Giving up an impulse food• Limiting sodas• Gathering traditional foods

and preparing them • Increasing fiber• Starting doctor

recommended supplements

Yellow Bead—Spiritual Cultural

• Volunteering at the Canoe Journey

• Attending pow-wows• Going to church• Helping youth with

important cultural activities

• Teaching a language class

• Learning to weave

Orange Bead--Intergenerational

• Teach at the school• Take your grandchildren

to events• Spend some time talking

to troubled youth• Volunteer at Head Start• Babysit• Go to a sporting event• Ride the school bus

At the end of the year….

• Beads are awarded and given to the elder

• For participating in the program, a charm is given to hold the beads on the bag

• The following year, more beads can be earned for different activities.

Hopes!

• Some tribes are planning to work with a committee of elders to set the goals

• Others will also have a monthly meeting of Warriors to keep the program participants engaged

• One tribe is interested in having the whole tribe participate in the program

• Another tribe is going to incorporate it into their “Way of Life” effort

• We just hope that the elders enjoy themselves, learn, and continue provide leadership.

Contact Information• Pain Clinics- Melissa Schafer, Nursing Manager,

schafml@dshs.wa.gov (509) 965-0105 ext. 108• Rural Health- Jessie Stopsen, Director of Nursing,

stopsja@dshs.wa.gov (360)538-2456• Large Health Systems- Anne Whigham,

whighas@dshs.wa.gov (509)458-2509 ext. 215Nancy Ludwick, CDSMP Coordinator, nludwick@chas.org (509) 434-0402

• Tribes- Shelly Zylstra, Planning Director, zylstra@dshs.wa.gov (360) 676-6749