We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byAlban Hall
Modified about 1 year ago
Michele J. Karel, PhD Psychogeriatrics Coordinator Mental Health Services, VA Central Office ©AAHCM
Need for mental health services among homecare population VHA Home Based Primary Care Mental Health Initiative Strategies and resources for addressing behavioral and mental health concerns in the home care setting 2 ©AAHCM
Rates of depression, dysthymia, anxiety, cognitive impairment more than twice among homebound vs non-homebound older adults (Bruce & McNamara, 1992) Mental health conditions contribute to excess disability, premature institutionalization, increased mortality, and reduced quality of life among homebound and other older adults (Davitt & Gellis, 2011; Qiu et al., 2010; Reifler & Bruce, 2014) 3 ©AAHCM
Integrated care! ◦ Improving Mood-Promoting Access to Collaborative Treatment (IMPACT); Prevention of Suicide in Primary Care Elderly Collaborative Trial (PROSPECT); VHA Primary Care Mental Health Initiative Growing evidence base for MH interventions for older adults, in general ◦ Psychological interventions for depression, anxiety, insomnia, pain, sexual dysfunction, challenging behaviors in dementia, caregiver distress ◦ Psychopharmacological treatments And, for homebound older adults, in particular ◦ Problem Solving Therapy for depression, including in context of cognitive impairment; Cognitive Behavioral Therapy for depression; Integrated models for case management in home care 4 ©AAHCM
5 of 10 top diagnoses in HBPC are mental health conditions (Edes, 2010) ◦ Depression, anxiety, PTSD, substance abuse, schizophrenia ◦ Dementia also among top 10 diagnoses; related behavioral and caregiving concerns Also, common behavioral health challenges ◦ Coping with disability, insomnia, chronic pain, adherence Caregiver strain 5 ©AAHCM
Difficult for Veterans in HBPC to access clinic- based mental health services Starting in 2007: Integrate a Mental Health Provider (psychologist or psychiatrist) onto every HBPC team Position description duties include providing/ promoting: ◦ Screening, assessment, diagnosis, treatment of mental disorders ◦ Assessment of cognitive deficits, and decision making and functional capacities ◦ Services for family caregivers, and couples/families ◦ Behavioral medicine interventions ◦ Communication/interaction among team members ◦ Supervision/training 6 ©AAHCM
7 Interdisciplinary Care Care Management Stepped Care Collaborative Care Patient- Centered Care Evidence-Based Psychological and Psychopharm Assessment and Intervention Evidence-Based Psychological and Psychopharm Assessment and Intervention ©AAHCM
Top themes included: Helping team to increase knowledge and skills, for understanding and working with Veterans/families with complex behavioral and mental health issues Increasing holistic conceptualization/approach to patient care Enhancing overall program quality/quality of care Supporting team development and cohesion Contributing to integrated team treatment planning Being available for staff consultation and support 9 ©AAHCM
Depression ◦ PHQ-2/PHQ-9: ◦ GDS: Anxiety ◦ GAD7: PTSD ◦ Primary Care PTSD Screen: type/doctors/screening-and-referral.asp type/doctors/screening-and-referral.asp Alcohol use ◦ AUDIT and MAST-G: Suicide risk o VHA has developed suicide risk assessment tools for primary care and other settings, including, but not limited to, a suicide prevention pocket card and guide (http://www.mentalhealth.va.gov/docs/VA029AssessmentGuide.pdf)http://www.mentalhealth.va.gov/docs/VA029AssessmentGuide.pdf 10 ©AAHCM
AGS Geriatric Evaluation & Management Tools ◦ Including on depression, insomnia, dementia-related behavioral problems ◦ management-tools/B007/ management-tools/B007/ American Psychiatric Association ◦ Major Depression Disorder (2010): f f ◦ Other guidelines and tools: VA/DoD Clinical Practice Guidelines ◦ MDD, Bipolar Disorder, PTSD, Substance Use Disorder, Assessment and Management of Patients at Risk for Suicide ◦ 11 ©AAHCM
Ask questions about a patient’s (and caregiver’s) mood, fears, strategies for coping, and reasons for living. This sends message that it is okay to discuss such issues with you. Provide education for patients and caregivers; normalize behavioral and mental health struggles. Encourage patients and their caregivers to plan for regular engagement in pleasant activities in their lives, in a manner consistent with their abilities and interests. 12 ©AAHCM
Learn and teach patients a few simple relaxation/ mindfulness strategies. Communicate an attitude of hope that, although things may be difficult, there are always ways to address a problem, either through directly altering the problem in some way or working on one’s ability to cope with the problem. Help people acknowledge and utilize their strengths, in addition to grieving for losses. Elicit discussion about what people feel grateful for and what gives meaning to life. 13 ©AAHCM
NIA Age Pages ◦ American Association for Geriatric Psychiatry ◦ American Psychological Association Office on Aging ◦ Caregivers ◦ Family Caregiver Alliance (http://caregiver.org/)http://caregiver.org/ ◦ VA Caregiver Support (http://www.caregiver.va.gov/)http://www.caregiver.va.gov/ ◦ Alzheimer’s Association (www.alz.org)www.alz.org 14 ©AAHCM
In 2010, 50% of men aged 65 and older were Veterans ◦ (http://www.agingstats.gov/Main_Site/Data/2012_Documents/Population.aspx)http://www.agingstats.gov/Main_Site/Data/2012_Documents/Population.aspx Most Veterans are eligible for VA health care For enrollment: ◦ Call VETS(8387) ◦ VA Caregiver Support site 15 ©AAHCM
Alexopoulos, G. S., Reynolds, III, C. F., Bruce, M. L., et al. (2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT Study. The American Journal of Psychiatry, 166, Bruce, M. L., & McNamara, R. (1992). Psychiatric status among the home bound elderly: an epidemiological perspective. Journal of the American Geriatrics Society, 40, Davitt, J., & Gellis, Z. (2011). Integrating mental health parity for homebound older adults under the Medicare home health care benefit. Journal Of Gerontological Social Work, 54, Edes, T. (2010). Innovations in homecare: VA home-based primary care. Generations, 34, Scogin, F., & Shah, A. (Eds.) (2012). Making evidence-based psychological treatments work with older adults. Washington, DC: American Psychological Association. Hicken, B. L. & Plowhead, A. (2010). A model for home-based psychology from the Veterans Health Administration. Professional Psychology: Research and Practice, 41, Hunkeler, E. M., Katon, W., Tang, L., et al. (2006). Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. British Medical Journal, 332, ©AAHCM
Karel, M. J., Gatz, M., & Smyer, M. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist, 67, Karlin B. E. & Karel, M. J. (2013). National integration of mental health providers in VA Home-Based Primary Care: An innovative model for mental health care delivery with older adults. The Gerontologist, doi: /geront/gnt142, First published online: December 3, Karlin, B. E. and A. M. Zeiss (2010). Transforming mental healthcare for older veterans in the Veterans Health Administration. Generations, 34, Post, E. P., Metzger, M., Dumas, P., Lehmann,L. (2010). Integrating mental health into primary care within the Veterans Health Administration. Fam Syst Health, 28, Qiu, W., Dean, M., Liu, T., George, L., Gann, M., Cohen, J., & Bruce, M. (2010). Physical and mental health of homebound older adults: an overlooked population. Journal Of The American Geriatrics Society, 58, Reifler, B., & Bruce, M. (2014). Home-based mental health services for older adults: a review of ten model programs. The American Journal Of Geriatric Psychiatry, 22, Unützer, J., Katon, W., Callahan, C. M., et al. (2002) Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288, ©AAHCM
Karen Gayman Senior Director, Senior’s Health Primary and Community Care.
Implementing the HPPAE model in VA Social Work Graduate Education-GRECC Pilot Project Lorn Gingrich, LCSW-R National Social Work Program Manager Care Management.
Presenters: Kellee R. Bivens, PhD Sheila Phillips, RN, BSN Health Promotion and Disease Prevention Program VA Gulf Coast Health Care Systems Implementing.
Diane Grieder, M.Ed AliPar, Inc. NYAPRS Conference September 2011 USING PERSON-CENTERED PLANNING AS A ROADMAP FOR CARE COORDINATION AND BETTER OUTCOMES.
Models of Community Collaboration for Long-Term Care Nancy Whitelaw, Ph.D. Director, Center for Healthy Aging National Council on Aging March, 2006
Integrating Mental Health Services into Primary Care Linda Van Egeren, Ph.D. Clinical Psychologist Women’s Clinic Minneapolis VA Medical Center Theresa.
TREATMENT TOOLS. SESSION 8 C This session will identify various treatment tools and techniques that have been found useful in working with a dual diagnosis.
Depression Care: Implementing Integrated Primary Care- Behavioral Health Solutions Mark Dreskin, MD Depression Care Program Southern California Kaiser.
Developing Competence in Pediatric Psychology within a General Child Internship Jennifer C. West, PhD. University of Rochester Medical Center Departments.
Putting Health back into Clinical Mental Health Counseling Presented by: Jim Messina, Ph.D., NCC, CCMHC At: Utah Mental Health Counselors Association Date:
Depression in adults with a chronic physical health problem Implementing NICE guidance 2009 NICE clinical guideline 91.
Welcome to Integrated Behavioral Health in Primary Care Settings Presented by Peter Van Houten MD, Medical Director Michael Johnson PhD, LCSW, Behavioral.
Obsessive-compulsive disorder Clinical Guideline Published: November 2005.
RARE Networking Webinar:Improving Care Transitions for Patients with Mental Illnesses and Substance Use Disorders Speakers: Paul Goering, MD Allina Health,
Recovery: The Family’s Process of Healing and Hope CMHACY Conference Steve Hornberger, MSW May 2014 Pacific Grove, CA.
Development of a Rating Scale to Assess Geropsychology Practice Competencies Michele J. Karel, PhD VA Boston Healthcare System Harvard Medical School For.
Depression in Adolescents Preeti Patel Matkins, MD Teen Health Connection Levine Children’s Hospital Charlotte, NC 2008 We’ve Moved!
Occupational Therapy in Productive Aging: The Top 10 Things Everyone Needs to Know Stephanie Stephenson, MOT, OTR/L AOTA Emerging Leaders Development Program.
Self-harm: longer-term management Implementing NICE guidance November 2011 NICE clinical guideline 133.
Dementia September This presentation covers: Background Key recommendations Interventions Implementation.
Enhancing the Mental Health Delivery System for Elders in Illinois Illinois Governors Conference 2009 Anne Posner, Age Options Patty Black, Pillars Mike.
Rule 132 New Services Clinical Overview April 2007.
11 Date April 19th, 2013 (Friday) 8:00AM-7:30PM Location Location UCSF Mission Bay Conference Center 1675 Owens Street, San Francisco, CA
Fostering and Assessing Adherence to Treatment Your name Institution/organization Meeting Date International Standards 9, 17.
Fostering and Assessing Adherence to Treatment Your name Institution/organization Meeting Date International Standard 9.
Patient Centered Medical Home Data and Recognition Review for Saint Lukes Medical Group by Jennifer Woods, RN, BSN Director of Physician Practice Management.
Session One Slides Session One - Setting the Scene - developing a framework for understanding mental illness Session Two - Recovery Session Three – Understanding.
Overview of the common symptoms of PTSD. Overview of the common problems in children of veterans with PTSD including some common mechanisms of vicarious.
Psychological Assessment and Treatment of Pain Matthew Bailly, Ph.D., C.Psych. Department of Clinical Health Psychology University of Manitoba School of.
© 2016 SlidePlayer.com Inc. All rights reserved.