1. Depression & Anxiety Intervention Christine Garcia, BA, Research Assistant Rachael Meir, PsyD, Director of Health and Wellness Services Rachel Speer, LCSW,Behavioral Health Clinician Marisa Taylor, LPC, Behavioral Health Clinician Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Session # B4b October 12, 2013

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Learning Assessment A learning assessment is required for CE credit. Presenters Will: Incorporate audience interaction through a brief Question & Answer period during or at the conclusion of our presentation.

4. Objectives Identify benefits of telephonic counseling as an adjunctive treatment for depression and anxiety Explain specific skills and techniques taught by this counseling intervention

5. Overview Introduction to Telephonic Counseling Past Research Current Practice Specific Interventions Case Presentation Conclusion & Future Directions Q & A

6. Telephonic Counseling Intervention Benefits: To provide adjunctive treatment for the reduction of anxiety and depression symptoms To provide counseling to populations that may experience many barriers to participating in traditional treatment To be a cost-effective intervention

7. Benefits: Enhancing Treatment Our overall aim is to enhance PCP’s treatment of depression and anxiety by: (1) Providing evidence-based psychotherapy (2) Improving adherence to antidepressant medications (3) Improving depression and anxiety outcomes (4) Identifying previously undiagnosed psychiatric comorbidities (5) Providing feedback to PCPs on depression and anxiety outcomes, skills learned, and other recommendations

8. Benefits for Patients Telehealth benefits patients by: ☺Eliminating need for transportation and childcare ☺Increasing access to care through lower costs, provider availability, extended coverage to underserved populations and underserved geographical regions. ☺Reducing stigma associated with being seen in a mental health clinic ☺Facilitating willingness to disclose personal information

9. Benefits for Healthcare Institutions Telehealth allows institutions to offer more cost-effective care by: Lowering costs of administrative and reception personnel, waiting areas, and patient care rooms. Reducing problematic no-show rates

10. Psychiatric assessment 3 outcomes monitoring calls Psychiatric assessment 3 outcomes monitoring calls Behavioral Activation Therapy Medication adherence monitoring Relapse prevention counseling Control Group: Enhanced Usual Care (EUC) Experimental Group: Telephone Counseling (TC) DH conducted a depression study from 2009-2013, including 300 participants… Findings: *TC had statistically significant reductions in levels of depressive symptoms at 6, 12, and 24 weeks *TC had increased depression remission rate at 24 weeks Research

11. Steps in Treatment 1.Referrals & Outreach 2.Consent, Disclosures, Initial Assessment 3.Patient chooses 3 module topics 4.Complete module calls 5.Final call: Self-Care Plan 6.Update providers about patient’s progress 7.Research assistant tracks progress

12. Referrals & Outreach Referrals: Self PCP Other Staff PharmacyOutreach: Highlights include: free service how it benefits the patient module choices can opt-out at any time monetary incentive. *English and Spanish

13. Initial Assessment PHQ-9 to assess Depressive Symptoms GAD-7 to assess Anxious Symptoms Mini International Neuropsychiatric Interview (M.I.N.I.) to assess additional diagnoses

14. Module Choices Patients can chose at least 3 call topics  Getting Going  Grief and Loss  Healthy Eating  Healthy Relationships  Improve Sleep Patterns  Manage Stress Better  Mind Tricks for Pain  Overcoming Illness  Physical Activity  Positive Thinking  Problem-Solving  Worrying Less

15. Our Database

16. Anxiety Module: Call 1

19. Belly Breathing Activity (Audience participation recommended!)

20. More Skills Guided Imagery CBT DEAR MAN Self- Management Action Plan Gate Control Theory Progressive Muscle Relaxation Pacing Motivational Interviewing Sleep, Eating, Exercise Habits

21. Last Call: Self-Care Plan

22. Updating the PCP Our practices: – Emails to PCPs at initial enrollment, and 6, 12, and 24 weeks, including symptom severity, medication recommendations, and comorbidities – Enter notes into medical records 80.5% of PCPs noted reviewing our emails and/or medical record notes – Provide recommendations for PCPs to reinforce patient goals/skills learned – Encourage three-way communication between PCP, telehealth clinician, and patient – Schedule follow-up appointments with PCPs if needed

23. Tracking Progress: Reduction in Depression Scores

24. Tracking Progress: Reduction in Anxiety Scores

25. Patient Testimonials “I feel she really cares. When you have a sickness like cancer, everybody cares about you but when you have a mental illness, people flee and run away. So when you find somebody who really cares, it gives you that positive boost. I’m a private person so how she got me to talk about my feelings is a miracle.” “If it wasn’t for her, I don’t know where I’d be.” “I’ve met with other people before and they were so stuffy and used big words and I didn’t feel comfortable. It’s hard for my feet to get goin’ and I like that I don’t have to go anywhere to talk with her.” “I don’t know if it’s the deep breathing exercises or the medication or talking with her but I have noticed a definite positive change.”

26. Case Study Demographic Presenting problem PHQ-9/GAD-7 scores Module work Skills learned Outcome PHQ-9/GAD-7 scores

27. Future Directions FUTURE  Trauma work  Interactive videos  Motivational texts/emails  Sustainability

28. Conclusions ♥ Enhances depression and anxiety treatment ♥ Benefits to patient & healthcare institution ♥ Evidenced-based treatment ♥ Future developments & applicability

29. Questions & Comments

30. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!