Webinar Instructions

1. Webinar Instructions Thank you for joining today, please wait while others sign in. Due to the number of participants, all lines will be muted during the call. If you want to ask a question, please type it into the box.

2. Marketing CDSMP to Specific Populations • 10:00 -10:30 Pain Clinics Kathy Medford, SE WA ALTC • 10:30-11:00 Rural Health Systems Jessie Stopsen, Olympic AAA • 11:00-11:30 Large Health Care Systems Anne Whigham, ALTC of Eastern WA Nancy Ludwick, Community Health Association of Spokane • 11:30-Noon Tribes Shelly Zylstra, NW Regional Council

3. CDSMP and working with a Pain Management Clinic SE Washington Aging and Long Term Care February 9, 2012

4. A Quick Look at the Data The number of Americans with chronic conditions is expected to increase from 125 million in 2000 to 157 million by 2020. The number of people with multiple chronic conditions will rise from 60 million to 81 million. Care for people with chronic conditions accounts for 77 percent of Medicaid spending for beneficiaries living in the community. (Mollica and Gillespie, 2003)

5. Chronic Illnesses per the CDC • Chronic diseases cause 7 in 10 deaths each year in the United States. • About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness, including chronic pain. • More than 75% of health care costs are due to chronic conditions. • Approximately one-fourth of persons living with a chronic illness experience significant limitations in daily activities.

6. CDSMP Symptom Cycle and Pain CDSMP demonstrating how symptoms may progress in a circle or cycle, each exacerbating the next

7. Connecting With Our Community Partner Waters Edge Yakima Memorials Pain Management Clinic

8. Getting Started Educating the staff about workshops and curriculum Making referrals Follow up communication and coordination

9. Learning our lessons Early Challenges Early Wins Responses from clients and clinicians

10. Evaluations/Life Changes • Evaluations from CDSMP Workshops held at the Pain Clinic • This class is very helpful. Glad to know that there is a brighter side to this chronic pain. It will not control me, I will have better control of it. Making an action plan and find someone to be supportive of these plans, like a friend, group or your family. • ……..It has really helped me to see what others do to deal with their chronic pain issues. • I was surprised to find the class more relevant to my personal issues (kidney transplant recipient) than to my issues as a caregiver.

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

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

13. Olympic Area Agency on Aging presents Marketing CDSMP to Hospitals

14. Olympic Area Agency on Aging • Olympic peninsula service region - entire west coast of Washington • Extremely rural, rugged with difficult access • Home to 7 Hospitals • Home to nine registered Indian Tribes • Native Americans have the highest prevalence & mortality rates for preventable diseases and conditions. • Four rural service counties with higher proportion of older adults • Two service counties (Grays Harbor & Pacific) lead the state in ‘counties with the greatest chronic disease burden.’ • Limited access to public health resources and health care services, compared with chronic disease burden of service population

15. Western Washington Coast Hospital Locations

16. Strategies to open door • Know your hospitals mission and vision • How does your hospital provide education to their patients ( investigate) • Know your potential key contacts • Be prepared to briefly explain CDSMP • Be prepared to know what you can potentially offer the hospital to make it easy to refer.

17. Strategies to open door 1. Know your hospitals mission and vision • Most hospitals are committed to preventive care and community wellness through education.

18. Strategies to open door 2. How does your hospital provide education to their patients ( investigate) • Face to face • Internal media system on local network • Portable media system • Handouts

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

20. Strategies to open door 4 . Be prepared to briefly explain the evidence- based program • How CDSMP can support their mission or vision with the challenges their patients face • Keep staff presentations under 15 minutes • Develop a variety of approaches (show the dvd; give them a brochure; CDSMP in 3 minutes)

21. Why refer patients to CDSMP? • Evidence-based; numerous studies confirm results • Adopted by national health systems in many countries (UK, Australia, others) • Shown effective across multiple cultures • Gets results! Participants experience • Increased exercise • Improved self-reported health indicators • Diminished health distress • Increased energy • Decreased disability • Fewer hospital & ER visits • Appears to work for the long run…

22. CDSMP supports patients after discharge: The Self Management Tool Box: • Disease-related problem-solving • Managing emotions /Fatigue • Exercise / Breathing techniques/fall prevention • Cognitive symptom management • (relaxation, distraction, self-talk, visualization, pain management ) • Communication skills • Developing patient/physician partnership • Use of community resources • Nutrition • Managing medications • Advanced directives

23. Strategies to open door 5. Be prepared to know what you can potentially offer the hospital to make it easy to refer. Use available resources: “Healthier Living: Managing On-going Health Conditions” – 10 minutes – Patient version “Chronic Disease Self-Management Program [The Healthier Living Program]” – 11.35 minutes  - Professional Bull Publishing Co. P.O. Box 137 Boulder, CO 80306

24. Strategies to open door • Fall Prevention DVDs FREE “Fall Reduction through Exercise and Education” w/ hand outs • Go4Life Everyday Exercises From the National Institute on Aging at NIH

25. Be prepared to know what you can potentially offer the hospital ! • Portable DVD Player 9” • CDSMP brochures

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

27. Living Well TV Series • North Beach Community TV • Ten 30” programs on a healthy aging topic featuring interviews w/ local health providers • Program topics include exercise, mental health, community resources, advanced directives ……

28. CDSMP Resource Links • Stanford University CDSMP http://patienteducation.stanford.edu/programs/cdsmp.html • National Council on Aging http://www.ncoa.org/ • Olympic Area Agency on Aging http://www.o3a.org Presentation: Jessie Stopsen RN stopsja@dshs.wa.gov Director of Nursing 360-538-2456 Olympic Area Agency

29. Marketing to Large Health System Nancy Ludwick Community Health Association of Spokane Anne Whigham Aging and Long Term Care of Eastern Washington

30. Aging and Long Term Care of Eastern Washington • Area Agency on Aging - ALTCEW • Cover north eastern portion of Washington State with five counties, mostly rural • Contract with 27 agencies to provide in-home social services that help people remain in their homes • State and Older American Act Funding

31. Connecting With Our Community Partners • Spokane is the Medical Hub for the Inland Northwest with Health Care as the primary employer • We have four hospitals in Spokane County and 7 smaller hospital in the five surrounding communities. • We have two federally funded health centers • And two major medical practices throughout the county, including Group Health

32. Getting Started • Started March, 2011 with a small grant for books and supplies and support from our Director • Attend a quarterly Medical Clinics Committee with flyers and enthusiasm for the program • Determined who might listen to me and called them • Set up a lay leader meeting with CHAS and Group Health

33. What Is Working At ALTCEW! • We are developing on-going working relationships with one of the major hospitals, meeting with staff from the emergency and social work departments • Incorporating into our Care Transition Program • Incorporating into our Chronic Care Management Program • AND working with CHAS

34. Community Health Association of Spokane • Federally funded health clinic • 6 clinics with more than 80 providers • Urgent Care across from one of the major hospitals in Spokane • Averages 360 patients per day • Medical, Dental, & Behavioral Health

35. Community Health Association of Spokane • Started CDSMP in 2009 • The Medical Director took the Master Training at Stanford • Program fits the mission of CHAS to bring quality health care and wellness to the community • CEO involved the Board of Directors

36. Community Health Association of Spokane • 2 workshops in 2009 • 10 workshops in 2010 • In 2011, provided training for 9 new lay-leaders and facilitated 19 workshops • Graduated approximately 225 participants • Contract with ALTCEW to expand program in Spokane County

37. Moving Forward ALTCEW received a grant from ADSA for program expansion Contracted with CHAS for Spokane County Also contracted with our case management agencies to expand the program in four rural counties Reaching out to medical and social services staff to develop more lay-leaders

38. Challenges • Getting to the right people at the right time • Getting the doctors and the medical clinic staff to see the benefits of the program • Finding the time to keep going to their offices, the hospitals with updated program schedules • Health Care Reform • And of course, funding to keep the program going

39. Recommendations • Find a Champion within the healthcare organization • Present to staff at monthly meetings • Utilize the benefits of Health Care Reform that is bringing social and medical services together – find the various meetings and be pushy • Have flyers always updated and available

40. Wisdom Warriors:Living Long, Living Strong Shelly Zylstra Northwest Regional Council zylstra@dshs.wa.gov

41. A Disparate Culture • Indian lands were exchanged for treaty promises, most of which have not been upheld • Food, medical care, education were primary and common to most treaties • Commodity foods, IHS on the non-entitlement budget, and Indian Boarding Schools were what the tribes received • Years of poverty, poor medical care and loss have left tribes in a vulnerable position

42. Disparities • Infant mortality +33% • Accidental death +38% • Diabetes death +54% • Cirrhosis death +126% • Alcohol death +178% • CVD unheard of 40 years ago! • Diabetes unheard of in 1900!

43. Socioeconomic Characteristics

44. Chronic Disease Rates

45. Health in Indian Country • Great emphasis on all aspects of person—emotional, spiritual, physical, and community • “Tolerated Illness”—based in importance of community; acceptance • Traditional practices • Require connectedness between healer and self • Self-care is viewed as a complement to the care of family members • “I cannot care for them unless I care for myself.”

46. The Classes • Tribal people get their information from a number of sources—usually word of mouth • Doctors • Social Service Directors • Health Clinic Staff • Elders’ Program Coordinators • Tribal Breakfasts or Newspapers • Connect your class with another event—a congregate meal or another well-attended activity • NOTHING beats a personal invitation!

47. CDSMP Dissonance • Is a self-efficacy model • The answer is inside yourself and you hold the power to overcome and manage your symptoms • How to encourage self-efficacy in a community where it is considered rude to think of yourself first? • How to promote self-reliance and empowerment in a culture where family and community are more important than self?

48. Requires Incentives • Patterned after the Wisdom Steps program in Minnesota • Very population with tribal elders there • Provides incentives for health behaviors learned in CDSMP

49. Plan So Far • When elders complete CDSMP, they are given a medicine bag with the owl pin on it • It is the beginning of the new behaviors • Elders can earn beads for continuing healthy behaviors

50. All Tribes are not Created Equal • Each tribe will work with their health center to determine which health behaviors they need to emphasize • Tasks must fit under the same category for the color of the bead • Blue Beads—medical check ups • Black Beads—self care • Red Beads—exercise • Green Beads—nutrition • Yellow Beads--Spiritual/cultural • Orange Bead—intergenerational activities