Group Work: Does it Really Help? Unified Community Services, Grant and Iowa Counties, Wisconsin Change Team Members: Marjorie Bennett, Myranda Culver, Cheryl Knapp and Jeff Lockhart Change Project Dates: May, 2012 to October, 2012

Big Aim: to prevent all re-hospitalizations for Community Support Program (CSP) consumers that had been previously hospitalized during 2011 or 2012 Big Aim: to prevent all re-hospitalizations for Community Support Program (CSP) consumers that had been previously hospitalized during 2011 or The goal of preventing re-hospitalizations including reducing hospitalizations related to both mental health and physical health -The goal of preventing re-hospitalizations including reducing hospitalizations related to both mental health and physical health -In 2011 there were three psychiatric hospitalizations for CSP consumers -In 2011 there were three hospitalizations for medical reasons by CSP Consumers and three consumer deaths related to natural causes -For the past three years 24% of the CSP Consumers that ended services did so due to physical health conditions -So far in 2012 there have been seven psychiatric hospitalizations for CSP consumers, with three of the hospitalizations either being preceded by or followed by hospitalizations related to physical health conditions Little Aim: to increase coping mechanisms for CSP consumers in order to prevent re-hospitalizations through use of a symptom management group Little Aim: to increase coping mechanisms for CSP consumers in order to prevent re-hospitalizations through use of a symptom management group

First change: Staff started a symptom management group that included walking as a coping mechanism. First change: Staff started a symptom management group that included walking as a coping mechanism. The goal of walking during group time was to try to decrease symptoms of depression and anxiety and to increase positive social interactions. *Monthly measurements were to be taken of consumer ’ s anxiety and depression, along with weight and waist circumference. The symptom management group was discussed with all Community Support Program Consumers prior to the group beginning. The goal of walking during group time was to try to decrease symptoms of depression and anxiety and to increase positive social interactions. *Monthly measurements were to be taken of consumer ’ s anxiety and depression, along with weight and waist circumference. The symptom management group was discussed with all Community Support Program Consumers prior to the group beginning. Changes made along the way included after one month adding the group to all Community Support Program Consumers monthly calendars, even if they decided not to attend, so they would have the option should they change their minds. Changes made along the way included after one month adding the group to all Community Support Program Consumers monthly calendars, even if they decided not to attend, so they would have the option should they change their minds. After two months staff decided to do the anxiety and depression measurements at every group session instead of on a monthly basis. After two months staff decided to do the anxiety and depression measurements at every group session instead of on a monthly basis. By three months staff decided to continue to use walking as a coping mechanism for consumers, along with other group activities to include relaxation and mindfulness techniques that are taught during group sessions By three months staff decided to continue to use walking as a coping mechanism for consumers, along with other group activities to include relaxation and mindfulness techniques that are taught during group sessions

Did re-hospitalizations occur during the reporting period? Over all of 2011 and most of 2012 there were 11 psychiatric hospitalizations for consumers and six hospitalizations related to physical health symptoms Over all of 2011 and most of 2012 there were 11 psychiatric hospitalizations for consumers and six hospitalizations related to physical health symptoms During the reporting period four of the originally hospitalized consumers attended the symptom management group with zero re-hospitalizations During the reporting period four of the originally hospitalized consumers attended the symptom management group with zero re-hospitalizations Seven of those hospitalized did not attend the symptom management groups Seven of those hospitalized did not attend the symptom management groups Three of those consumers were re- hospitalized during the group reporting period of May, 2012 to October, 2012 (two for psychiatric stability and one to stabilize physical health symptoms) Three of those consumers were re- hospitalized during the group reporting period of May, 2012 to October, 2012 (two for psychiatric stability and one to stabilize physical health symptoms)

Adopt, Adapt, Or Abandon Changes? The Symptom Management Group did have a positive correlation to the number of re-hospitalizations for those who attended the group The Symptom Management Group did have a positive correlation to the number of re-hospitalizations for those who attended the group The group will continue with weekly sessions, including measuring depression and anxiety The group will continue with weekly sessions, including measuring depression and anxiety The group will not focus on walking at every group and will use the time to teach other symptom management skills The group will not focus on walking at every group and will use the time to teach other symptom management skills The CSP nurse will continue to monitor physical health symptoms to include waist circumference and weight on a monthly basis The CSP nurse will continue to monitor physical health symptoms to include waist circumference and weight on a monthly basis The group will continue to be offered to all CSP consumers through verbal notification and through adding this to monthly calendars given to each consumer The group will continue to be offered to all CSP consumers through verbal notification and through adding this to monthly calendars given to each consumer

Everyone Had Positive Gains Our CSP gained $ from holding the Symptom Management Group for one week versus the potential cost that could have occurred from one three day hospital stay by one of those that participated in the group($ ) Our CSP gained $ from holding the Symptom Management Group for one week versus the potential cost that could have occurred from one three day hospital stay by one of those that participated in the group($ ) CSP Consumers that have attended the group have expressed an interest in continuing the group CSP Consumers that have attended the group have expressed an interest in continuing the group

What We Hope to Do in the Future Continue the Symptom Management Group Continue the Symptom Management Group How do we get other consumers to have better focus on their physical and mental health symptoms How do we get other consumers to have better focus on their physical and mental health symptoms We know group work is not for everyone We know group work is not for everyone