Engaging Consumers Panelists Dr. Robert Freeman, St. Vincents Services and Tony Trahan, NYS OMH with Celia Brown and Dr. Anthony Salerno NYS Office of Mental Health

Introduction St. Vincents Services St. Vincents Services Wellness/Recovery Orientation Wellness/Recovery Orientation Engaging Consumers Engaging Consumers Shared decision making & motivational interviewing Shared decision making & motivational interviewing Conversations about coping & how to talk about medications Conversations about coping & how to talk about medications Questions for consumers to ask Questions for consumers to ask Webinar Q&A Webinar Q&A

Setting the Stage Wellness and Recovery Orientation

St. Vincents Services Wellness Center Initiative Ideas Fitness Day Fitness Day Heart Healthy Clinic Heart Healthy Clinic Cholesterol/Lipid Screening Day Cholesterol/Lipid Screening Day Blood Glucose Levels Blood Glucose Levels Trendy Topics Trendy Topics

Wellness Perspective Learning about recovery and what it can mean for you Fostering hope in wellness rather than maintenance Fostering hope in wellness rather than maintenance Start with consumers goals and hopes, not with their symptoms Start with consumers goals and hopes, not with their symptoms Fostering a healthy lifestyle Fostering a healthy lifestyle Resources: Wellness Self-Management Workbook Resources: Wellness Self-Management Workbook

Wellness Self-Management Talking Points Making the best use of your mental and physical health services Staying well by decreasing symptoms of a mental health problem Learning how to manage day-to-day stress and prevent relapse Staying well by connecting with others Staying well by living a healthy lifestyle Recognizing and building on your cultural values and experiences to support your personal recovery *Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.

Engaging Consumers Shared Decision Making Shared Decision Making Motivational Interviewing Motivational Interviewing

Shared Decision Making Institute of Medicines Rules for Patient- Centered Care Institute of Medicines Rules for Patient- Centered Care Customize patient needs and values Customize patient needs and values Patient is the source of control Patient is the source of control Shared knowledge and free flow of information Shared knowledge and free flow of information Need for transparency Need for transparency Anticipation of needs Anticipation of needs

Motivational Interviewing What is Motivational Interviewing? What is Motivational Interviewing? The Principles of Motivational Interviewing The Principles of Motivational Interviewing Express empathy Express empathy Develop discrepancy Develop discrepancy Avoid argumentation Avoid argumentation Roll with resistance Roll with resistance Support self-efficacy Support self-efficacy

Principles of MI Express empathy Express empathy Goals are to build trust & supporting client Goals are to build trust & supporting client Active and reflective listening Active and reflective listening Develop discrepancy Develop discrepancy Clarify clients goals that are both feasible and healthy Clarify clients goals that are both feasible and healthy Identify steps to reach goal Identify steps to reach goal Avoid argumentation Avoid argumentation focus on discrepancy, or ambivalence, within the client's thinking vs. discrepancy between the client and the counselor focus on discrepancy, or ambivalence, within the client's thinking vs. discrepancy between the client and the counselor

Principles of MI cont. Roll with resistance Roll with resistance If a client doesn't want to go in a certain direction, dont fight it/roll with it If a client doesn't want to go in a certain direction, dont fight it/roll with it Encourage the client to explore all the possible answers to his own questions and concerns Encourage the client to explore all the possible answers to his own questions and concerns Support self-efficacy Support self-efficacy Demonstrate optimism and belief in the client's ability to change Demonstrate optimism and belief in the client's ability to change Help client achieve success on small, realistic goals Help client achieve success on small, realistic goals

Engaging Consumers Conversations about Coping Conversations about Coping Talking about Medications Talking about Medications

Conversations about Coping Coping with Stigma Coping with Stigma Coping with Stress Coping with Stress Identifying personal stress triggers Identifying personal stress triggers Strategies for preventing stress Strategies for preventing stress The illusory quest for chemical balance The illusory quest for chemical balance Coping with Side Effects of Medication Coping with Side Effects of Medication

Medication Recovery vs. Maintenance (Pat Deegan) Recovery vs. Maintenance (Pat Deegan) Any changes can create some anxiety which can be used for positive change Any changes can create some anxiety which can be used for positive change How to discuss side effects with consumers –(refer to NMHA brochure) How to discuss side effects with consumers –(refer to NMHA brochure) Resources: Wellness Self-Management: Personal Workbook and National Mental Health Association brochures (NMHA) Resources: Wellness Self-Management: Personal Workbook and National Mental Health Association brochures (NMHA)

Medication Discussion Points Purposes of Medication* Purposes of Medication* Reducing current symptoms Reducing current symptoms Reducing the chances of having symptoms in the future Reducing the chances of having symptoms in the future FDA oversight and current issues FDA oversight and current issues Antidepressants Antidepressants *Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.

Medication Discussion Points cont. What is a cross taper? What is a cross taper? Risks and benefits of medication Risks and benefits of medication Side effects (NMHA brochure) Side effects (NMHA brochure) Effective use of medication Effective use of medication Making an informed decision Making an informed decision Identifying barriers to effective use Identifying barriers to effective use Strategies to overcome barriers Strategies to overcome barriers

St. Vincents Services Medical Staff Meetings Medical Staff Meetings Needed changes discussed at every meeting Needed changes discussed at every meeting Involve each medical staff member Involve each medical staff member Risk management and liability assessment Risk management and liability assessment Tools Tools Medical/Psychiatric Assessment Monitor Medical/Psychiatric Assessment Monitor Chart Review Form Chart Review Form Wellness Materials and Tips Wellness Materials and Tips

SVS: Medicalize Office Space Media: bulletin boards, literature displays, internet Media: bulletin boards, literature displays, internet Forms: family medical history, symptom checklist, compliance tool, medication consents & side effects Forms: family medical history, symptom checklist, compliance tool, medication consents & side effects Tests: physical exam, labs, consults Tests: physical exam, labs, consults Keeping appointments on time Keeping appointments on time Able to be reached to discuss problems with medications Able to be reached to discuss problems with medications

SVS: Issues/Approach for Successful Medication Change Engage consumer around problems of medication Engage consumer around problems of medication Development of medical/psychiatric special review form Development of medical/psychiatric special review form Change through the prism of lifestyle enhancements Change through the prism of lifestyle enhancements Non-compliant or is something else happening? Non-compliant or is something else happening? Concept of medical traumatic stress disorder Concept of medical traumatic stress disorder Encouragement Encouragement

Questions for Consumers to Ask NMHA Fostering a Dialogue for Recovery brochure – how doctors can enhance communication with consumers ( very for resources) NMHA Fostering a Dialogue for Recovery brochure – how doctors can enhance communication with consumers ( very for resources) veryhttp:// very default.htm for questions for consumers to ask about medications (Food and Drug Administration) default.htm for questions for consumers to ask about medications (Food and Drug Administration) default.htm default.htm o_kids_about_mental_illnesses for parents to talk about mental illness with their children (American Academy of Child and Adolescent Psychiatry) o_kids_about_mental_illnesses for parents to talk about mental illness with their children (American Academy of Child and Adolescent Psychiatry) o_kids_about_mental_illnesses o_kids_about_mental_illnesses

Webinar Q&A Please feel free to type any questions you may have regarding any of the topics we discussed today. Thank you for your participation.

Summary Thanks to panelists and participants. PSYCKES website will be updated for your reference. for any additional questions or comments about todays webinar.