PowerPoint Presentation

Ruth Nutting, MA, PLMHP, Behavioral Medicine SpecialistJennifer Harsh, PhD, LMFT, Behavioral Medicine Program DirectorSean Hearn, MD, Family Medicine Physician

Session #A6bOctober 17th, 2015Brief Couple-Based Interventions: Getting to the Heart of Coping with Chronic IllnessCollaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.Ruth intro

Approx 5 minutes per person

Thank you for joining us for this presentation. Over the next 20 minutes, Dr. Harsh, Dr. Hearn, and I will be addressing why we firmly believe brief couple-based interventions are the most valuable approach when working with patients with chronic illness. Dr. Harsh and I are joining you from UNMC, and Dr. Hearn is joining from Allina Healthcare in Minnesota.

1 min. 1Faculty DisclosureThe presenters of this sessionHave NOT had any relevant financial relationships during the past 12 months. Ruth2Learning ObjectivesAt the conclusion of this session, the participant will be able to:

Identify the benefits of brief couple-based interventions.

Implement brief couple-based interventions in a healthcare setting. Describe an approach to training residents to incorporate brief couple-based interventions into patient care.Ruth

It is our hope that at the end of this session you will all be able to:

.53ReferencesCanavarro, M. C. & Dattilio, F. (2011). Family therapy and medical issues. Contemporary Family Therapy, 33, 87-90.

Centers for Disease Control and Prevention. (2014). Chronic disease prevention and health promotion. Retrieved from http://www.cdc.gov/chronicdisease/overview/

Lister, Z. C., Fox, C., & Wilson, C.M. (2013). Couples and Diabetes: A 30-Year Narrative Review of Dyadic Relational Research.Contemporary Family Therapy: An International Journal,35, 613-638.

McLean, L. M. (2013). A couple-based intervention for patients and caregivers facing end-stage cancer: Outcomes of a randomized controlled trial.Psycho-Oncology,22(1), 28-38.

Pakenham, K. C., & Samios, C. (2013). Couples coping with multiple sclerosis: A dyadic perspective on the roles of mindfulness and acceptance. Journal of Behavioral Medicine, 36(4), 389-400.

Ruth4PrevalenceRuth

In the United Stated over of all American adults live with chronic illness. Chronic illness poses psychosocial needs of not only patients, but their partners as well. Some of these psychosocial needs may include increased rates of anxiety & depression, decreased rates of communication, and over lower relationship satisfaction. These symptoms are often manifested by the ambiguity and isolation of chronic illness.

1-min. 5Couple-oriented interventions more effective than individual-focused interventions in promoting positive copingWhy are they more effective?Increase communicationIncrease treatment adherenceIncrease attachment bondsReduce relationship and psychological distress

Ruth

You might ask, why are couple-oriented interventions more effective than individual-focused interventions in promoting positive coping? Well, couple-oriented interventions: increase communication between partners about their experience of chronic illness, and allows both partners to understand the importance of treatment adherence and what treatment adherence will look like. Through this experience partners are able to increase their attachment which in turn reduces relationship and psychological distress.

In the next few slides we are going to demonstrate how to adapt three commonly used brief individual interventions to brief couple-based interventions for the following case study.

1.5 min. 6Commonly Used Individual InterventionsJen7Solution Focused InterventionsJen8Collaborative Goal SettingCoupleIndividualOur goal is: _______________________We will: __________________________When: ___________________________We will do this first: _________________Challenges that may arise: ___________We will handle them by: _____________We will reward ourselves when: _______Our reward will be: _________________

My goal is: ____________________I will: _________________________When: ________________________I will do this first: ________________Challenges that may arise: ________I will handle them by: ____________I will reward myself when: _________My reward will be: _______________

Khatri, P., & Mays, K. (2011). Brief interventions in primary care [PowerPoint slides]. Retrieved from http://www.integration.samhsa.gov/Brief_Intervention_in_PC,_pdf.pdfJen9Behavioral ActivationJen10Provider TrainingMany healthcare providers are not trained to intervene at the couple level.What is training focused on?

Individual interventions that providers DO learn can be modified to target couples. Easier for providers to incorporate in care.

Sean 11UNMC-Resident EducationNoon ConferencesPresentation and experiential activitiesSeminarVideo reviewAttention to bio-psycho-social needsRapport; agenda; psychoeducation; couple- based interventions; teach back

Ruth

At UNMC our residents are trained in an integrated-biopsychosocial model of healthcare. Dr. Harsh and I provide monthly seminars in which residents share clips of patient encounters in order to receive feedback on how they are attending to patients biopsychosocial needs, as well as whether they are building strong rapport with patients, setting a manageable agenda, incorporating couple-based interventions, and allowing patients to reframe what they have been told and understand, this is also known as the teach back method. We also provide monthly noon conferences in which presentations and activities are provided for residents to more about implementing various interventions with differing patient populations, such as: (refer to diagram)

112Case ExampleGarth was diagnosed with Type II DM one year ago. Since his dx he has struggled to change his eating habits and his A1C has remained at 8.0. He checks his blood glucose levels solely when he is feeling off.

Sean 13Individual Intervention

Sean14Couple Intervention

Sean15SummaryCouple CenteredInterventions Couple focus on healthcare goals.Committing to lifestyle changes.Taking controlMaintaining bonds

IndividualInterventions Individual focus on healthcare goals.

Ruth

.25 16Session EvaluationPlease complete and return theevaluation form to the classroom monitor before leaving this session.Thank you!

Q&A if time allows18Contact Information Ruth Nutting, MA, PLMHPruth.nutting@unmc.edu

Jennifer Harsh, PhD, LMFTjennifer.harsh@unmc.edu

Sean Hearn, MDseanhearnmd@gmail.com

Video LinksCouple Intervention link http://webmedia.unmc.edu/eLearning/COM/IntMed/couple%20intervention%20mp4.mp4Individual Intervention linkhttp://webmedia.unmc.edu/eLearning/COM/IntMed/individual%20intervention%20mp4.mp4