1. Chronic Disease Self- Management Program Six Weeks to a Healthier Life Maureen (Mo) Lally ALTSA/DSHS lallym@dshs.wa.gov

2. Presentation Overview Why Prisons? What is Self Management? CDSMP Model Results Moving Forward

3. Leading Chronic Diseases in Prison Populations (2010)* For 34 - 49 year old men and women in US prisons: 1. Overweight (47%) less than 20 pounds 2. Hypertension (24.7%) 3. Obesity (24.7%) 20 + pounds 4. Arthritis (23.1%) 5. Asthma (13.9%) 6. Hepatitis (12.9%) Ingrid A. Bingswanger, MD,MPH “Chronic Medical Diseases Among Jail and Prison Inmates”, Society of Correctional Physicians newsletter, Winter 2010

4. Limited studies about incarcerated females in the U.S. “consistently identify intense physical and mental health needs of both the newly and long term incarcerated women, including care of chronic health conditions” Binswanger, I, Mueller, S. Clark, C.B. & Cropsey, K.L (2011) “ Risk factors for cervical cancer in criminal justice settings” Journal of Women’s Health 20 (12), 1839-1845

5. Researchers found “Women entering prison are more likely to require healthcare education to help them build a self-care skill set to better prepare them for release” *Shirley Dinkel, PhD, APRN. BC & Katie Schmidt, BSN,RN “Health Education Needs of Incarcerated Women”, Journal of Nursing Scholarship,2014; 46:4, 229-234 Women in medium and maximum security in Midwest interviewed in 2014

6. Preferred Methods for Women Offender Education Women in the study spoke of their need for comprehensive health education at all levels of prevention Offenders want to decide on something that is meaningful; desire for involvement in the educational process-interactive and met needs of adult learners Opportunity to share stories in small group setting would enhance learning A variety of teaching and learning techniques that include hands-on activities

7. Themes from Offender Interviews Importance of nutrition & exercise to prevent and treat obesity Range of women’s health concerns Communicable disease transmission and prevention Dental hygiene Symptoms and Complications of chronic disease and Mental health conditions- stress management/coping

8. A Great Fit …the Chronic Disease Self Management Program (CDSMP) Brings people with chronic conditions together Tools for day-to-day living with chronic conditions Goal: to promote better self care and confidence in managing one’s health and taking control of symptoms

9. People with different conditions have many of the same symptoms Chronic Condition Stress/Anxiety Pain Tense Muscles Fatigue Difficult Emotions Depression Shortness of Breath

10. One symptom can lead to a number of other problems which often creates more symptoms It becomes a vicious cycle Self management is what you can do to decrease symptoms and break the symptom cycle

11. Break The Symptom Cycle By exploring a variety of ways to: Regain control of your life to do the things that matter Have more energy and get relief from fatigue, pain, and other symptoms Share what you know, and learn new ways to feel better by… Participating in a 6 week workshop “Living Well with Chronic Conditions”

12. What is CDSMP? Six, weekly 2.5 hour sessions Small group, supportive setting Led by two peer facilitators Action oriented curriculum to deal with pain, fatigue, physical limitations Practice skill building like goal-setting, problem-solving, overcoming barriers

14. CDSMP Program Principles People with long term (chronic) health conditions have similar concerns and problems Deal not only with their condition, also with the impact of the condition on their lives and emotions Peer facilitators teach workshops as effectively as health professionals

15. How is CDSMP delivered? 2 Master Trainers train Peer Facilitators 2 Peer Facilitators conduct workshops for small groups of people (10-18) Peer Training is valuable so there is no “authority figure”

16. Self Management Traditional Model Self Management Model

17. With No Known Cure for Many Chronic Conditions… Self management or what you can do to deal with your chronic condition is very important It involves using various tools to handle the problems experienced

18. The Self-Management Toolbox Oregon Living Well Physical activity Medication usage Managing fatigue and pain Action Planning Better breathing Dealing with difficult emotions Relaxation approaches Working with your health care professional and system Problem-solving Using your mind to manage symptoms Preventing falls Getting a good night’s sleep Communication skills Healthy eating Making informed treatment decisions Dealing with depression Future plans

19. What You Can Do as a Self Manager Keep informed; ask questions Take part in planning your treatment, communicate your preferences/goals Inform your health care team about problems/changes you experience Try new things and give them at least a 2 week trial Set goals and work towards them

20. Action Planning Something you want to do Achievable Action-specific Answers the questions: What? When? How much? and How often? Rated on a Confidence level of 7+ (out of 10)

21. What People Say “I was tired. My pain was my boss. It was telling me what I could and couldn’t do. This workshop put ME back in charge.” “I put life back in my life.” “I learned we’re all in the same boat, but the boat isn’t sinking.”

22. Results 3 months+ Better Health –Less fatigue, pain, stress, depression –Improved sleep, more energy Better Care –Improved communication –Medication compliance Lower Health Costs –Fewer hospitalizations

23. Next Steps Moving Forward: 32 hour Training of Peer Facilitators in August Peer Facilitators Offer Workshops

24. Contact: Maureen (Mo) Lally – lallym@dshs.wa.gov – 360-725-2449lallym@dshs.wa.gov