Partners in Care Foundation Self-Management Technical Assistance Center

Supported by:

Partners in CareWho We Are

Partners in Care is a transforming presence, an innovator and an advocate to shape the future of health care

We address social and environmental determinants of health to broaden the impact of medicine

We have a two-fold approach, creating and using evidence-based models for: health system practice change and enhanced patient self-management

Changing the shape of health care through new community partnerships and innovations

Partners in CareWho We Are

Health Self-Management Services

Partners in Care FoundationTechnical Assistance Center

Licensing & Quality Assurance

Data Entry & Management Training Communication

Materials

Coalition Administration

Partnership Development

New System Partners

HEALTHIER LIVING / CHRONIC DISEASE SELF-MANAGEMENT PROGRAM

Program Overview

California Chronic Disease

Self Management Education

Workshops (2012-2015)

What is Self-Management?The actions that individuals living

with chronic conditions must do in order to live a healthy life.

Physical Activity

Medications

Decision Making

Action Planning

Breathing Techniques

Understanding Emotions

Problem-Solving

Using Your Mind

Sleep

Communication

Healthy Eating

Weight ManagementWorking with Health Professionals

Target Population

People with at least one chronic condition – OR –

A family member, friend or caregiver of someone with a chronic condition

Stamina to attend 2 ½ hour sessionCognitive function to participate

Self-Management Programs• Chronic Disease

Self-Management*

• Arthritis

• Diabetes

• HIV/AIDS

• Chronic Pain

• Tomando Control de su Salud (Spanish)

• Arthritis (Spanish)

• Diabetes (Spanish)

Healthier Living (CDSMP)• Award-winning evidence-based program

developed by Stanford University

• 12 -16 participants & 2 Trained Leaders

• People with different conditions or their caregivers

Six-week Program 2 ½ hours, one day a week Includes:

Group discussions Activities Short lectures

Workshop Materials: Healthier Living Book, Relaxation CD, & Charts

CDSMP Leader Training

• 4 day training (6-8 hours per day)

• Facilitated by two certified Master Trainers for groups of 10-20 new leaders

• License from Stanford University is required to train or offer CDSMP

PROGRAM ACTIVITIES & CONTENT

Session Structure

• Welcome• Feedback & Problem Solving• Activities & Education

– Brainstorming– Discussion– Demonstration & Practice– Lecturette

• Making an Action Plan• Closing

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Intro to Workshop &

Group Introductions

Feedback & Problem Solving

Dealing with Difficult

Emotions

Making Decisions

Better Breathing

Making Health Food Choices

Working with Health Care

Providers & the Health Care

System

Pain & Fatigue Healthy Eating

Medication Usage

Mind-Body Connection

Weight ManagementMaking

Informed Treatment Decisions

Getting a Good Night’s

Sleep

Physical Activity Endurance Exercise

Commun-ication Looking Back &

Planning for the Future

Depression Management

Preventing FallsRelaxation Problem Solving Positive

Thinking

Making An Action Plan Making An Action Plan

OUTCOMES & EVALUATIONParticipant Health & Healthcare Utilization Savings

Participant Health Outcomes

CDC Meta-analysis of 20 studies show that CDSMP

contributes to improvements in:

Psychological statusPhysical health status

Self-efficacy andSelected health behaviors

Brady, Teresa J. Executive Summary of ASMP/CDSMP Meta-Analyses. CDC, May 2011. http://www.cdc. gov/arthritis/docs/ASMP-executive-summary.pdf

Participant Health Outcomes

2013 National Study found IMPROVEMENTS in:

Ory, Jiang, Lorig, Laurent, Whitelaw, and Smith, 2013.

21% Depression

16% Managing Sleep Problems

13% Physical Activity

10% Fatigue Management

11% Pain Management

12% Medication Compliance

9% Communication with Physicians

Reduction in ER and Hospital Stays, resulting in $714 of savings per person

EvaluationAttendance Log

EvaluationCover Sheet

DRAFT

EvaluationParticipant

Questionnaires

Session 1 and Final Session

DRAFT

Fidelity Monitoringhttp://patienteducation.stanford.edu/licensing/FidelityManual2012.pdf

MATERIALS & COSTS

Program Licensing CostsSub-license from Partners in Care *prices subject to change

Up to 8 workshops per year (Multiple Programs) $150

Up to 16 workshops per year (Multiple Programs) $300

Single-Program License Fees from Stanford *prices subject to change

30 or fewer workshops, 6 Leader trainings $500

90 or fewer workshops,12 Leader trainings $1000

Multiple-Program License Fees from Stanford *prices subject to change

Up to 75 total workshops and 6 Leaders trainings $1000

Up to 120 total workshops and 12 Leaders trainings $1500

Training Requirements and Costs

• Attend a 4-day training taught by two Master Trainers• Facilitate a 6-week workshop within six months of training• Facilitate two or more 6-week workshops per year to maintain fidelity

Leader Training

Local Training – 4 full days $800 - $1600/person

Stanford Training – 4 to 5 days $900 - $1600/person + Travel Costs

Workshop Materials and Fees

Workshop MaterialsPrice for one

Number Needed for Workshop

Total Price Ongoing Price

Pencils $0.10 20 $2.00

Kleenex $1.49 1 $1.49

Dry Erase & Flip Chart Markers $18.58 1 $18.58

Workshop Charts Printing $97.00 1 $97.00

Dry Erase Easel Pads (or White Board)

$40.00 1 $40.00 $40.00 or $0.00

Blank Easel Pads (paper) $23.00 1 $23.00 $23.00

Easels $74.99 2 $149.98

Folding File Cart with wheels $24.99 1 $24.99

CD Player $40.00 1 $40.00

Book & CD $24.00 20 $480.00

TOTAL $877.04 $63.00

Other Potential Program Costs• Volunteer Leader Stipends (optional)• Food & Refreshments (optional)• Mileage (as needed)

• Staffing Program Coordinator

─ Schedule and coordinate workshops─ Coordinate & Manage Fidelity Monitoring─ Outreach and registration─ Identify and support implementation sites─ Collect data and reporting

Volunteer Coordinator─ Recruit and orient volunteers─ Provide volunteer appreciation─ Monitor volunteers, provide fidelity checks

TITLE III-DPotential Models & Additional Considerations

Potential Ways to Move Forward

• Provide & Coordinate EB Programs• Use IIID Funding to provide all or a portion of

EBP Implementation in your Service Area– Contribute towards materials, licensing, leader

stipes, etc. – Contract with Agency to serve as ‘Central Hub’

that administrates program & maintains a cadre of trained Leaders that travel throughout service area

– Other Network Models

Additional Evidence-Based Programs

PHYSICAL ACTIVITY• Arthritis Exercise Program• Walk With Ease

MEDICATION MANAGEMENT• HomeMeds

FALL RISK REDUCTION• A Matter of Balance

DEPRESSION MANAGEMENT• Healthy Ideas• PEARLS

CAREGIVER PROGRAMS• Powerful Tools for Caregivers• Savvy Caregiver

Creating Pathways to Health

Develop referrals among/between evidence-based programs

CDSME

MOB

MOB Tai Chi

Cartoon Images developed by Preston Blair. Source: https://cdn.tutsplus.com/vector/uploads/2013/12/cartoonmovements-18a.gif

*Program can be facilitated in Chinese, Portuguese, Vietnamese, and Russian.

Research by the Roybal Center for Enhancement of Late-Life Function at Boston University

Designed to benefit community-dwelling older adults who:• Are concerned about falls• Have sustained a fall in the past• Restrict activities because of concerns about

falling• Are interested in improving flexibility, balance

and strength• Are age 60 or older, ambulatory ( able to get to a

class) and able to problem-solve• Class size 8-12 participants

During 8 two-hour classes, participants learn:• To view falls and fear of falling as controllable• To set realistic goals for increasing activity• To change their environment to reduce fall risk

factors• To promote exercise to increase strength and

balance

WHAT PARTICIPANTS ARE SAYING

Testimonials• “Because I have been afflicted with Parkinson’s for over 20 years, I have suffered a

great deal of depression. The skills you've taught me in maintaining positive thinking and combating depression have really helped to improve my condition.” - John, age 69

• “I found the interaction with the other students in the class to be most enlightening. I realized that although I have a chronic illness I am not alone. Thank you for all the lessons in helping me to deal with this.” - Suzanne, age 57

• “The workshop put me back in charge of my life, and I feel great. I only wish I had done this sooner.” - Robert, age 68

Thank you!

Dianne Davis, MPH, Senior DirectorHealth Self-Management Services

Partners in Care Foundation818.837.3775 116

ddavis@picf.orgwww.picf.org

WWW.CAHEALTHIERLIVING.ORG