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Health Integration for Aging New Yorkers : Don’t Say “ No ” to Screening New York State Geriatric Mental Health Integration Projects Description, Evaluation and Lessons Learned for Screening Older Adults. Steve Huz, PhD Jeff Gleba, MS, CRC. ACUU Conference 2014 - June 4 , 2014 – Albany, NY.

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Health Integration for Aging New Yorkers : Don’t Say “ No ” to Screening New York State

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Health integration for aging new yorkers don t say no to screening new york state

Health Integration for Aging New Yorkers:

Don’t Say “No” to Screening

New York State

Geriatric Mental Health Integration Projects Description, Evaluation and Lessons Learned for Screening Older Adults

  • Steve Huz, PhD

  • Jeff Gleba, MS, CRC

ACUU Conference 2014 - June 4, 2014 – Albany, NY

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Why Screen?

  • Health screening for such illnesses as heart disease, high blood pressure, and diabetes often provides a quick and easy way to spot the first signs of serious illness.

  • Like screening for these illnesses, screening for depression and anxiety in older adults can do the same. a

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Depression in Older Adults

  • Depression is not a normal part of aging.

  • Depression is a medical problem that affects many older adults and usually can be successfully treated but is widely under-identified and under-treated in older adults.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Prevalence of Depression in Older Adults

Source: Hybels and Blazer (2003). Epidemiology of late-life mental disorders.Clinics in Geriatric Medicine 2003 Nov;19(4):663-96,

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Why Screen for Depression?

  • Depression is a leading risk factor for suicide in older adults.

  • In older adults, depression can lead to disability in functioning and physical health and complicate co-occurring medical conditions.

  • Older adults with depression are more disabled with respect to self care and community living skills.

  • Two-thirds of those suffering from the illness do not seek treatment.

  • Effective depression treatment can be provided to older adults

  • Screenings are often the first step in getting help.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Who Should be Screened for Depression?

People with depression often exhibit some of these symptoms:

  • Persistent sad, anxious, or "empty" mood

  • Sleeping too much or too little, early morning awakening

  • Reduced or increased appetite and related weight loss or gain

  • Loss of interest or pleasure in activities once enjoyed

  • Restlessness (irritability) or slow movement

  • Difficulty concentrating, remembering, or making decisions

  • Fatigue or loss of energy

  • Frequent thoughts of death or suicide or a suicide attempt

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Anxiety in Older Adults

It is common for older adults to worry about health, family, finances, and their own mortality, but anxiety becomes a mental health problem when:

  • It is experienced with great intensity and frequency

  • It interferes with psychosocial functioning or daily activities

  • It occurs when there is no real danger or threat

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Prevalence of Anxiety in Older Adults

  • Anxiety is a common illness among older adults, affecting as many as 10-20% of the population.

  • Older women are twice as likely to have an anxiety disorder than older men.

  • The most prevalent anxiety disorders among older adults are generalized anxiety disorders (GAD), characterized by constant worries, though there may be nothing or little to cause these worries.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Why Screen for Anxiety?

  • Untreated anxiety can lead to cognitive impairment, disability, poor physical health, and poor quality of life.

  • For older adults, depression often goes along with anxiety, and both can debilitating, reducing overall health and quality of life.

  • Anxiety can interfere with memory, and significant anxiety can contribute to amnesia or flashbacks of a traumatic event.

  • Many older adults living with anxiety suffered an anxiety disorder – possibly undiagnosed – when they were younger.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Who Should be Screened for Anxiety?

People with anxiety often exhibit some of these symptoms:

  • Excessive worry or fear

  • Refusal to do or preoccupation with routine activities

  • Overly concerned about safety

  • Racing heart, shallow breathing, trembling, nausea, sweating

  • Poor sleep

  • Muscle tension, feeling weak and shaky

  • Hoarding/collecting

  • Self medication with alcohol or other CNS depressants

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

What Screening Does

Screening for behavioral health conditions such as depression or anxiety helps identify the presence or absence of important symptoms but is no substitute for a diagnosis made by a healthcare professional.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Screening Tools

PHQ-9 and GAD-7

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

PHQ-9 Screening Questions

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

PHQ-9 Scoring

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

GAD-7 Screening Questions

not at all

several

nearly

During the last 2 weeks, how

more than

days

half the

every day

often have you been bothered

days

by the following problems?

1

Feeling nervous, anxious, or on

0

1

2

3

edge

2

Not being able to stop or control

0

1

2

3

worrying

3

Worrying too much about

0

1

2

3

different things

4

.

Trouble relaxing

0

1

2

3

5

.

Being so restless that it is hard

0

1

2

3

to sit still

6

.

Becoming easily annoyed or

0

1

2

3

irritable

7

.

Feeling afraid as if something

0

1

2

3

awful might happen

Total Score: _______

= Add columns:

_____+

_____

+

_______

If you checked off any problems, how difficult have

these problems made it for you

to do your work, take care of things at home, or ge

t along with other people?

Not difficult

Somewhat

Very

Extremely

at all

difficult

difficult

difficult

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

GAD-7 Scoring

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

New York State Geriatric

Mental Health/Physical Health Integration Demonstration Projects

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Geriatric Mental Health Act

  • Formed in 2004, the Geriatric Mental Health Alliance of New York is an advocacy and education coalition that successfully led the advocacy movement that resulted in the passage of the NYS Geriatric Mental Health Act of 2005 – the first of its kind in the nation.

  • The law laid the groundwork for policy and practice reforms to meet the mental health challenges of the state’s growing population of older adults.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Geriatric Mental Health Act

The Geriatric Mental Health Act authorized the establishment of:

  • An Interagency Geriatric Mental Health [and Chemical Dependence] Planning Council

  • A geriatric service demonstration program

  • A requirement for an annual report to the Governor and the Legislature

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Service Demonstration Program Grants

  • The Act specifically called for OMH to establish a geriatric service demonstration program to provide grants to providers of mental health care for the elderly.

  • The program is administered by OMH in cooperation with the Office for the Aging and other state agencies.

  • The first round of grants funded “Gatekeeper” geriatric outreach programs and geriatric health integration projects.

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Geriatric Health Integration Projects: Round 1 (2007-2012)

  • 5-year grants to provide physical and mental health care for older adults whose independence, tenure, or survival in the community is in jeopardy because of a behavioral health problem

  • Co-location of mental health specialists within primary care or the improvement of collaboration between separate providers

  • 7 projects (6 funded and 1 additional)

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • University of Rochester – GEMM Care, Rochester, NY

  • Warren and Washington

  • Counties, NY

  • Greene County Mental

  • Health, Greene County, NY

  • New York Presbyterian Hospital – The Wright Center, New York, NY

  • South Oaks Hospital, Suffolk County, NY

  • Metropolitan Hospital, New York, NY

  • Flushing Hospital Medical Center, Queens, NY

NYS Office of Mental Health

22


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • Flushing Hospital Medical Center

  • Flushing Hospital is expanding the integration of mental health care within the hospital’s primary care clinic to co-locate culturally appropriate services and provide support, outreach, and educational services. The program’s objectives are to de-stigmatize mental illness for people of all cultures age 65 or older, increase their access to mental health care, increase interdisciplinary collaboration, and promote long life and healthy living. Ambulatory Care Clinic patients age 65 or older are screened for depression, anxiety, and cognitive impairments; those who screen positive are assessed; and those who need treatment are offered individual/group therapy, including lifestyle modification, and pharmacotherapy as needed.

NYS Office of Mental Health

23


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • Greene County

  • Greene County’s program is designed to provide mental health assessment and treatment in primary care physician offices to reach people – especially the elderly – who would not otherwise seek or be able to access mental health clinic treatment services. Social workers from the Greene County Mental Health Center clinic are co-located one day a week at a number of primary care practice sites which screen for depression, anxiety, and alcohol use as a routine part of physical health screening (these sites are also OMH-approved satellites of the clinic). Two psychiatric nurses from the clinic are available as needed, as is psychiatric consultation for primary care physicians currently providing psychotropic medication.

September 10, 2013

NYS Office of Mental Health

NYS Office of Mental Health

24


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • Metropolitan Hospital Center

  • Metropolitan Hospital co-located mental health with physical health services in the hospital’s new geriatric outpatient center to primarily serve the underserved, socio-economically disadvantaged, mostly minority populations within East Harlem and other communities in its service area. In support of goals to integrate services and provide one-stop shopping for medical, emotional, and supportive services, current activities include mental health screening in the geriatric outpatient center and for patients age 65 or older in primary care clinics; additional assessment and social work services based on that assessment; as needed psychiatrist services; and outreach to community centers and other agencies.

September 10, 2013

NYS Office of Mental Health

NYS Office of Mental Health

25


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

New York-Presbyterian Hospital

New York-Presbyterian’s Irving Sherwood Wright Medical Center on Aging is co-locating mental health screening, assessment, and treatment services with its existing outpatient geriatric primary care services and integrating mental health services in its geriatric medical house calls program. The program is also implementing a case consultation approach for assessing and treating the mental health needs of elder abuse victims seeking services. Program design includes the utilization of a Geriatric Psychosocial Screening Tool the Center has developed to screen for a range of psychological and social problems undermining the health, mental health and well-being of older adults.

September 10, 2013

NYS Office of Mental Health

NYS Office of Mental Health

26


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • South Oaks Hospital

  • The South Oaks program seeks to increase access to mental health services and improve the integration of physical and mental health care for older adults on the North Fork of Long Island. The project’s mental health practitioner is co-located at a primary care physician’s office that now screens patients age 65 or older for depression and relies on her for additional assessment, treatment recommendations, and/or referral. She is also co-located in offices at Eastern Long Island Hospital and at the Town of Southold’s Senior Services Center, where she provides depression screening and assessment for the local senior population on a weekly basis.

September 10, 2013

NYS Office of Mental Health

NYS Office of Mental Health

27


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • University of Rochester: GEMM Care Program

  • The University of Rochester, Jewish Senior Life, and Jewish Family Service of Rochester are integrating physical and mental health care in a homebound, older adult population beginning with initial mental health screening by the primary medical team. Full diagnostic assessments are completed by the mental health team. Mental health services include psychopharmacology, psychotherapy, supportive counseling, and community resource referrals. Interdisciplinary medical and mental health team communication and consultation are coordinated by a mental health case manager and facilitated by regular interdisciplinary team meetings and periodic training sessions. The program is also using the Zarit Caregiver Burden Interview to screen for caregiver burden associated with this population.

September 10, 2013

NYS Office of Mental Health

NYS Office of Mental Health

28


Health integration for aging new yorkers don t say no to screening new york state

1st Round Health Integration Project Sites

  • Warren and Washington Counties

  • The Office of Community Services for Warren and Washington counties oversees the implementation of a collaborative physical and mental health integration program in two large rural counties. A network of federally qualified health centers, a county public health department, a county home care program, and a hospital-affiliated internal medicine practice are collaborating to screen older adults for depression and anxiety, assess those who screen positive, and treat those with mental health issues that need to be addressed. The program also includes a care coordinator who is available to assist patients whose needs or circumstances are particularly complicated or when multiple providers are involved.

September 10, 2013

NYS Office of Mental Health Office of Performance Measurement and Evaluation

NYS Office of Mental Health

29


Health integration for aging new yorkers don t say no to screening new york state

Evaluation of Geriatric Mental Health/Physical Health Integration Sites

  • The evaluation design included:

    • Assessment of implementation process

    • Evaluation of individual-level outcomes

    • Identification of models for integration of mental health in physical health settings for older New Yorkers

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Evaluation of Geriatric Mental Health/Physical Health Integration Sites

Evaluation Measures

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Screening and Assessment for Mental Illness and Recommendation for Treatment

All Ages

Ages 60+

Total Screens Conducted for Depression and Anxiety

17,678

Total Screens Conducted for Depression and Anxiety (60+)

14,162

Individuals Screened

10,404

Individuals Screened (60+)

8,283

Individuals Recommended for Assessment (60+)

2,893

Individuals who Received an Assessment (60+)

2,123

Individuals

who were Recommended for Treatment (60+)

1,941

35%

73%

91%

23%

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Individuals Screened and Percent Recommended for Treatment by Gender and Age

Gender

Percent of Individuals Screened

(n=10,404)

Age

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Profile of Need Areas for Individuals Screened

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Linkage to Service by Mental Health and Physical Health Need

High Moderate Low High Moderate Low

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

PHQ-9 Scores at Initial Screening & Change between

Baseline and Last Follow-up for Treatment Group: Individuals 60+

At Initial Screening

(n=6,461)

Change on PHQ-9 Scores

between Baseline and Last Follow-up

Moderate,

10-14

8%

Moderately Severe, 15-19

4%

Severe,

20-27

2%

Mild, 5-9

18%

None, 0-4

68%

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

GAD-7 Scores at Initial Screening & Change between

Baseline and Last Follow-up for Treatment Group: Individuals 60+

At Initial Screening

(n=5,776)

Change on GAD-7 Scores

between Baseline and Last Follow-up

At

Moderate,

10-14

6%

Severe,

15-21

4%

Mild, 5-9

11%

None, 0-4

79%

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Three Ingredients for Screening Success

  • Protocols for screening

  • Capacity for assessment

  • Access to treatment

NYS Office of Mental Health


Health integration for aging new yorkers don t say no to screening new york state

Want More Information?

  • Visit the NYS Office of Mental Health’s Geriatric Mental Health Website at:

  • http://www.omh.ny.gov/omhweb/geriatric/

  • Contact Steve Huz: [email protected]

  • Contact Jeff Gleba: [email protected]

  • Contact Kim Williams, Geriatric Mental Health Alliance of New York: [email protected]

NYS Office of Mental Health


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