Peer-Delivered Health Self-Management: Development and National Implementation of Whole Health Action Management (WHAM) Judith A. Cook University of Illinois at Chicago Medical Center Sherry Jenkins Tucker Georgia Mental Health Consumer Network Presented at University of Illinois at Chicago, State-of-the-Science Summit on Integrated Health Care Chicago, IL October 17, 2014

Supported in part by the University of Illinois at Chicago National Research and Training Center on Psychiatric Disability and Co- Occurring Medical Conditions through funding from the U.S. Department of Education, National Institute on Disability and Rehabilitation Research; and the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, under Cooperative Agreement Number H133B Acknowledgement of Funders

Today’s Agenda 1.Welcome and Introduction 2.What is WHAM? 3.WHAM Implementation 4.Outcomes 5.Sustainable Funding

Whole Health Action Management, known as WHAM, is a peer-led intervention to activate whole health self-management in community mental health centers, federally qualified health centers, health homes, and Veterans Administration programs.

More than 1700 peers in 25 states have participated in the WHAM training delivered by the National Council for Behavioral Health. The Georgia MH Consumer Network has trained 334 Georgia Peer Specialists to become Whole Health and Wellness Coaches using WHAM. WHAM is also available in Spanish.

WHAM Core Beliefs  People cannot be forced or coerced to change their unhealthy life-style habits; PSWHR training needs to be voluntary  Participants must acknowledge having health issues they wish to address.  People are more likely to create a healthier life-style when the focus is on their interests, strengths, supports & what they see as possible; PSWHR training helps people focus on what they want to create in their lives, not on what they need to change.  People find it easier to create new habits than to change old ones; PSWHR training focuses on creating new habits or disciplines on a weekly basis, monitoring how well they are doing, and accepting support from their peers.

WHAM 5 Keys to Success A person-centered goal built on 10 evidence-based whole health and resiliency factors A weekly action plan that breaks the goal into small, achievable successes A daily/weekly personal log One-to-one peer support A weekly WHAM peer support group

IMPACT Planning Process Helps peer identify a whole health goal that: Improves health quality Is Measurable Is Positively stated Is Achievable Calls forth actions Is Time limited Weekly Action Plan breaks goal into small steps achievable in 7 days (eat 2 servings fruit 3 X week) Confidence Scale (0=none, 10=total) allows peers to rate whether they can complete the step that week

WHAM’s 10 evidence-based health and resiliency factors 1.Stress Management 2.Healthy Eating 3.Physical Activity 4.Restful Sleep 5.Service to Others 6.Support Network 7.Optimism Based on Positive Expectations 8.Cognitive Skills to Avoid Negative Thinking 9.Spiritual Beliefs and Practices 10.Sense of Meaning and Purpose

Relaxation Response Taught as an essential resiliency tool Can attenuate the stress-induced, fight-or-flight response. Counters unremitting stress that can negatively impact genetically vulnerable areas of our bodies to promote mind/body illness and premature death (Benson et al., 1974, Lancet)

Optimism Based on Positive Expectations - Resiliency Research 15-year study of 2,800 patients who had undergone coronary angiography at Duke University Medical School Found that patients with positive expectations about recovery were 27% less likely to die from heart disease over the next 15 years, controlling for confounds like disease severity & depression (Barefoot et al. 2001, Arch Intern Med)

Randomized Controlled Trial Study of WHAM: Study Collaborators

Random Assignment to One of Two Conditions PSWHR delivered by Certified Peer Specialists in Georgia and Illinois Services as Usual plus a health manual and a $25 gift card to use toward pursuing a health goal

Initial Study Findings 100 percent reached their whole health goal (N=24) From baseline to 3-month follow-up, participants reported sig. increases in hopefulness & sig. decreases in bodily pain (p<.05) 78% very satisfied & 22% somewhat satisfied w WHAM (N=9) 100% liked getting support from peers (N=9) 89% very satisfied, 11% somewhat satisfied w group mtgs (N=9) 89% reported improvement in their whole health, 11 percent reported whole health about the same (N=9) 100% liked program’s focus on a simple health goal (N=9) Average of 3.8 health conditions, most common were hypertension, asthma, & arthritis (N=9)

Integrated Health System Lived Experience + Peer Certification + Health Skills Training IndividualNeed SkilledWorkforce WHAM Sustainable Mechanisms (Funding, Billing) Billable Service (Tiegreen, 2014) WHAM in the State of Georgia

Want to find out more? For information about WHAM… wellness/wham For information about GA MH Consumer Network… For information about the UIC Center…