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Improving the lives of 10 million older adults by 2020 | © 2019 National Council on Aging
National Coalition on Mental Health and Aging
and
National Council on Aging
PRESENT
HOME AND COMMUNITY-BASED MENTAL HEALTH SERVICES: MEETING THE NEEDS OF OLDER ADULTS
2019-2020
October 10, 2019
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging
Mission:
To provide opportunities for professional, consumer and government organizations to work together towards improving the availability and quality of mental health preventive and treatment strategies to older Americans and their families through education, research and increased public awareness.
Visit: www.ncmha.org
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging
History, Membership and Activities:
• Formed in 1991 by a group of organizations from the aging and mental health fields
• Comprised of 100 national and state associations, state coalitions, and governmental agencies, e.g., SAMHSA and ACL.
• Co-sponsor events to highlight challenges of mental health and aging
• Identify new approaches to addressing problems.
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging
Webinar Series on “Addressing Disparities in Behavioral Health Care for Older Adults”
• Following the May 20th National Older Adult Mental Health Awareness Day (OAMHD) events, NCMHA developed a plan to collaborate with interested government agencies, private sector groups, and experts to maintain the momentum and recommendations generated from OAMHD.
• A series of webinars during 2019/2020 that target specific topics with a practical focus and accompanying tools/resources to address the needs of older adults with mental health conditions, as well as state/local efforts/best practices.
• A special feature of the webinars will be that the sessions will coincide with monthly, weekly and daily national mental health or aging observances.
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging
Key Objectives of the Webinar Series
• Identify specific approaches that address disparities in behavioral health care for older adults
• Ensure that older adults with mental health and addiction-related conditions are integrated within all MH awareness raising, policy, programmatic and research efforts going forward.
• Raise awareness among primary care, mental health, other health service providers and the aging network about the impact of suicide, opioid use, and interrelated problems, and impact provider practice patterns for older adults.
• Identify specific tools such as geriatric assessment, questions – suicide ideation, firearm presence, opioid use and other screening tools – and detailed guidance.
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging
Webinar Series Roll Out – 2019-2020
November 13 – (12:00 PM EST) Family Caregivers and Alzheimer’s Awareness Month
“The Invisible Health Care Provider: Family Caregivers of Individuals with Dementia”
January 23, 2020 (12:00 PM EST) – Mental Health Wellness Month
“Solutions to Behavioral Health Workforce Shortages & Lack of Funding”
February 27 (2:00 PM EST) – Eating Disorders and Mental Health Month
“Bridging the Science-Practice Gap: Potential Opportunities for Geriatric Mental Health”
March 26 (3:00 PM EST) – National Brain Injury Awareness Month
“Traumatic Brain Injury and Mental Illness Among Older Adults: The Problem and New Management Approaches”
April 10, 2020 (12:00 PM EST) – National Public Health Week
“Social Determinants of Mental Health for Older Adults: A New Perspective”
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging
Today’s Webinar
In recognition of World Mental Health Day:
“Home and Community-Based Mental Health Services: Meeting the Needs of Older Adults”
Presenters:
Sheila Greuel, Covenant Transitions
Judith Cook, University of Illinois at Chicago
Sharon Smith, Harvard Senior Center
Home and Community-Based Mental Health Services: Meeting the Needs of Older Adults
Sheila Greuel, MA
Director, Covenant Transitions
What is PEARLS?
PEARLS is a brief, time-limited, and participant-driven program that teaches depression management
techniques toolder adults withdepression.
PEARLS Program Plan
Three Components of PEARLS
• Problem Solving Treatment
• Social and Physical Activation
• Pleasant Activity Scheduling
• Psychiatric Supervision and Consultation
The floor beneath the stool
PEARLS in Illinois
• 2016-2018 Trainings were held in 4 locations in Illinois through a collaboration among Rush University Medical Center, Illinois Association of Area Agencies on Aging, and Covenant Transitions;
• 50 professionals were trained during over 4 years through the GWEP Grant; • An additional 20 individuals were trained for a County Mental Health
Program;• 6 professionals were trained for Jun Ma’s project at UIC entitled, “Engaging
self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes”. This project is funded by NHLBI and participants are adults with co-morbid obesity and depression;
• 26 different agencies had staff trained; and • Approximately 7 known agencies are currently offering PEARLS
Healthy IDEAS
• Identifying
• Depression
• Empowering
• Activities for
• Seniors
• An evidence-based community depression program designed to detect and reduce the severity of depressive symptoms in older adults with chronic health conditions and functional limitations through existing community based case management services.
Behavior Activation• Improve Mood by:
• Increasing frequency of behaviors that lead to positive outcomes
• Doing activities that “feel good” or are pleasurable or reduce stress
Four Program Components
1. Screening for symptoms of depression and assessing severity • Two-question screen and standard assessment
• 15 item Geriatric Depression Scale (GDS) or PHQ-9
2. Educating older adults and caregivers about depression and effective treatment
3. Referral, linkage, and follow-up for older adults with untreated depression to health or mental health providers
4. Behavior Activation (BA) empowering older adults to manage their symptoms by engaging in meaningful and positive activities
Healthy IDEAS in Illinois
• Healthy IDEAS was reintroduced in Illinois through the GWEP Grant in 2017.
• 19 professionals from 8 agencies participated in the 2-day training.
• 7 agencies were Care Coordination Units and 1 Counseling Center
• Healthy IDEAS is being offered by CCUs in Illinois.
The Harvard Community Senior Center…“Community” is our middle name
Presenter:Sharon Smith, PEARLS Project Director
▪Serves approximately 500 unduplicated seniorsannually across all of McHenry county with adeliberate shift in services and programs that helpeach older adult achieve their lifelong humanpotential.
• Provides evidence-based, health~wellness, educational, nutrition,
self- management, and SHIP benefit enrollment/counselling services;
• Partnering with the UIC WRAP for Seniors Project to teach WRAP to adultsage 60 or older in McHenry County;
• Provides the McHenry County PEARLS – community-based,
depression treatment - Program for both Older Adults AND individuals
with Epilepsy. Will begin serving Veterans with PTS in 2020.
State of Illinois
13.1% 14.7 %
McHenry County
The percentage of Medicare beneficiaries who were treated for depression.
Depression: Medicare Population
Source: Centers for Medicare and Medicaid Services 2015, updated March 2018.
14.7%14.4%
14.0%
13.5%13.1%
12.4%
13.1%
12.7%
13.2%13.0%
12.6%
12.0%
State of Illinois
13.1% 14.7 %
McHenry County
The percentage of Medicare beneficiaries who were treated for depression.
Depression: Medicare Population
Source: Centers for Medicare and Medicaid Services 2015, updated March 2018.
14.7%14.4%
14.0%
13.5%13.1%
12.4%
13.1%
12.7%
13.2%13.0%
12.6%
12.0%
18%
PEARLS WORKS:
1Is evidence based and delivered in the home or other comfort setting;
Increases access to other community resources through the Case Management component;
2
3
4 Is provided across all of McHenry County by MSWs through the Harvard Community Senior Center; and
Participants are 11x more likely to experience a reduction in depressive symptoms than non participants.
5Is offered free of charge for McHenry County residents thanks to generous donors, the McHenry County Mental Health Board, Advocate-Aurora Health System, and the McHenry County Senior Services Grant Commission.
PHQ-9 Score on 6/6/19
Pam & PEARLS
PHQ-9 Score on10/10/19
Social Connectedness on 6/6/19
Social Connectedness on 10/10/19
2
0
1
7
2
0
1
8
2
0
1
9
SERVICE AREA EXPANSION
McHenry County PEARLS Program
WELLNESS RECOVERY ACTION PLAN (WRAP®) FOR SENIORS PROJECT
JUDITH A. COOK, PHD
PROFESSOR
DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF ILLINOIS AT CHICAGO
PRESENTED FOR NATIONAL COALITION ON MENTAL HEALTH AND AGING WEBINAR SERIES -- HOME AND COMMUNITY-BASED MENTAL HEALTH
SERVICES: MEETING THE NEEDS OF OLDER ADULTS
OCTOBER 10, 2019
FUNDING ACKNOWLEDGEMENT
Supported, in part by grant number 90CSSG0011-01-01, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.
YOUR WELLNESS – YOUR WAY
Wellness Recovery Action Plan is a program that anyone can use to get well, stay well, & make life the way they want it to be. It helps people to:
• Identify safe, simple tools to support healthier & happier aging
• Discover & reduce everyday stressors
• Build on personal strengths & interests
• Feel more hopeful, confident, & engaged in health care decisions
WRAP IS AN EVIDENCE-BASED WELLNESS SELF-MANAGEMENT PROGRAM
• Wellness encompasses both physical & mental health
• Research shows that WRAP reduces psychiatric symptoms (anxiety & depression), enhances hopefulness, increases empowerment, improves quality of life, increases self-advocacy, & lowers formal service utilization*
• It is taught by peers (defined as users of WRAP) many of whom have lived experience of mental health disorders
*(Cook et al., 2012a, 2012b, 2013; Jonikas et al., 2013)
CREATING A WRAP PLAN
• Each person’s WRAP will be unique & revised on an ongoing basis
• Developing a WRAP can be a highly creative process
• It includes much more than filling out forms & making lists
(Berg, 2017)
WRAP COMPONENTS:
• Wellness Toolbox
• Daily Maintenance Plan
• Triggers & Action Plan
• Early Warning Signs & Action Plan
• Recognizing When Things Are Getting Worse & Action Plan
• Crisis Plan
• Post-Crisis Plan
WELLNESS TOOLBOX
• People identify things they’ve done in the past to help them become well & stay well
• They hear about other group members’ wellness tools, which can increase their own repertoire
• Emphasis is on tools that are simple, safe, & free or low-cost (take a walk, call a friend, listen to music)
DAILY MAINTENANCE PLAN
• Participants describe themselves when they are feeling well
• They identify what they need to do every day to keep themselves feeling well
• The make an intentional choice to do these things
• Reviewing this list daily helps the person stay on-track
TRIGGERS
• Triggers are external events or circumstances that make a person feel very uncomfortable
• Participants identify these things in their own lives
• They develop a plan of how to avoid triggers & what to do if they occur
EARLY WARNING SIGNS
• Early Warning Signs are internal & not necessarily tied to triggers or stressful situations
• They are subtle signs that indicate a person may need to take further action
• Participants are asked to identify any early warning signs they’ve experienced
• Then they develop a plan to deal with early warning signs
WHEN THINGS ARE GETTING WORSE
• In spite of their best efforts, people may notice that their very uncomfortable feelings are worsening
• They identify how to tell when they are nearing the crisis stage
• They learn that there is still time to act & do things to avoid a full-blown crisis
• They develop a plan for when this occurs that is very directive with fewer choices & very clear instructions
CRISIS PLAN
• People identify behaviors that indicate to their supporters the need to take full responsibility for their care & make decisions on their behalf
• They specific what they would like to have happen & what kind of help they would like or not like & from whom
• They identify signs that indicate the plan no longer needs to be followed
• The plan is signed by the participant & their supporters
POST-CRISIS PLAN
• People learn to give themselves time when they are healing from a crisis, whether medical or emotional
• They develop a schedule for resuming responsibilities that supports their wellness & promotes a fuller recovery
• At the end of this session, everyone celebrates their achievements in a graduation ceremony
• Broadened emphasis from mental wellness to overall wellness
• Focused on everyday stressors that impede wellness, versus solely on emotional triggers
• Expanded Crisis Plans to include medical hospitalization
• Included shared decision-making with doctors, since people increasingly interact with medical providers as they age
• For role modeling, coached WRAP facilitators to share personal examples that illustrate overall wellness & physical health in addition to mental health
• To address age-related needs, such as fatigue & concentration, intersperse didactic information with personally-meaningful activities
IMPLEMENTING WRAP FOR OLDER ADULTS
HOW HAS WRAP BEEN RECEIVED BY OLDER ADULTS?
• Members of Illinois community-based senior centers, residents of public housing, & faith communities have been enthusiastic participants
• Participants average a score of 8.8 on a 10-point scale asking how confident people feel about their ability to manage their physical and emotional wellness after completing WRAP
COMMENTS BY OLDER ADULT WRAP PARTICIPANTS
“Seniors need this class. I didn't realize I needed a safe place to share what's getting in the way of my wellness and happiness.”
“WRAP teachers didn't talk above us or at us. They were right there with us. They helped everyone see that we already know what to do. We just needed a gentle push to move forward.”
“This class was good for me. It’s good to talk about things that will improve my wellness and life.”
IMPLEMENTATION STRATEGIES & SUCCESSES
• Collaborated with IDoA to make presentations about the project to each of the state’s 13 Area Agencies on Aging
• Connected with senior-serving housing entities, such as Chicago Housing and Urban Development, Habitat, and Catholic Charities. Older adults often prefer to attend classes where they live.
• Embedded WRAP in Illinois’ CDSME Network by partnering with Illinois Pathways to Health, which added WRAP to its web site
owww.ilpathwaystohealth.org
IMPLEMENTATION STRATEGIES & SUCCESSES
• Embedded WRAP in Illinois’ CDSME network by partnering with the Illinois Mental Health Collaborative for Access and Choice, which added WRAP & the WRAP for Seniors Project to its web site
owww.illinoismentalhealthcollaborative.com
• Continue to identify experienced WRAP facilitators throughout the city & state who are interested in learning how to deliver WRAP to older adults.
PARTNERING WITH THE CHICAGO HOUSING AUTHORITY
• Our work with the Illinois Coalition on Mental Health and Aging connected us to leadership of the Chicago Housing Authority (CHA).
• We liaison with CHA residence on-site staff via meetings, phone calls & emails to schedule WRAP classes in senior independent living buildings.
• We are officially recognized as a CHA Health Partner, a status that further facilitates recruitment of CHA sites.
• When recruiting participants, we rely on a CHA residence’s “mayor” to be a WRAP champion. We hope that these people will join our WRAP Ambassadors Program, designed to sustain the older adult WRAP workforce.
REFERENCES• Berg, A. (2017). WRAP: Wellness Recovery Action Plan. Vancouver Coastal Health, BC.
• Cook, J. A., Copeland, M. E., Jonikas, J. A., Hamilton, M. M., Razzano, L. A., Grey, D. D., ... & Boyd, S. (2012a). Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Schizophrenia Bulletin, 38(4), 881-891.
• Cook, J. A., Copeland, M. E., Floyd, C. B., Jonikas, J. A., Hamilton, M. M., Razzano, L., ... & Boyd, S. (2012b). Impact of Wellness Recovery Action Planning on depression, anxiety, and recovery: results of a randomized controlled trial. Psychiatric Services, 63(6), 541-547.
• Jonikas, J. A., Grey, D. D., Copeland, M. E., …& Cook, J. A. (2013). Improving propensity for patient self-advocacy through Wellness Recovery Action Planning: results of a randomized controlled trial. Community Mental Health Journal, 49(3), 260-269.
• Naslund, J. A., Grande, S. W., & Elwyn, G. (2014). Naturally occurring peer support through social media: the experiences of individuals with severe mental illness using YouTube. PLOS one, 9(10), e110171.
• Cook, J. A., Jonikas, J. A., Hamilton, M. M., Goldrick, V., Steigman, P. J., Grey, D. D., ... & Copeland, M. E. (2013). Impact of Wellness Recovery Action Planning on service utilization and need in a randomized controlled trial. Psychiatric Rehabilitation Journal, 36(4), 250–257.
CONTACT INFORMATION
JUDITH A. COOK, PHD
UNIVERSITY OF ILLINOIS AT CHICAGO
1601 W. TAYLOR ST. M/C 912
CHICAGO, IL 60612
312-355-3921, [email protected]
HTTP://WWW.CMHSRP.UIC.EDU/HEALTH/
Improving the lives of 40 million older adults by 2030 | © 2019 National Council on Aging | ncoa.org | @NCOAging 48
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