Chronic Disease Self- Management: A Health Center's Success Story Using Promotores de Salud Maria Blancas, Priscilla Tovar & Mary Jo Ybarra-Vega Living Well/Tomando Control Master Trainers Moses Lake/Quincy Community Health Center September 24, 2015 Tukwila, WA

Moses Lake/Quincy Community Health Center Mission The Moses Lake Community Health Center is committed to provide high quality, compassionate, and comprehensive primary health services for the entire family, with a special focus on the underserved and migrant farm-workers in our community.

Programs offered by Moses Lake & Quincy Community Health Center 1. Living Well with Chronic Conditions English language Stanford Chronic Disease Self- Management Program 2. Tomando Control de Su Salud Spanish language and cultural adaptation of Living Well with Chronic Conditions workshops.

How Did We Get Here? WA State CHW/Promo Network Alex P. Lilia G. Pris T. MJ Eric Lilia Gomez WA DOH Francisco WA DOH Maria Blancas Veronica Sosa Luis Perez Lupe Hernandez

Locations served By Tomando Control de Su Salud and Living Well with Chronic Conditions Quincy Warden Moses Lake Wenatchee George Ritzville Grand Coulee Wilbur Wenatchee Warden George Wilbur

Review of Stanford’s Program Tomando Control de su Salud and Living-well are community-based workshops given two and a half hours, once a week, for six weeks. Tomando is not a direct translation of the Living-well. Topics are similar, but they are presented in a culturally appropriate manner. Workshops are facilitated by two trained certified and active leaders, one or both of whom are non-health professionals with a chronic disease themselves.

How was the Program developed? The Department of Medicine at Stanford University received a five year research grant from the National Institute of Nursing Research (NINR) and the State of California Tobacco-Related Diseases office. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based Spanish-language self-management program that assists Latinos with chronic illness. (Promotores de Salud) Living-well was also developed at Stanford University Patient Education Research Center as a collaborative research project between Standard and the Northern California Kaiser Permanente Medical Care program.

Self-Efficacy The Stanford model is based on the Self-Efficacy Theory developed by Albert Bandura: More than knowing ‘what to do’; people must believe that they can be successful.

The Program is Unique… 1. The process is the key that makes the course effective. Classes are highly participative Build the participants’ confidence to manage their health Mutual support amongst participants 2. MLCHC/QCHC did consider the Diabetes Pathway to Self Care, but opted for CDSMP since its all inclusive

What Sessions Look Like Healthy eating Appropriate exercise for maintaining and improving strength, flexibility, and endurance Managing depression Appropriate use of medications Communicating effectively with family, friends, and health professionals Relaxation techniques Appropriate use of the health care system How to evaluate new treatments Better breathing Sleep better Weight control Reducing falls

The Symptom cycle/ Círculo de los Síntomas Poor Sleep/ Falta de Sueño Pain/ Dolor Physical Limitations/ Limitaciones físicas Fatigue/ Fatiga Difficult Emotions/ Emociones Difíciles Depression/ Depresión Shortness of Breath/ Dificultad para respirar Stress & Anxiety/ Estrés y Ansiesdad

Action Planning Every week, participants develop an Action Plan (Propositos) Something they want to do Realistic and specific: “Next week I will walk with my friend for 30 minutes on 4 out of 7 mornings” “Next week I will eat dessert only on 2 of 7 evenings” High confidence that they can do it Share action plan with the group and report on progress the following week. The group problem solves together whenever action plans are not met.

Evaluations and Outcomes 1. How is the Program evaluated? Pre and post tests Review of health benchmarks (A1C pre and post and then once again) Self-reporting EMR Quality Assurance Director runs a report on both the ML and the Quincy groups that are patients. 2. Stanford saw after 4 months: Improved health Health behavior, and Self-efficacy, as well as Fewer emergency room visits. At one year, the improvements were maintained and remained significantly different from baseline condition. ** Our pt. in 2012 had an A1C of 14.7 and still today in 2015 it is 6.6

Integrating the CDSMP into the Clinic Setting We had a vision to be fully integrated into the clinic Gained administrative support Financial support (DOH, AAA, MLCHC/QCHC) Trained Staff Promotora staff (the heart of service) Used EMR changes to integrated program (worked with EMR tech, promotoras, admin., providers, Front-line staff, internal referrals) Outreach

EMR Promotor Encounter Instructors name Each Session Drops down with Description/objectives

Self Management Goals Can Print Record of Goals SMG/Propositos Documented Weekly

Long Term Care plan

SMG-Long Term Plan Handouts/Educational Materials Long-Term Goal/Plan

Recommendations Organizations need a champion within the organization to support program Stanford does not offer Leader trainings. Licensed organizations may organize Leader trainings. Build a core team Summarize the results if things go as proposed Promotores and line staff are great at recruiting Offer classes during down time Meet monthly, often, share responsibilities Share stories that move you with others

Thank You-Gracias!