Bi Cycle Health Initiative

RUNNING HEAD: BI-CYCLE, A PROGRAM TO FIGHT BIPOLAR DISORDER

BI-CYCLE A PROGRAM TO FIGHT BIPOLAR DISORDER 1

BI-CYCLE, A PROGRAM TO FIGHT BIPOLAR DISORDER

IN THE MISSOURI COMMUNITY

AMY ALEWEL

SIMONE BAKER

ASHLEY BURDOLSKI

C ARRIE CALLICOAT

MAURICIO CABRERA

SYNN JOHNSON

UMKC UNIVERSITY

HEALTH PROGRAM MANAGEMENT


TABLE OF CONTENTS

I. Executive Summary…………………………………………………..4

II. Rationale……………………………………………………………...5

III. Logic Model………………………………………………………….10

IV. Planning Committee………………………………………………….12

V. Planning Model………………………………………………………16

VI. Needs Assessment……………………………………………………18

VII. Mission Statement, Vision Statement, Objectives, and Goals……….20

VIII. Intervention-theoretical Framework………………………………….23

IX. Resources……………………………………………………………..25

X. Marketing Plan………………………………………………………..31

XI. Implementation Strategy……………………………………………...34

XII. Evaluation Strategy…………………………………………………...42

XIII. References…………………………………………………………….45

XIV. Appendices……………………………………………………………46


Frequently Asked Questions

What is BI-Cycle?Good question! It is a program designed to add social support to bipolar sufferers. The typical treatment for people with bipolar disorder is medicine which is quite effective, however very little treatment programs offer social support to the extent that BI-Cycle intends to. (refer to the Executive Summary and Rationale for more details)

Is there a need for BI-Cycle?Absolutely! There are millions of people who suffer from this debilitating disorder in the U.S. Unfortunately there are instances where extreme tragedies happen that could have been avoided with quicker intervention, and BI-Cycle intends to solve this by encompassing those suffer with constant social support (refer to Needs Assessment for more details)

How will BI-Cycle help those that it intends to serve?BI-Cycle will offer a many services that intends to serve those with bipolar disorder, but first it requires a logic solution that outlines it’s goals and purposes (refer to Logic Model for more details)

Who will operate BI-Cycle?Simply, the people that it intends to serve. The planners and operators of the planning committee are plucked straight from the priority population (refer to Planning Committee and Planning Model for more details)

Who will BI-Cycle serve and where?BI-Cycle is a program built to serve the Missouri communities of St. Louis, Kansas City, Columbia, and Springfield (refer to Needs Assessment for more details)

What is BI-Cycle’s purposeBI-Cycle wants to help reduce mood cycling by helping diagnosing accurately, reducing misdiagnosing, create better education, and offering social support (refer to Mission Statement and Goals for more details)

What resources are required for BI-Cycle to work?BI-Cycle is not an expensive program to implement, one of its selling points. It will however require human resource to operate and run it (refer to Resources for more details)

How will BI-Cycle be evaluated?Great question! The evaluation process will use resources from UMKC and/or KU med to externally evaluate the program alongside periodical internal evaluation methods that will be employed to make sure BI-Cycle hits is goals and objectives (refer to Evaluation for more details)


How will BI-Cycle reach the masses?Through a marketing program that intends on advertising after careful segmenting variables that have been identified so that the campaign can reach the priority population (refer to Marketing plan for more details).


I. Executive Summary

BI-Cycle is an intricate support system program that aims at the bipolar community of

Missouri. This program adds an extra twist to the main type of interventional treatment given to

those who are diagnosed with bipolar disorder. BI-Cycle relies on a specific diagnostic tool,

family or friend support, healthy living, constant education, and constant report. The program is

meant to address the main issues with bipolar sufferers and those are: wrongful diagnosis,

medication adherence, mood cycling, and lack of social support. According to NIMH, the U.S.

is home to approximately 14 million bipolar sufferers. Bipolar sufferers in the Missouri

community stretches from Kansas City, to St. Louis, Springfield, and Colombia. There are over

400,000 poor souls that are struggling to cope with this debilitating disorder in Missouri alone.

(The National Institute of Mental Health (NIMH), 2009).

BI-Cycle hopes to change some of the tragic outcomes that happen to those who suffer

from bipolar disorder by making those individuals more informed, more educated, and more

supported to reduce suicide rates, depression, and many other issues resulting from the lack of

proper treatment. BI-Cycle will have a support staff and planning committee that come straight

from the priority population and who are specialist in mood disorders. The BI-Cycle Dream

Team is the name of the planning committee and most members have extensive knowledge about

the disorder and are even part of research teams that are looking for better therapies. BI-Cycle

has chosen a reliable evidence based measurement tool to help with diagnosis, along with an

education program that meant to inform the priority population as well as the creators and

planners of the BI-Cycle program. Proper evaluation is key to making sure the program is fresh

and on course for meeting its objectives and goals. Along with a marketing mix that includes

price, product, place, and promotion are essential to the success of the BI-Cycle program.


II. Rationale

A rationale for “BI-Cycle”: A campaign to create an effective encompassing treatment program for bipolar sufferers in the state of Missouri.

Bipolar disorder (manic depression) is a lifelong mental illness that creates debilitating

episodes of mood swings that affect a person’s ability to function. Sufferers teeter back and

forth between “mania” and depressive moods, hence the term “manic depressive.” It is usually

diagnosed at around the ages 15-25 years old according to the Center for Disease Control (CDC,

2011). According to the World Health Organization, 35 million people suffer from bi-polar

disorder worldwide ("The global burden," 2002). The prevalence rate for bipolar disorder

worldwide is over 1.5% of the total population (The National Institute of Mental Health (NIMH),

2009). Approximately 1.5 in 100 people suffer from this disorder. Although globally the

disorder is not prevalent in all countries equally, where it does show up it has been shown to

follow the aforementioned prevalence rate (plus or minus 1%). It’s no coincidence that more

developed nations have the highest number of sufferers, both China and the USA contains the

largest bipolar populations in the world. With faster paced societies and increased workloads,

anxiety disorders such as bipolar disorder are starting to rise.

The United States has between 4-6 million bipolar sufferers and China has between 10-

14 million, according to the World Health Organization ("The global burden," 2002). According

to the CDC, “Bipolar disorder has been deemed the most expensive behavioral health care

diagnosis, costing more than twice as much as depression per affected individual. Total costs

largely arise from indirect costs and are attributable to lost productivity, in turn arising from

absenteeism and presenteeism. For every dollar allocated to outpatient care for persons with

bipolar disorder, $1.80 is spent on inpatient care, suggesting early intervention and improved

prevention management could decrease the financial impact of this illness “(CDC, 2011). In the


United States alone the estimated annual cost of treating and diagnosing bipolar disorder is over

$45 billion dollars a year (Hirschfeld & Lana, 2005)! If the numbers follow this trend, China

and the United States are estimated at easily spending more than $100 billion to combat bipolar

disorder.

Approximately 2.6% of the U.S. population suffers from bipolar disorder (Kesseler &

Chiu, 2005). That is an estimate of 1-3 people out of 10 or approximately 7.2 out of a 1000. In a

state such as Missouri that would mean that over 400,000 people would suffer from bipolar

disorder. Incidence reporting shows that about 40,000-80,000 U.S. citizens will be newly

diagnosed every year (CDC, 2011). Although that number does not seem intimidating, what are

intimidating are the symptoms of bipolar disorder. Those who suffer from it have extreme mood

fluctuations that can be dangerous to themselves or others. Even those that are diagnosed tend to

be diagnosed late in life, misdiagnosed, or sometimes fall through the cracks because of self-

efficacy issues. There is also a high incidence of suicide among bipolar sufferers. Of the 400,000

Missouri sufferers of bipolar disorder almost half will contemplate suicide at least once in their

lifetime ("www.wfmh.org," 2006). That means that 200,000 current Missouri citizens will try to

take their life or contemplate it today or in the near future!

Why? There seems to be a break in the system. Although regimented medications are

extremely effective in controlling bipolar disorder, sufferers need support taking medications and

support in their day to day lives (Rogge, 2012). Without the support and just allowing the

sufferer to their own devices, sufferers tend to only take medications when they feel an episode

come on, or when depression sets in. This is a huge problem. Without a valid support system

50% of bipolar sufferers have more than 1 extreme episode every year ("www.wfmh.org," 2006).

In the case of an extreme episode deep depression or severe mania attacks cause debilitating


halts to life for an individual. Symptoms include: being easily distracted, little need for sleep,

poor judgment, poor temper control, reckless behavior and lack of self-control, binge eating,

drinking, and/or drug use, sex with many partners (promiscuity), spending sprees, very elevated

mood, excess activity (hyperactivity), increased energy, racing thoughts, talking a lot, very high

self-esteem (false beliefs about self or abilities), very involved in activities, very upset, agitated

or irritated (Rogge, 2012). These symptoms are dangerous because in “manic” or “depressive”

states, individuals who suffer have shown symptoms of temporary insanity and haziness.

There are two types of bipolar disorder and a hybrid called “mixed state” or cyclothymia.

Bipolar I is the most dangerous, sufferers swing between extreme high moods and extreme low

moods. Bipolar II sufferers typically do not experience mania or elevated moods, but they

experience something less extreme called hypomania, followed by extreme depression. Mixed

state or cyclothymiac sufferers alternate between depression and hypomania. Both Bipolar II

and cyclothymiacs are estimated to be misdiagnosed about 70% of the time (Hirschfeld & Lana,

2005). This is typically due to patients finally seeking help, but usually when they are suffering

from severe depression, which is what they are diagnosed with 70% of the time.

Several cases document infamous U.S criminals, including convicted murderers and

rapists, as diagnosed with bipolar disorder. Interesting enough these people include some of the

most notorious criminals of all time, Charles Manson, Ted Bundy, Jeffrey Dahmer, and BTK

killer Dennis Rader all had a form of bipolar disorder.

The World Health Organization (WHO) recommends a regimented medication plan that

is monitored by a licensed psychologist, psychiatrist or physician. WHO conducted several

studies and concluded using evidence based information that medication alone is not the most


effective treatment. Social support, licensed therapy, and physician or psychological care

together are extremely effective. They recommend that family or friends close to a bipolar

individual could help in social therapy for the individual. WHO recommends strongly that

someone close to the sufferer assist them with daily activities, which can become a strong

intervention with the disorder ("World health organization," 2012).

A proposed intervention program called “BI-Cycle,” could be an effective treatment

program that helps bipolar sufferers with the needed support system recommended by WHO.

BI-Cycle tries to create an effective ecosystem around a sufferer. First, a regimented medication

schedule is prescribed by a licensed physician or therapist. Secondly, the physician or therapist

creates a “dream team” with the sufferer using a family member or trusted friend that commits to

be an involved piece to the therapy of the sufferer. The entrusted person becomes very important

to the day to day life of the sufferer by being a support beam to him/her. This person will help

remind the sufferer to take medications, give emotional support, and be the eyes and ears for the

physician. BI-Cycle uses a special phone application to track daily, weekly, and monthly mood

levels, which can be in turn promptly emailed to physician or therapist to help keep track of

mood swings. This could help provide quicker and more detailed information to the physician or

therapist so if treatment adjustments need to be made they can be.

Thirdly, BI-Cycle intends to try to offer discount programs to local gym and fitness

facilities to encourage bipolar sufferers to get regular exercise. The CDC has documented that

studies show that exercise has been linked to reduce stress and regulate moods in people rather

they suffer from bipolar disorder or not (CDC, 2011). The dream team partner could help with

exercise by attending one low impact exercise class or routine offered by sponsoring gyms with

the sufferer. If there is not an available gym, the dream team partner could commit to a brisk


walk once a week with the sufferer. Finally, when the sufferer sees his/her physician or therapist

again, the therapist can count on being better informed because he/she would have gotten regular

status updates from the phone application to their email, and more valid information from the

dream team partner even if the sufferer can’t be counted on to do so by himself/herself. BI-

Cycle could also receive sponsorship help from drug stores. The drug stores would get a long-

term customer in turn for offering a specialized discount to certain medications. Also BI-Cycle

could create a Facebook page that links the sufferer with social support. The page could be used

by other bipolar individuals who share their support, tell stories, and offer advice to each other.

Now that we understand bipolar disorder more than ever, it is time to accept that sufferers

in most cases are experiencing the symptoms of it by themselves and no real support system is

out there. There are support groups, therapy sessions, and even family advocacy programs, but

nothing that tries very hard to create a support bubble around those who suffer. The WHO

recommends this using evidence based information, but there is a huge need now for intervention

that is supported by social support and life style changes that could help those who suffer. Yes,

medication is an effective tool, but it is not the problem solver, it needs help and that help can

only come from people surrounding those who suffer, and that’s why BI-Cycle could and would

work. It builds on the effectiveness of medication and takes the social support to a level that

could make a real difference.


III. Logic Model

This logic model was built for the purpose of mapping out where BI-Cycle will start and

where it plans to ultimately be in the future. Logic models are important because:

They communicate the purpose of the program

Describe the actions expected and desired results

Used as a reference point for everyone involved

Help with planning, implementation, and evaluation

Involves all stakeholders

(McKenzie, Neiger & Thackeray, 2013)

The model created can be tweaked where needed, but is specific enough to specify BI-

Cycle’s roadmap. This will also allow the planners to create an solid implementation strategy

that is sure to increase the chances of a successful program. See next page for the logic model

map.

See next page for Logic Model Map.



IV. Planning Committee

Following the recommended guidelines outlined in a typically planning process regarding

creating and implementing a solid program. The planning members were selected under the

following criterion:

1. This committee is comprised of members who are readily available within the priority

population that the program BI-Cycle is geared towards serving. The committee

representatives were carefully selected by expertise first and if he or she lives, works, or

has a vested interest in the Missouri community that BI-Cycle intends on serving. These

members are well respected and trusted and already representatives to the target

population.

2. The committee will also include at least one “doer” that is someone who is diagnosed

with bipolar disorder and believes in the cause of BI-Cycle. This person will be sensitive

to this disorder and understand the importance of BI-Cycle’s mission to the priority

population it aims to serve.

3. The committee will comprise of a healthy mix of “doers” and “influencers.” BI-Cycle

intends on having specific members promote itself through political prowess, community

influence, and leadership capabilities. Other members will promote BI-Cycle’s cause

from within the community itself, by using BI-Cycle as an alternative available program.

Educating and promoting within the community will also be a task by those considered

“doers.”

4. The committee will also include at least two sponsors that may help share financial

support and help with the promotion and education as well. Sponsors will be able to not

only promote BI-Cycle but be allowed to partake in the residual promotion of their own


company or business by understanding that BI-Cycle and his or her business is a

partnership. BI-Cycle understands that any sponsor who believes in its cause has a

vested interest in the success of the program.

5. At this time BI-Cycle only seeks sponsorships from partners in the priority population

who are in the category of health awareness, which includes: those who sell and

distribute bipolar disorder medications, those who offer exercise programs that help

relieve stress and anxiety, and possible private sponsors that fall into one or more of these

categories.

6. BI-Cycle’s planning committee will meet at least once each quarter of the year to discuss,

evaluate, and select new members if necessary. The planning committee will discuss

new program details, progression details, adjustments to marketing campaigns, education

updates etc.

7. Each member can serve up to six years on the BI-Cycle committee board. There will be

a voting process that will determine new members. A member can serve up to two terms,

with one term being three years. Potential members will be voted in by current

committee members not up for re-election. A majority vote of over 50% will win a new

member a position on the committee board.

8. Each member must pledge into office once elected and take an oath of commitment to

BI-Cycles purpose, understanding that BI-Cycle only acknowledges those with the

highest ethically regard to its cause. BI-Cycle does not encourage fraternizing amongst

its members or biases.


9. BI-Cycle committee members will determine if more members are needed because of

population growths or more representatives are needed within the priority population. As

it stands BI-Cycle estimates it needs approximately 22 committee members now.

10. At the moment, there will only be one committee board located within a centralized

location within the target population. If there is a need for additional committee

members or subcommittees, that will be determined by the main committee members. It

is the responsibility of all BI-Cycle members to determine the number of group members

needed at a given time.

11. BI-Cycle will follow the formula below to guarantee a solid committee team:

+ + + +

+ =


Recognized members (BI-Cycle Dream Team):

1. Dr. Todd Schaible – Columbia, Missouri/ Burrell Behavioral Health Facility Influencer

has links to Governor Jay Nixon

2. Keith Schafer, Ed.D., Director – Missouri Mental Health Program Influencer

3. Jan Heckemeyer, Deputy Director- Missouri Mental Health Program Influencer

4. Mr. R. James Kelly, Director – Jackson County Health Department Influencer

5. Marguerite Grandelious – St. Louis Mental Health Board Influencer

6. Leon Ashford, Ph.D. – St. Louis Mental Health Board Influencer

7. Ted Brandt, Assistant Manager – University of Missouri Health System Influencer

8. Harry Veo, Regional President of Sales – 24 Hour Fitness Influencer

9. Charlotte Taff, Regional Manager – Anytime Fitness Influencer

10. CVS Member Sponsor

11. Walgreens Member Sponsor

12. Wal-Mart Member Sponsor

13. Also: 6-10 members from the priority population who are bi-polar sufferers that can help

advocate program, educate other sufferers and help implement program objectives in the

community. DOERS


V. Planning Model


The stakeholders of the BI-Cycle program will use the Generalized Model for planning

and evaluation. According to McKenzie, Neiger & Thackeray (2013), the Generalized Model

consists of five elements or steps: (1) assessing needs, (2) setting goals and objectives, (3)

developing interventions, (4) implementing interventions, and (5) evaluating results.

After careful pre-planning it has been determined that the stakeholders of BI-Cycle will

collect data in a few key categories: medication adherence, the amount of Missouri population

that suffers from bipolar disorder and manic/depressive incidence.


1. Assessing needs: Data was collected using the most recent statistics and information from

local state records, Center for Disease Control, and the World Health Organization. The

information complied has helped identify the priority population being located within the

Kansas City, Columbia, St. Louis, and Springfield zone.

2. Goals and objectives: Each goal set in BI-Cycle is meant to perpetuate an ongoing cycle

of support and growth within the program. BI-Cycle’s objectives are measurable and

benchmarks are set using statistical data from reliable sources.

3. Developing interventions: The intervention used will be BI-Cycle itself. It serves to solve

the problem of low social support among bipolar disorder sufferers and low medication

adherence.

4. Implementing interventions: BI-Cycle will be implemented using a strong committee

front that sets guidelines, education, and other information to be delivered. Strong

marketing will be required, and cooperation with key medical personal using the

STABLE measurement tool is key.

5. Evaluating results: BI-Cycle will be evaluated by a team of UMKC students, which will

allow them to be able to publish those results in the school journal for further research

purposes.


VI. Needs Assessment

The purpose of a needs assessment is many. First, it must be determined if the

community targeted has a need for a program such as BI-Cycle. Secondly, it will allow the

appropriate use of planning resources. Third, a solid needs assessment should prevent delays to

a more important issue. Fourth, the assessment can determine the capacity of the Missouri

community. Finally the key to this needs assessment can provide a focus on developing an

intervention to meet the needs of the priority population (McKenzie, Neiger & Thackeray, 2013).

Step 1: Determining the scope and purpose of this needs assessment

The purpose of this assessment is to determine the demographics of bipolar disorder

among those living in the cities of Kansas City, Columbia, St. Louis, and Springfield. The

information gathered will be used to map out if a need exists among this community and if the

BI-Cycle program can serve as a useful tool to it.

Step 2: Gathering data

The information gathered to determine the needs assessment will consist of primary and

secondary data. The primary data tool that will be used is an evidence-based assessment tool

called the Mood Disorder Questionnaire (MDQ) see appendix for reference. The MDQ is quite

accurate and has a specificity rate of 70/100 and a sensitivity rate of 90/100. It would be used as

a general assessment tool in hospitals, clinics, and any other setting that someone may go to seek

medical or psychological help. The secondary data collected is referenced from the Center for

Disease Control and Prevention (CDC), World Health Organization (WHO), Missouri State

Health website, National Institute of Mental Health (NIMH), and medical journals listed in the

reference page (see reference page).


The priority population will be surveyed using the MDQ in clinical settings which will

also serve as a self-report assessment that can be mailed or used on a telephone interview. This

survey will also be used along with current evidence research and information to come to a

consensus on the priority population needs. The secondary data collection concludes:

•Bipolar disorder is the sixth leading cause of disability in the world. (World Health

Organization)

•Bipolar disorder results in a reduction in expected life span of 9.2 years, and as many as

one in five patients with bipolar disorder commits suicide.

•Approximately 2.6%-5% of the Missouri population suffers from bipolar disorder

(Kesseler & Chiu, 2005).

•About 1 in 20 people in the U.S. have bipolar disorder, which approximately 400,000

Missourians have it as well.

•Only half of those who suffer stick to their regular medication regimen.

•50% of bipolar sufferers have more than 1 extreme episode every year

(“www.wfmh.org,” 2006).

•Both Bipolar II and cyclothymia are estimated to be misdiagnosed about 70% of the

time (Hirschfeld & Lana, 2005).

Step 3: Analyzing Data


The primary data currently has not been fully collected. The secondary suggests that the

priority population targeted does currently have a need for such a program like BI-Cycle. It’s

quite evident with the data collected thus far that there is a portion of the Missouri community

that suffers from lack of a support system in regards to bipolar disorder.

Step 4: Identifying the links that contribute to the problem

The links to the lack of self-efficacy regarding medication adherence and lack of social

support was recently documented by NIMH. NIMH recognizes that there is a stigma associated

with bipolar disorder. Sufferers tend to feel denial, depression, and outcasted. This creates

situations where sufferers don’t want to take medication, adhere to therapy intervention, and feel

like there is little social support because of being diagnosed with a chronic illness (NIMH 2009).

Step 5: Program focus identification

The primary focus of BI-Cycle is to work with the current recommended therapy

treatment (medication) for those with bipolar disorder, but emphasizing a stronger social support

system that is the foundation to all therapy treatments. In order to work, BI-Cycle will try to

emphasize better medication adherence, better diagnosis processes and a strong system of

support from family, friends and the local community.


VII. Mission Statement, Vision Statement, Objectives, and Goals

Mission Statement

BI-Cycle intends to educate, promote, and improve therapy intervention to those who

suffer from bipolar disorder by recommending treatments that encompasses mind, body

and social support, with social support being the foundation to all therapeutic

interventions. Bi-Cycle’s mission is to serve those who suffer from bipolar disorder

through organized social support as the foundation to therapy, with psychological and

medical support being relevant processes to recommended therapy.

Vision Statement

BI-Cycle wants to make itself a known valid therapy solution by year end 2015. It will

do this by clever marketing and offering information along with services to the

following communities which includes: Kansas City, Columbia, St. Louis, and

Springfield.

Impact Objective:

Behavior: BI-Cycle will discover if individuals have skills to adhere to medication and

therapy; 60% of those who participate will adhere compared to the 50% benchmark

currently reported by year end 2016.

Impact Objective:

Attitude: BI-Cycle seeks to create better education that will help with attitudes towards

taking medication and sticking to therapy. 6-10 participants will have a positive attitude

towards adherence and education by year end 2016.


Process Objective:

BI-Cycle suggests that only those who have the interest of bringing awareness and

advocacy to those affected by bipolar disorder serve on committee. 100% of all members

must be approved by a voting committee that is selected among the priority population.

Outcome Objective:

BI-Cycle recognizes that the best therapy is one that encompasses mind, body, and social

well-being. 100% of all therapy interventions will have social support therapy as the

foundation to all therapy regimes prescribed.

Impact Objective:

BI-Cycle chooses to use the STABLE diagnostic tool to increase correct diagnoses and

decrease the incidence of wrongful diagnosis. Using STABLE, BI-Cycle aims to reduce

wrongful diagnoses by 20%.

BI-Cycle goals:

*To promote healthy living that encompasses the whole individual.

*To increase bipolar awareness and education.

*To prevent misdiagnosis and create happier individuals.

*To improve social support to those who suffer from bipolar disorder.


VIII. Intervention-theoretical Framework: Theory of Planned Behavior (TPB)



The theory of planned behavior (TPB) expands on the theory of reasoned action by

including the concept of perceived behavioral control. It promotes self-efficacy (McKenzie,

Neiger & Thackeray, 2013). This theory is important to the implementation of BI-Cycle because


the program itself will require that bipolar disorder participants have a positive attitude towards

treatment, education, and support. This intervention theory works hand and hand with the social

support therapy that is needed for BI-Cycle to work. An element of this theory’s success is the

positive attitudes and feedback from the community. If used properly, the TPB model should

predict the following in regards to the BI-Cycle intervention results:

Bipolar sufferer should have a positive attitude about social support treatment

Sufferers receive understanding and encouragement from family and friends

Sufferers perceive that with the social support around them they are encouraged to adhere

to treatment and their therapy regimens

The TPB model is an intrapersonal level theory that invokes change and self-efficacy

from the individual. According to Neiger & Thackeray, the interpersonal level concept

influences behavior, knowledge, attitudes, and personality traits (McKenzie, Neiger &

Thackeray, 2013).


IX. Resources

There are some essential resources needed for the BI-Cycle campaign to be successful.

They are divided into the following categories: Personnel, Curriculum and instructional

resources, Space, Equipment, Supplies, and Financial resources.

Personnel

Advisory committee: Amy Alewel, Simone Baker, Ashley Burdolski, Carrie Callicoat, Mauricio

Cabrera, and Synn Johnson alongside the BI-Cycle planning committee will be responsible for

the program planning and supervision of implementation. Keith Schafer will be the committee

director.

Planning Committee: Will consist of BI-Cycle Dream Team members. These individuals are

responsible for program direction, networking, and are responsible for not just community

education, but also to make sure that all “foot work” is completed. Foot work tasks contains

community education, medical community education, political legislation, disbursement of

funds, program direction, committee elects, and overall program needs.

Evaluation team: An evaluation team will be set up at the UMKC campus. The team will

consist of research students in the Health Sciences Department. Results from the evaluation will

be used to tweak program needs and can be published for research purposes.

Main office team: There will be a need for 2-3 hired people to run office in the Health

Department location. This team will relay information to committee members, advisory

committee and all other personnel. They will also be responsible for appointment keeping and

standard office upkeep. Office hours would mimic the Health Department’s regular schedule.


Curriculum and other instructional resources

Curriculum: Although there will be no need for direct classes, there will be a need to educate the

planning committee about the program and its resources. The Black Dog Institute has created an

educational program that would be a useful program that BI-Cycle could use. This educational

program would include homework and study guides. This educational class will be given over a

9 week timeframe and is quite informative. This educational class is available online for quick

access to the public and can be taught via Facebook or through self-pace instruction. The course

will also be recommended as part of the treatment as well for newly diagnosed patients or even

currently diagnosed patients as well. See appendix for a breakdown of the weekly curriculum.

A perk of the chosen committee members is they all have an expertise with bipolar disorder and

other mood disorders. This expertise will be used to educate the priority population. The

planning committee will have to use their experience and expertise to “sell” the program. The

planning committee is a makeup of teachers, educators, psychologists, psychiatrists, directors,

and political leaders. Once a month a member of the planning committee will host an

educational blog and an online educational class on Facebook. Planning committee members are

also responsible for making sure that members in the Missouri medical community are educated

about BI-Cycle. We also want for those who can diagnose bipolar disorder use the STABLE

diagnostic toolkit only and recommend the BI-Cycle support system in treatment. The NIMH

bipolar pamphlet will also be distributed to the community and referenced to in education

sessions. The “doers” of the planning committee will be responsible for its distribution along

with promoting BI-Cycle. See appendix for STABLE toolkit and NIMH pamphlet.


Space

Space: The space needed for BI-Cycle will be a committee meeting room, an office in the

Missouri Health Department, and research room in UMKC. The meeting room will be the place

where meetings take place. The office will be the central hub for BI-Cycle, here we will house

all the information and education. The office can even be used as computer access area where

members can host online meetings along with conferences as well.

Equipment

Equipment: The only equipment needed for the BI-Cycle program is approximately 5 computers

that will be located in the main office for bookkeeping purposes, emailing, video conferencing

and resourcing. The main office will need a copier machine and fax machine as well. There may

be a use for a projector and screen to show presentations in meeting room. The meeting room

will need to be furnished with standard office necessities such as conference tables and chairs.

Phone Application: There will be a need to use a mood report phone application as part of the

self-reporting requirement for patients and clientele. This phone application can be piggybacked

from a current free application available on the Apple and Android phone application markets or

one could be built that is more specific to BI-Cycle. The benefits of creating one would include

being able to advertise BI-Cycle in the applications market, the BI-Cycle name would be

attached to it as well and offering a surcharge to use the application. The surcharge could help

fund or payback initial costs of creating the phone application.

Website Creation: Currently the easiest method of managing and creating a website which has

multiple benefits is using Face Book. Face Book offers features that the BI-Cycle program can

take advantage of. First, Face Book offers blogs, status updates, and free postings that could


help BI-Cycle advertise or constantly promote information regarding the program. Secondly,

creating friends lists will hopefully draw in those who suffer from bipolar disorder to visit our

site looking for information or networking, which in turn will build the effectiveness of reaching

our priority population. Third, BI-Cycle can take full advantage of the video conference feature

by allowing followers to reach out and offer social support, gain new knowledge or by just

staying connected with one another. Finally, BI-Cycle promoters can host classes using

Facebook or by posting new info the Facebook’s wall so that there is a constant flow of up-to -

date information to anyone who seeks it.

Supplies

Supplies: Standard supplies such as mailing stamps, envelopes, copy paper, etc. are needed to

run the main office. There will be a healthy need for resource material such as pamphlets and

brochures to promote the program. Current generation computers that can handle the latest

software to be able to run video conferencing and web surfing are required as well. Webcams

for each computer are needed as well.

Financial Resources:

Money: The financial support that BI-Cycle needs will come from a few sources. We would ask

that some money come from the state of Missouri to help promote BI-Cycle within the

community. Sponsorships could also generate additional funds through special events such as

educational classes, fun runs, awareness meetings and other events that sponsors want to

participate in. For example, we would partner with 24 Hour Fitness to host an exercise event and

we would help promote new memberships to their facilities. In turn we could share the funds that


come in from donations from fun runs and such. In the future BI-Cycle will explore additional

funds from new products and services that will help generate additional funds.

Grants: Grants are a wonderful way to network with other programs and institutions that have

similar causes. Grants can be sought from some highly recognizable source groups that can

supply funds and other resources to help operate BI-Cycle.

Budget Sheet for BI-Cycle

Revenue and Support Amount

Contributions from sponsors $500

Gifts (see financial resources grants/gifts)

$1,000

Grants (see financial resources grants/gifts)

$35,000

Participant Fee N/A

Sale of Curriculum material N/A

Total Income 36,500

Expenditures

Direct Costs

Personnel

Salary and Wages $20,000

Fringe Benefits N/A

Consultants N/A

Supplies $1500

Instructional materials $250

Incentives N/A


Meeting costs N/A

Equipment $4,000

Travel $1,000

Postage $200

Advertising $1,000

Total of Direct Costs $27,150

Indirect cost (includes rent, insurance, telephone & other utilities

$3500

Total of Indirect Costs

$3500

Total expenditures $30,650

Balance +$4100

X. Marketing Plan


Using the process of segmentation to identify the unique characteristics of our priority

population will insure that the marketing campaign to promote BI-Cycle is effective and

sensitive to the promotion of the program. After assessing the needs of the priority population

and focusing on BI-Cycle’s ultimate short, mid, and long term goals; the following is the

roadmap to a successful marketing strategy for BI-Cycle:

Geographic segmentation: The bulk of the marketing push will be linked between the Kansas

City to St. Louis area. These two key cities are important because they are home to a large

segment of the state population. 3.3 million (half of the state total) people live in these two

cities, so the marketing strategy to these areas will be essential.

Demographic segmentation (Age): Research has shown that three quarters of those who suffer

from their first mood cycling episode are around the age of 25. Although new evidence is

showing that earlier ages are showing precedence, early and mid-20 year olds are where

preventive measures can show benefit. BI-Cycle would prove rather effective in places such as

health clinics, hospitals and gyms. Posters, pamphlets, and word of mouth from doctors,

clinicians and other health care providers will be the most effective marketing techniques in

clinics and hospital settings. In gyms, a myriad of trainers, classes, poster, and pamphlets can

help promote the healthy living aspect of the BI-Cycle program. Keeping this age group healthy

and happy is very important.

Demographic segmentation (Health History): Research has also shown that “new sufferers” of

bipolar disorder come from “old sufferers.” Three quarters of those who suffer from the disorder

has or had a parent that suffer from unipolar or bipolar disorder. It is key to focus a great deal of

attention to the established population of bipolar disorder sufferers, by educating them at the


clinics and hospitals where they receive their treatment. Educating them about the chances of

passing on the disorder to their children and living a healthy lifestyle would be accomplished by

doctors, psychologists, psychiatrists, and other healthcare professions using educational

brochures, taking time to go through medicine regimens, and explaining the support system of

the BI-Cycle that would be available to them. BI-Cycle’s most important marketing strategy will

be by “word-of-mouth”. The word-of-mouth recommendations from the healthcare professions

within the priority population will help spread the program’s intention and goals. Those who are

suffering from bipolar disorder will trust the provider’s advice because of their position and

expertise; this is a great benefit of word-of-mouth spread from trusted people within the priority

population.

Demographic segmentation (Gender): Bipolar disorder does affect about an equal number of

men and women. But because of the emotionally makeup of women, they are more prone to

mood-cycling which means they are a higher risk category for severe mood swings. There will

be an extra push for the healthy living component of BI-Cycle for women. Staying fit (gym

membership), staying supported (family and friends), and the right diagnosis with the right type

and amount of medication (medical support), are where BI-Cycle could really shine. The

population of females in Missouri is just the right size for this program.

Income segmentation: There are no specific data on the limitations or barriers regarding

marketing to the priority population regarding bipolar disorder.

Race/ethnicity: There is significant data that shows that non-Hispanic whites shows more of

prevalence to bipolar disorder. This is important because it helps with identifying a core market

within the priority population to center the BI-Cycle campaign around. Bipolar disorder knows


no boundary regarding race and every race is affected. Creating an informative campaign that is

colorblind to this disorder will help unite the priority population, therefore optimizing the

program’s results and goals.

Psychographic segmentation (Attitudes): There has been a correlation between medication

adherence and the frequency of mood-cycling from those who suffer from bipolar disorder.

There will be an extreme push for medication adherence with the education program created by

the Black Dog Institute. This education program will educate bipolar sufferers on what the

disease is, the importance of living with the disorder, treatment adherence, and healthy living.

This educational program is meant to change attitudes not just from an individual level but the

community at large. The Black Dog Institute Bipolar Disorder Education Program will be

marketed in healthcare settings and educational institutions within the priority population target

that will allow it.

Behavioral segmentation (Health): One of the main purposes and goals of the BI-Cycle program

is to create positive behaviors towards bipolar disorder. Part of the campaign will also be geared

towards improving overall attitudes towards living with or knowing someone with a mood

disorder such as bipolar disorder. There is research that points to many stigmas and stereotypes

that are attached with bipolar disorder. BI-Cycle can be a positive force to the total community

member’s attitudes. It is socially important that the community is educated with regards to

bipolar disorder, and that they take part in being an intricate element to an encompassing support

system for bipolar sufferers that live among them.

XI. Implementation


BI-Cycle will be implemented carefully and efficiently. This program is intended to help

a specific population along with having a residual effect on the surrounding population as well.

This is where a well-planned implementation process is key to the program’s success. BI-Cycle

has to be implemented in a way that diffuses it into the healthcare system already in place among

those in the priority population. The acceptance and adoption of this program is a fundamental

requirement for its success along with a sustainability component that keeps the plan operational

for an extended period of time.

Phase 1: Adoption of the Program

The adoption process includes a marketing strategy that is specific for the marketing mix

that was outlined in the marketing section of this document, along with understanding the

segmentation that will come from figuring out the specific characteristics of the priority

population. One way to do that is using the diffusion theory process to interpret the results of the

segmentation process. Using the diffusion theory will allow the program planners to target the

early adopters first and piggyback them, allowing them to spread word-of-mouth promotion,

while the rest of the marketing plan works in different ways.

Phase 2: Identifying and Prioritizing the Tasks to Be Completed

An important aspect of the implantation of BI-Cycle includes assigning all tasks to our

planning committee and “doers” of the BI-Cycle program. Most of these tasks are outlined in

either the appendix or in the case of the operational tasks required to get BI-Cycle up in running.

Those tasks are outlined on the following Task Development Time Line in the following pages.

See next page for Task Development Time Line.





Phase 3: Establishing a System of Management

BI-Cycle’s management team is the planning committee. The members chosen come with a

slew of skills that include them being master managers. Most of the members run programs,

institutions, or departments for the state of Missouri. These members can make sure the program

is effective and efficient. So taking from the member list outlined in the planning portion of this

document, the committee members responsibilities are as follows:

1. Dr. Todd Schaible will be responsible for heading the committee board. He will have

similar duties and responsibilities as a CEO, but will have to rely heavily on the other committee

members to make ultimate decisions.

2. Keith Schafer, Ed.D will be responsible for the financial planning and budgeting of the

BI-Cycle Program. Keith will have to consult and gain majority improvement from all

committee members in order to distribute funds, where to use funds, and how the funds will be

used.

3. Jan Heckemeyer, will be responsible for educational planning and sourcing. She will be

responsible for making sure the Bipolar Education Program curriculum is utilized, up to date,

and results are posted and available. She will also have a hand with directing online classes on

Facebook, making sure to schedule them and keeping source material up-to-date as well.

4. Mr. R. James Kelly, will share responsibility of running office, handling resources and

marketing material to participating hospitals, clinics, and other healthcare facilities.


5. Marguerite Grandelious will share responsibility of running office, handling resource and

marketing material. Marguerite also will be responsible for technical operations of the website

which includes maintaining office computers, webcams, and all other equipment to run online

components of BI-Cycle.

6. Leon Ashford, Ph.D., will primarily be used as a “spokesman” to the BI-Cycle program.

Leon will help host events to lobbyists, educators, and other healthcare professionals. Getting

the word out about the BI-Cycle program will be a large responsibility of Mr. Ashford’s.

7. Ted Brandt, will have a responsibility of understanding of new policies that affect the

program. He will also be responsible for published results for all aspects of the BI-Cycle

program. This includes: objective results, financial results, evaluation results, and any other

results that are important to the program.

8. Harry Veo, will be responsible for putting together an exercise program that works for his

gym business and attracting members to these classes. Harry will work alongside the BI-Cycle

program to help evaluate results of attendance and help with editing and implementation.

9. Charlotte Taff, will be responsible for putting together an exercise program with Harry

Veo. Mr. Veo works for her gym business and will be helpful with attracting members to these

classes. Charlotte will work alongside the BI-Cycle program to help evaluate results of

attendance and help with editing and implementation.

10. CVS Member Sponsor will be responsible for the medication adherence monitoring

survey using Medication Therapy Management (MTM) program. This sponsor will also educate

those who are on bipolar disorder medications.


11. Walgreens Member Sponsor will be responsible for medication adherence monitoring

survey using Medication Therapy Management (MTM) program and also educating those who

are on bipolar disorder medications.

12. Wal-Mart Member Sponsor will be responsible for the medication adherence monitoring

survey using the Medication Therapy Management (MTM) program. The sponsor will also be

responsible for educating those who are on bipolar disorder medications.

13. Also: 6-10 members from the priority population who are bi-polar sufferers that can help

advocate the program by educating other sufferers and helping implement program objectives in

the community. The other members of the planning committee will help with implementation,

evaluation, education, and all other aspects of the BI-Cycle program.

Phase 4: Putting the Plans into Action :

BI-Cycle will follow a three step process of implementation which includes: pilot testing,

phasing in, and then total program implementation. There are several advantages of following

this three step process of implementation. Pilot testing will allow the BI-Cycle Dream Team to

test the program out on a segment of the priority population, allowing a closer control of the

program. During the testing process, the Dream Team planners can check to see if BI-Cycle’s

intervention strategies were implemented as planned and if the intervention strategies are

working. If so, then there are enough resources available to operate the program and allow the

participants to adequately evaluate BI-Cycle for effectiveness. Participants will be allowed to

critique every aspect of BI-Cycle. Using the results from the pilot test, the BI-Cycle Dream

Team can phase the program accordingly. Phasing in also has its benefits, it allows the Dream

Team to have full control, evaluate as they go, and allow for proper filtration of the BI-Cycle


program. Phasing in will start in Kansas City, downtown in the city market area. This will limit

participants but will allow a good mix of the priority population. The first component of BI-

Cycle will be tested in this area, using the STABLE measurement tool for diagnosing newly

identified sufferers. It will be tested in this area for a month. Healthcare providers in this area,

who can diagnosis bipolar disorder, and are participating in the BI-Cycle program will use

STABLE as the only diagnosing tool. Part of using STABLE includes in selecting a “buddy” to

be a social support to the sufferer. After six weeks results will be quantified on the effectiveness

of using STABLE and the “buddy” support. Results will dictate when the next stages of the BI-

Cycle Support System can be implemented into the test area and thus the total priority

community. The goal is to test every aspect of BI-Cycle within the test area with a 6-8 weeks

maximum. Beyond 8 weeks, additional time could delay other operational objectives and goals

for the program.

Phase 5: Ending or Sustaining a Program:

The expectation for the BI-Cycle program is to keep it functional until all goals and

objectives have been met and there is no longer a need for the program in the Missouri

community. It would be ideal that BI-Cycle’s purposes are concluded smoothly with little or no

hindrances, but realistically that is not possible. Sustainability of the BI-Cycle program will

prove to be the challenge. Funding, environmental concerns not yet identified and etc., are

external elements are issues that may cause problems with keeping BI-Cycle up and running to

meet its goals and objectives. If need be then the Dream Team members and other planners will

try to institutionalize BI-Cycle and will constantly evaluate internally to allow critical feedback

and evaluation from participants. Also members can advocate for the program through necessary

channels, such as review boards, grant and funding sponsors, and even tapping into political


powers and even partnering with other organizations that believe in BI-Cycle is a possibility as

well.

BI-Cycle program concerns:

BI-Cycle will take great care to keep planners, participants, and other active parties safe,

secure, and try to invoke peace of mind by explaining the nature and purpose of BI-Cycle,

informing all involved about risks and dangers, benefits for participation, other treatments,

interventions or programs as alternatives, and allow complete discontinuance of program

participation. In case of medical emergencies that may prevent further participation or initial

participation, BI-Cycle will not accept anything less than a clearance from a physician. BI-Cycle

cares about its planners and participants and there will be OSHA workplace guidelines as

needed. MSDS sheets will be used, HIPAA guidelines, and other applicable state and federal

workplace requirements will be followed as well. All participants will have to follow program

guidelines to receive benefits from the BI-Cycle program and all planners along with other

personnel will be held to accountable to the utmost ethical codes. A program manual will be

available to all interested parties along with an SOP guideline for planners. Planners will also be

fully trained in the areas of diversity, sensitivity, and legal procedures regarding ethical conduct

and such. Any problems that arise will be handled by Dream Team members and appropriated to

the necessary person or persons that can resolve the issues. All issues will be documented and

filed and kept at the main office for recordkeeping.


XII. Evaluation

There are a few evaluation elements that will be included with evaluating BI-Cycle.

Formative evaluation will insure that important information is constantly checked and available

to stakeholders. This will also allow Dream Team members and other programmers to revise,

revisit, and redirect the BI-Cycle program as needed. This will be essential between

implementation cycles (pilot testing, phasing in, and total implementation). Elements that will

be evaluated will be adequacy of resources, consumer-orientation, support, accountability,

response, interaction, and satisfaction. The process evaluation elements that will be essential for

the BI-Cycle program are fidelity, reach, response and context.

Just like pilot testing is essential to total program implementation so is pretesting.

Pretesting will be done in between each cycle in at least the form of data collection. The data

collected from each stage will give important information on if BI-Cycle’s core elements are

effective and allow for checkpoint analysis of each stage. According to McKenzie, Neiger &

Thackeray, pretesting has been defined as an evaluation that involves systematically collecting

intended-audience reactions to messages and materials before the messages and materials are

produced in final form (McKenzie, Neiger & Thackeray, 2013). From the formative, process

and pretesting evaluation conclusions can be drawn using summative evaluation. The evaluation

design that will be used will be the experimental design. The experimental evaluation design is

one of the most useful and powerful design types. It allows random assignment of groups and

measures both.

Information gathered will be quantitative and qualitative in nature. Before participating

in the BI-Cycle program participants will fill out a quick questionnaire that will help program


directors assess their attitudes, knowledge, medication adherence, and current social support

level they are receiving. This questionnaire will be submitted using the phone app or directly on

line through email. This reporting requirement will be submitted weekly. The BI-Cycle office

personnel will pull these results as they come in and comply the results in an excel spreadsheet

so that graphs, charts, and so forth and be interpreted. This will create great quantitative and

qualitative data. Also during the pilot testing, BI-Cycle will be evaluated and changes can be

made accordingly. The limitations to this evaluation are it relies heavily on self-report and

participation from a home base. The information that is received will have to be analyzed

thoroughly to make sure it is unbiased, accurate, and complete. This will require a significant

amount of detail by the office staff or persons running the main office.


The goal is having a strong internal validity to validate the program. Factors like having another

program offered elsewhere within the same priority population that offers similar benefits may

affect internal validity; this is why that randomization will be used to choose group participants

of the evaluation process. These members will mimic the makeup of the priority population.


XIII. References

(2000). Stable resource toolkit. (4th ed.). Washington D.C.: American Psychiatric Association. DOI: www.cqaimh.org/pdf/STABLE_toolkit.pdf

Black Dog Institute. (n.d.). Retrieved from http://www.blackdoginstitute.org.au/public/bipolardisorder/bipolareducationprogram.cfm

Bipolar Disorder. (2008). Retrieved from http://www.nimh.nih.gov/health/publications/bipolar- disorder/nimh-bipolar-adults.pdf

CDC. (2011, July 01). Burden of mental illness. Retrieved from http://www.cdc.gov/mentalhealth/basics/burden.htm

http://www.cdc.gov/mentalhealth/basics/burden.htm

http://www.nimh.nih.gov/health/publications/bipolar-

http://www.blackdoginstitute.org.au/public/bipolardisorder/bipolareducationprogram.cfm

http://www.cqaimh.org/pdf/STABLE_toolkit.pdf


Hirschfeld, R., & Lana, V. (2005). Bipolar disorder "costs and comorbidity". The American Journal of Managed Care, 11(3), S85-S90. Retrieved from http://www.ajmc.com/publications/supplement/2005/2005-06-vol11-n3Suppl/Jun05-2074pS85-S90/

The global burden of disease. (2002). Retrieved from http://www.who.int/mip/2003/other_documents/en/globalburdenofdisease.pdf

Kesseler, R., & Chiu, W. (2005, June). National institute of mental health. Retrieved from http://www.nimh.nih.gov/statistics/1BIPOLAR_ADULT.shtml

McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2013). Planning, implementing & evaluating health promotions programs. Glenview: Library of Congress Cataloging-in-Publication Data.

The mood disorder questionnaire. (2000). Retrieved from http://www.dbsalliance.org/pdfs/MDQ.pdf

The National Institute of Mental Health (NIMH). (2009). Retrieved from National Institute of Health website: http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Rogge, T. (2012). Bipolar disorder. A.D.A.M. Medical Encyclopedia. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

www.wfmh.org. (2006). Retrieved from http://www.wfmh.org/PDF/KEEPINGCARE/Serious Mental Illness fact sheet.pdf

World health organization. (2012). Retrieved from http://www.who.int/mental_health/mhgap/evidence/psychosis/en/

Appendix A

Needs Assessment Mood Disorder Questionnaire

http://www.who.int/mental_health/mhgap/evidence/psychosis/en/

http://www.wfmh.org/PDF/KEEPINGCARE/Serious%20Mental%20Illness%20fact%20sheet.pdf

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

http://www.dbsalliance.org/pdfs/MDQ.pdf

http://www.nimh.nih.gov/statistics/1BIPOLAR_ADULT.shtml

http://www.who.int/mip/2003/other_documents/en/globalburdenofdisease.pdf

http://www.ajmc.com/publications/supplement/2005/2005-06-vol11-n3Suppl/Jun05-




The MDQ was developed by a team of psychiatrists, researchers and consumer advocates to addressa critical need for timely and accurate diagnosis of bipolar disorder, which can be fatal if left untreated.The questionnaire takes about five minutes to complete, and can provide important insights intodiagnosis and treatment. Clinical trials have indicated that the MDQ has a high rate of accuracy; it isable to identify seven out of ten people who have bipolar disorder and screen out nine out of tenpeople who do not.1A recent National DMDA survey revealed that nearly 70% of people with bipolar disorder had receivedat least one misdiagnosis and many had waited more than 10 years from the onset of their symptomsbefore receiving a correct diagnosis. National DMDA hopes that the MDQ will shorten this delay andhelp more people to get the treatment they need, when they need it.The MDQ screens for Bipolar Spectrum Disorder, (which includes Bipolar I, Bipolar II andBipolar NOS).If the patient answers:1. “Yes” to seven or more of the 13 items in question number 1;AND2. “Yes” to question number 2;AND3. “Moderate” or “Serious” to question number 3;you have a positive screen. All three of the criteria above should be met. A positive screen shouldbe followed by a comprehensive medical evaluation for Bipolar Spectrum Disorder.ACKNOWLEDGEMENT: This instrument was developed by a committee composed of the following individuals: Chairman,Robert M.A. Hirschfeld, MD – University of Texas Medical Branch; Joseph R. Calabrese, MD – Case Western Reserve Schoolof Medicine; Laurie Flynn – National Alliance for the Mentally Ill; Paul E. Keck, Jr., MD – University of Cincinnati College ofMedicine; Lydia Lewis – National Depressive and Manic-Depressive Association; Robert M. Post, MD – National Institute ofMental Health; Gary S. Sachs, MD – Harvard University School of Medicine; Robert L. Spitzer, MD – Columbia University;Janet Williams, DSW – Columbia University and John M. Zajecka, MD – Rush Presbyterian-St. Luke’s Medical Center.1 Hirschfeld, Robert M.A., M.D., Janet B.W. Williams, D.S.W., Robert L. Spitzer, M.D., Joseph R. Calabrese, M.D., Laurie Flynn, Paul E. Keck, Jr., M.D.,Lydia Lewis, Susan L. McElroy, M.D., Robert M. Post, M.D., Daniel J. Rapport, M.D., James M. Russell, M.D., Gary S. Sachs, M.D., John Zajecka, M.D.,“Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder

Questionnaire.” American Journal of Medicine


Appendix B

STABLE TOOLKIT


(file could not be attached electronically, some excerpts included on following pages)



http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=8B8ru6iOM7hBkM&tbnid=Hrd_o-FhkeYQkM:&ved=0CAUQjRw&url=http://www.docstoc.com/docs/54243042/CIDI-based-Screening-Scale-for-Bipolar-Spectrum-Disorders---Overview&ei=dsSCUbGDEZDQ8wTWo4CQDg&bvm=bv.45960087,d.dmQ&psig=AFQjCNEmeqHUQSbaVXtAh2KEXM6LJANkzQ&ust=1367610833311350


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=bB-OfKUeL4lp9M&tbnid=gGwYBHta4M4C_M:&ved=0CAUQjRw&url=http://www.docstoc.com/docs/132885672/Depression-_-Bipolar-Disorder-Coding-Reference&ei=5sSCUZ3mMY3I9gTNkYH4Dg&bvm=bv.45960087,d.dmQ&psig=AFQjCNEmeqHUQSbaVXtAh2KEXM6LJANkzQ&ust=1367610833311350


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=94qD0iCmDVVYqM&tbnid=0_CZwTLfDqV3SM:&ved=0CAUQjRw&url=http://www.docstoc.com/docs/61444503/Genogram-Template&ei=MMWCUaulBIWy8QSVoIC4Aw&bvm=bv.45960087,d.dmQ&psig=AFQjCNEmeqHUQSbaVXtAh2KEXM6LJANkzQ&ust=1367610833311350


Appendix C

NIMH Bipolar Disorder Pamphlet

http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-read-/adult_updated

%20(2).pdf

(pamphlet could not be added electronically)

http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-read-/adult_updated%20(2).pdf

http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-read-/adult_updated%20(2).pdf


Appendix D

Black Dog Course


(On-line course, cannot be added electronically)



Appendix E

Flyers




Health & Medicine

Bi Cycle Health Initiative