1. Disseminating a Public Mental Health Intervention What is UPLIFT? INTRODUCTION AND BACKGROUND Statement of the Problem In a review of depression, suicide, and epilepsy, Jones and colleagues 1 reported that the rate of depression in people with epilepsy is between 32% and 48%. Suicide rates among people with epilepsy also are much higher than in the general population. One study reported that 14% of deaths in people with epilepsy were attributable to suicide. 2 Boylan and colleagues 3 found that depression more strongly predicted reduced quality of life than did seizure frequency. Originally funded by the Centers for Disease Control and Prevention (CDC) as a home-based treatment for depression in people with epilepsy, Project UPLIFT was developed to provide group delivery of depression treatment by telephone or Web. Project UPLIFT Based upon Mindfulness-based Cognitive Therapy for Depression, 4 the UPLIFT materials include modules for eight sessions. Each session was designed to be one hour in length and was comprised of the following components: 1. Check-in period4. Skill-building exercise 2.Teaching on topic of the week5. Homework assignment 3.Group Discussion Program Design Timeline: A stratified, randomized, crossover design, was used to randomly assign participants to one of four strata. During the first 8 weeks of the study, two strata received the intervention: one by telephone conference call, and one by Internet. The other two strata received treatment as usual; they continued any psychotherapy or antidepressant medication they were prescribed. During the second 8 weeks of the study, the other two strata received the intervention: one by each delivery mode. A schematic representation follows: Archna Patel, MPH, CHES, Ukwuoma Ilozumba, MPH, CHES, Nancy Thompson, PhD, MPH   Forming New Partnerships  Partnerships with a wide array of organizations was essential to the successful recruitment of targeted participants.  Copyrighting  In disseminating a material for independent use it is paramount that the intellectual rights of the program developer are protected and through Emory University the program is protected by copyright laws.  Training Material Development  Despite the two prior iterations of Project UPLIFT, ensuring usability of the training manuals was imperative. To this end key informant interviews were conducted with past Project UPLIFT facilitators and members of the target population. Feedback from these interviews led to the development of Sessions 1 and 10 and the manual review.  Manual Presentation  Project UPLIFT training materials had previously been delivered as single pages in 3-ring binders. To ensure the durability of the manual a printing consultant was hired and the manual underwent format and binding changes.  Continuing Education Credits  In addition to a free training, participants were also provided with continuing education credits from the CDC at no extra cost. This required extensive preparation of documents and revising of specific objectives in line with their criteria.  Documentation  Extensive noting of all negotiations is imperative.  The training program underwent a change in lead project coordinator shortly before the training program began. While most information was stored in a shared research file, some information related to negotiation for continuing education credits and print services suffered from the absence of “institutional memory.” Stratum 1 Pretest 8-week phone intervention Interim Test 8 weeks follow-up Posttest Stratum 2 8-week Web intervention Stratum 3 8 weeks TAU 8-week phone intervention Stratum 4 8-week Web intervention References: 1 Jones, J. E. et al. (2005). Screening for major depression in epilepsy with common self-report depression inventories. Epilepsia, 46, 731-735. 2 Fukuchi, T. et al. (2002). Death in epilepsy with special attention to suicide cases. Epilepsy Research, 51, 233-236. 3 Boylan, L. S. et al. (2004). Depression but not seizure frequency predicts quality of life in treatment resistant epilepsy. Neurology, 62, 258-261. 4 Segal, Z. V. et al. (2002). Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York: Guilford. 5 Thompson, N. J. et al. (2010). Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy & Behavior, 19, 247-254. ABSTRACT Issues: Depression is a common co-morbid disorder among people with epilepsy, but is often under-treated. In part, this is because research on the treatment of depression in epilepsy is a relatively new focus and interventions are rare. Readily available interventions aimed at improving access to depression treatment could improve depression referral and treatment rates, improving quality of life for individuals with epilepsy. Description: Funded by the Centers for Disease Control and Prevention (CDC) as a home-based treatment for depression in people with epilepsy, Project UPLIFT was developed to provide group delivery of depression treatment by telephone or Web. The intervention was shown to be acceptable and effective. Now in the dissemination phase, the goal is to train at least one person (N=94) with mental health credentials in each state to deliver Project UPLIFT, since mental health licensure is at the state level. Lessons Learned: When an intervention program moves from the assessment stage to the dissemination stage, many new issues arise. Challenges include forming new partnerships with service delivery organizations, addressing copyright issues, ensuring that the materials are distributed to appropriate program delivery personnel and will be delivered faithfully, developing training for those who will deliver the program, and ensuring that training can be sustained. This poster explores each of these issues using Project UPLIFT as a case study. Recommendations: Dissemination planning must begin at the development stage of any intervention program. The dissemination portion of Project UPLIFT is still ongoing. ABSTRACT Issues: Depression is a common co-morbid disorder among people with epilepsy, but is often under-treated. In part, this is because research on the treatment of depression in epilepsy is a relatively new focus and interventions are rare. Readily available interventions aimed at improving access to depression treatment could improve depression referral and treatment rates, improving quality of life for individuals with epilepsy. Description: Funded by the Centers for Disease Control and Prevention (CDC) as a home-based treatment for depression in people with epilepsy, Project UPLIFT was developed to provide group delivery of depression treatment by telephone or Web. The intervention was shown to be acceptable and effective. Now in the dissemination phase, the goal is to train at least one person (N=94) with mental health credentials in each state to deliver Project UPLIFT, since mental health licensure is at the state level. Lessons Learned: When an intervention program moves from the assessment stage to the dissemination stage, many new issues arise. Challenges include forming new partnerships with service delivery organizations, addressing copyright issues, ensuring that the materials are distributed to appropriate program delivery personnel and will be delivered faithfully, developing training for those who will deliver the program, and ensuring that training can be sustained. This poster explores each of these issues using Project UPLIFT as a case study. Recommendations: Dissemination planning must begin at the development stage of any intervention program. The dissemination portion of Project UPLIFT is still ongoing. Results: The pilot study of Project UPLIFT indicates that it is effective in preventing depression and increasing knowledge and skills. When compared to the Treatment-As-Usual waitlist group, those in the intervention group had a significantly lower incidence of major depressive disorder (p = 0.028) and a greater increase in knowledge and skills (p = 0.03). 5 OBJECTIVES The goals of this dissemination program funded by the Centers for Disease Control and Prevention are to: (1)revise the Project UPLIFT for treatment materials for use in training licensed mental health professionals; and (2)train 94 licensed mental health professionals in all 50 U.S. states to use and deliver the Project UPLIFT materials in the epilepsy community. Dissemination of UPLIFT Training Overview The training program is a 10 week course that meets once a week for one hour via phone conference. The training is led by Dr. Nancy Thompson, a licensed clinical psychologist, and the developer and PI of Project UPLIFT. The 10 training sessions are comprised of the following: Session 1: Overview of UPLIFT, Epilepsy, and Depression Session 2: Monitoring Thoughts Session 3: Challenging & Changing Thoughts Session 4: Coping & Relaxing Session 5: Attention & Mindfulness Session 6: The Present as a Calm Place Session 7: Thoughts as Changeable, Thoughts as Impermanent Session 8: Focus on Pleasure & the Importance of Reinforcement Session 9: Preventing Relapse Session 10: Logistics and Resources Program Materials Training materials:  Participants in the training session are provided with the facilitator and participant manuals from the treatment version of Project UPLIFT.  Both the treatment and prevention versions of UPLIFT have 8 sessions that comprise the bulk of the training.  Two additional sessions were added to the training program for the licensed mental health professionals:  Session 1: Introduction to CBT, Mindfulness, and UPLIFT. −Although, all participants are licensed mental health practitioners, their areas of expertise and practice varies, making an introduction essential.  Session 10: Logistics involved in running Project UPLIFT independently. −The session covers a variety of subjects ranging from UPLIFT as treatment versus education, to conference call costs, to Medicare reimbursement practices in the 50 states, to specific state laws to consider. Training Design Recruitment:  Individual e-mails were sent to potential participants through an existing database of professionals working in mental health and epilepsy.  E-mails were submitted to several Epilepsy Foundations and Epilepsy Centers.  An announcement was submitted through the Epilepsy Foundation e-flash.  Phone calls were made to mental health professional specializing in epilepsy throughout the nation.  An announcement was posted on the Managing Epilepsy Well (MEW) organization website.  Resources  A successful dissemination effort requires collaboration and communication with potential qualified participants and relevant organizations.  Logistics  Training and implementation logistics are crucial components required for disseminating a program in real world applications.  Stick to Study Results  Emphasis on the applications and limitations of previous studies results is required to maintain the integrity of a program when disseminating a distance- delivery program. CaliforniaLouisianaOklahoma ColoradoMaineOregon GeorgiaMichiganTexas HawaiiMarylandVermont KentuckyNew HampshireVirginia  Consultation with TeleMental Health Specialist  A one-hour consultation with a specialist from the TeleMental Health Institute provided many new insights into disseminating a program like Project UPLIFT throughout the nation.  Due to variations in issues such as state and county mental health laws, local mental health resources, and professional licensing for differing disciplines, factors to be considered in dissemination vary by location and practitioner.  Telemedicince Coverage Mandates  Currently, 15 states have passed a law requiring insurance companies to pay for telehealth services.  The 15 states include:  Geographic Differences  In disseminating Project UPLIFT, the spread of participants over different time zones and governed by different state and county laws impacts logistic al and legal considerations.  Flexibility  Identification of some of the legal and geographic issues led to unavoidable delays that significantly altered the original timeline. It was imperative that the research team be flexible in what they planned to accomplish.  Feedback of Program  Overall feedback of the program has been positive with emphasis on the ease of use of the manual.  Feedback of Program Materials  We have had the opportunity to receive feedback from training participants about program materials and ways to improve the content to be accepted in more settings, populations, and geographical locations. CURRENT TRAINEES BY STATE  Participants In training  Interested Participants Conclusion Conferencing:  The training is conducted over the phone through conference calls over the course of 10 weeks.  Each training consists of 12-14 group members.  The training is for dissemination of the telephone UPLIFT program only.  The Web portion of UPLIFT is not supported outside of Emory University and cannot be disseminated as of yet. Lessons Learned Dissemination of UPLIFT (continued)Lessons Learned (continued) For additional information please contact: Nancy J. Thompson, Ph.D., M.P.H. Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, nthomps@emory.edu