1. www.pspbc.ca Pain Management Mental Health Tools Learning Session 3 Presenter’s name here Location here Date here

2. 2 Faculty/Presenter Disclosure Speaker’s Name: Speaker’s Name Relationships with commercial interests: -Grants/Research Support: PharmaCorp ABC -Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd -Consulting Fees: MedX Group Inc. -Other: Employee of XYZ Hospital Group

3. 3 Disclosure of Commercial Support This program has received financial support from [organization name] in the form of [describe support here – e.g. educational grant]. This program has received in-kind support from [organization name] in the form of [describe the support here – e.g. logistical support]. Potential for conflict(s) of interest: -[Speaker/Faculty name] has received [payment/funding, etc.] from [organization supporting this program AND/OR organization whose product(s) are being discussed in this program]. -[Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: [enter generic and brand name here].

4. 4 Mitigating Potential Bias [Explain how potential sources of bias identified in slides 1 and 2 have been mitigated]. Refer to “Quick Tips” document

5. 5 Certification  Up to 21 Mainpro+ Certified credits for GPs awarded upon completion of: › All 3 Learning Sessions (NOTE: C redits and payment will be based on the exact number of hours in session ) › At least 1 Action Period › The Post-Activity Reflective Questionnaire (2 months after LS3)  Up to 10.5 Section 1 credits for Specialists › All 3 Learning Sessions (NOTE: C redits and payment will be based on the exact number of hours in session ) › The Post-Activity Reflective Questionnaire (2 months after LS3)

6. 6 Learning Session 1 Interactive group learning Create Action Plan (using template) Action Period 1 Planning & initial implementation in practice; review of Action Plan & improvements attempted in practice + AP1 requirements Learning Session 2 Interactive group learning Update/revise Action Plan Report of AP1 experiences & successes Payment for: PMV (optional) LS1 Action Period 1 Action Period 2 Refine implementation; embed & sustain improvements attempted in practice via Action Plan + AP2 requirements Learning Session 3 Interactive group learning Finalize Action Plan Report of AP2 experiences & successes Payment for: LS2 Action Period 2 LS3 Reflection Reinforce & validate practice improvements - GPs & Specialists complete Post- Activity Reflective Questionnaire (PARQ) 2 months after LS3 & submit to PSP Central Learning Session & Action Period Workflow Pre-Module Visit Opportunity for in-practice visit to introduce applicable EMR-enabled tools & templates prior to LS1

7. 7 Payment Stream 1 (ideal) Current Rates: GPsSpecialistsMOAs Hourly Rate$125.73$148.31$20.00 Action Period 1$880.10$1,038.16N/A Action Period 2$660.07$778.62N/A Payment made after attending LS2 GPs: PMV= $125.73 LS1= $440.05 ($125.73 x 3.5hrs max.) AP1= $880.10 TOTAL$1,445.88 Specialists LS1= $519.08 ($148.31 x 3.5hrs max.) AP1= $1,038.16 TOTAL$1,557.24 MOAs PMV= $20.00 LS1= $80.00 ($20.00 x 4hrs max.) TOTAL$100.00 Payment made after attending LS3 GPs: LS2= $440.05 ($125.73 x 3.5hrs max.) AP2= $660.08 LS3= $440.05 ($125.73 x 3.5hrs max.) TOTAL$1,540.18 Specialists LS2= $519.08 ($148.31 x 3.5hrs max.) AP2= $778.62 LS3= $519.08 ($148.31 x 3.5hrs max.) TOTAL$1,816.78 MOAs LS2= $80.00 ($20.00 x 4hrs max.) LS3= $80.00 ($20.00 x 4hrs max.) TOTAL$160.00

8. Agenda 1. Introductions & Sharing Learnings (75 mins) Hand out evaluation forms at beginning of session 2. Yellow Flags & Mental Health Tools (30 mins) Break (15 mins) 3. Community Resources (30 mins) Describe local community resources and how teams can collaborate with them How to collaborate with your community to integrate changes 4. Sustainability (45 mins) Identify ways to sustain changes in practice 5. Wrap up and evaluations (15 mins)

9. 9 Report increased confidence in supporting patients that experience chronic pain Reflect on his/her delivery of Pain tools and develop a process improvement plan Learning Objectives – LS 3

10. 10 Yellow Flags

11. The information presented here is taken entirely, without any content modification from: Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition). Suggested steps to better early behavioral management of low back pain problems Psychosocial Yellow Flags: Helping Someone at Risk

12. 12  Psychosocial indicators suggesting risk of progression to long-term distress, disability and pain  Designed for acute low back pain  Can be applied more broadly to assess development of persistent problems Medical Practice Guidelines: Hunter Integrated Pain Services, Updated Nov. 2005, New Zealand Yellow Flags

13. 13  Can relate to patient’s behaviour, attitudes, emotions, beliefs, family and workplace  Behaviour of health professionals can also have a major influence Yellow Flags

14. 14 Key Factors:  Belief that pain is harmful or severely disabling  Fear-avoidance behaviour  Low mood and social withdrawal  Expectation that passive treatment rather than active participation will help Yellow Flags

15. 15 Mental Health

16. Mental Health Algorithm

17. 17 Cognitive Behavioural Interpersonal Skills (CBIS) Manual

18. Problem List

19. Resource List

20. Activation Daily activities Energize Small goals Problem solving Chunking time Improving mood Self supportive

21. Cognition Changing behaviour Changing thinking Changing feeling

22. Relaxation Benefits Stress management Breathing Grounding Relaxation Mindfulness Meditation

23. Lifestyle Sleep Nutrition Substances Exercise Wellness

24. Navigating the Skills Manual Three ways to begin: Problem list action plan Symptoms Self-assessment questionnaire

25. Problem List Action Plan No job – I’m too old to retrain ACTIVATION RELAXATION COGNITION LIFESTYLE MEDICATION REFERRAL No job – job coach Bankruptcy – debt counselling I feel tired all the time Tired all the time I don’t want to do anything Irritable – tense Drinking more coffee Having a few beers Not interested in seeing friends I overreact I feel like a failure – I’ll never get a job Stay up late watching TV Sleeping during the day Arthritis – pain Arthritis – Bounce Back

26. Flow Chart Healthy Habits For Sleeping, pg 68 It’s True: You Are What You Eat, pg 69 Physical Activity, pg 71 The Wellness Wheel, pg 72 Anti-Depression Activities, pg 31 Depression’s Energy Budget, pg 32 Small Goals, pg 34 Problem Solving, pg 36 Opposite Action Strategy, pg 37 Chunk The Day, pg 38 Improve The Moment, pg 39 Appreciation Exercise, pg 40 ACTIVATION LIFESTYLE

27. Flow Chart NEGATIVE THINKING COGNITIVE DISTORTIONS COGNITION MODULE The Circle Of Depression, pg 42 Common Thinking Errors, pg 44 Thought Change Process, pg 45 Self Talk (Mean Talk), pg 47 Thought Stopping, pg 48 Good Guilt / Bad Guilt, pg 50 Is Anger A Problem For You, pg 54 PANICKY RELAXATION MODULE Abdominal Breathing, pg 57 Grounding, pg 58 Passive Relaxation, pg 61 Mindfulness, pg 64

28. Self-assessment Questionnaire 0 = never or rarely true to me; 1 = somewhat true; 2 = quite a bit true; 3 = very true of me 1.____ It’s hard for me to say no to people even if I don’t want to agree or don’t have the time or energy 2.____ I will do almost anything to avoid hurting people’s feelings, whatever the cost to myself 3.____ I do lots of things for others, even at the expense of meeting my own needs

29. Flow Chart ACTIVATION MODULE Anti-Depression Activities, pg 31 Depression’s Energy Budget, pg 32 Small Goals, pg 34 Problem Solving, pg 36 ACTIVATION OVER-THINKER PROFILE ASSESSMENT MODULE Over-thinker Profile, pg 24 RELAXATION MODULE Abdominal Breathing, pg 57 Grounding, pg 58 Passive Relaxation, pg 61 Mindfulness, pg 64 PANICKY

30. “Is there anything you would like to do for your health in the next week or two?” Brief Action Plan “How confident (on a scale from 0 to 10) do you feel about carrying out your plan?” “Would you like to check in with me to review how you are doing with your plan?” Behavioral Menu If Confidence <7, Problem Solve Barriers Follow-up Elicit a Commitment Statement SMART Behavioral Plan

31. BounceBack

32. Antidepressant Skills Workbook