1. Join the conversation! Our Twitter hashtag is #CPI2011. The WellMed Care Companion Program: Selecting and Training Peer Mentors to Empower Patients. STFM AAFP Conference December 2011 Margie Gomez, RN, CCM, CDE Clinical Program Manager Cynthia Henderson, RN, CCM, Director – Clinical Programs

2. Objectives On completion of this session, Participants will: have the tools needed to determine if peer-to-peer mentoring is right for their clinic/community have the tools needed to determine if peer-to-peer mentoring is right for their clinic/community know what will be needed to bring a peer-to-peer mentoring program to their clinic/community know what will be needed to bring a peer-to-peer mentoring program to their clinic/community know how peer-to-peer mentoring might effect patient outcomes know how peer-to-peer mentoring might effect patient outcomes know how each individual involved plays an integral roll in a peer-to-peer mentoring program know how each individual involved plays an integral roll in a peer-to-peer mentoring program gain insight on how to train mentors in their community/medical setting gain insight on how to train mentors in their community/medical setting

3. Agenda Examples from a Diabetic Peer Mentoring Program Examples from a Diabetic Peer Mentoring Program –Overview –Implementation Selecting the best Mentor candidates Selecting the best Mentor candidates Training strategies Training strategies Some things to consider Some things to consider Questions/Discussion Questions/Discussion

4. Join the conversation! Our Twitter hashtag is #CPI2011. Program Overview – WellMed Medical Management and the Care Companions Program

5. WellMed Overview Founded in 1990 in San Antonio, Texas by George Rapier, MD Specialize in managing medical services for Medicare eligible patients Primary Care –34 Clinics in Texas and 4 in Florida –Serve more than 38,000 patients Patient-centered medical home approach Health Coaches in clinics for Self Management Support Group Education supported by a centralized team

6. WellMed Overview Mission Our name, WellMed, is a daily reminder of our objectives as a medical group. Our goals are to help the sick become well and to help patients understand and control their health in a lifelong effort at proactive wellness. Purpose To change the face of healthcare delivery for seniors by providing quality, proactive patient care with a focus on prevention.

7. Peers for Progress Grant Opportunity to enhance current Patient-Centered Medical Home model Opportunity to enhance current Patient-Centered Medical Home model Opportunity to reinforce our self-management support effortsOpportunity to reinforce our self-management support efforts WellMed was one of 14 grantees in 6 continents to evaluate the contribution of peer support in diabetes and to provide a model for peer support programs around the worldWellMed was one of 14 grantees in 6 continents to evaluate the contribution of peer support in diabetes and to provide a model for peer support programs around the world PartnersPartners –American Academy of Family Physicians –Latino Health Access (Orange County, CA) –Modeling Dr. America Bracho’s Carpeta Roja Program in our Senior population

8. Peers for Progress Grant Program Purpose Empower patients to become “managers of their own health and health care” Empower patients to become “managers of their own health and health care” Group dynamic develops during Diabetes 101 classes Group dynamic develops during Diabetes 101 classes Volunteers who have diabetes provide support to patient partners through mentoring activities Volunteers who have diabetes provide support to patient partners through mentoring activities

9. Why is Self-Management Support Important? Emphasizes the patient’s role and collaborative decision-making for healthEmphasizes the patient’s role and collaborative decision-making for health Professionals are experts about diseases, but…..Professionals are experts about diseases, but….. Patients are experts about their own lives!Patients are experts about their own lives!

10. Why is Peer Support Important? Individuals living with diabetes spend 8,900 hours a year outside of the health care environment and average only 6 hours per year with their health care provider. Peer-to-peer support programs can be an important resource for providing support during these out of clinic hours to improve individual self-management and healthy living skills Studies have found an almost 1 point reduction in HbA1c values for patients participating in peer-to-peer support programs

11. The Time Pyramid Family/community Peer mentors MAs Health Coaches MD Amount of time spent w/ patient

12. Getting Started Getting Provider/Clinic Buy-in Included clinic administration and staff in planning process Integrated program within familiar/existing processes (group classes, health coach identification, clinic volunteer program Initiated physician and staff “roll-out” meetings Added physician and staff dinner meetings with provider and patient testimonials and Dr. America Bracho from Latino Health Access

13. Implementation Offered Diabetes 101 Classes – 8 week courses conducted by diabetes educators Class participants were referred by provider and clinic staff Whenever possible, patients attended Diabetes 101 classes at their home clinic Class participants shared successes and challenges Support network evolved Potential Mentors within the group were identified for additional training Potential Mentees identified and invited to continue

14. Diabetes 101 Curriculum Developed as a combination of LHA’s Carpeta Roja curriculum and the WellMed Disease Management curriculum for diabetes Week 1 – What is Diabetes and Stages of Change Week 2 – Blood Glucose Monitoring Week 3 – Healthy Eating Week 4 – Meal Planning Week 5 – Medication Week 6 – Get Up and Move – Physical Activity Week 7 – Diabetes Complications Week 8 – Coping and Living With Diabetes

15. Mentor and Mentee Interaction Ongoing monthly support meetings Minimum contact 4 hours per month by Mentor Encounters between Mentor and Mentee are documented and tracked, as well as Mentor contact with community and family members Encounters focus on healthy eating, monitoring, reducing risk factors, problem solving, physical activity, goal setting, emotional support, encouragement and motivation

16. Lessons Learned Provider and Clinic Administration buy-in Feedback from patients for class improvements Direct referrals from Providers and clinic staff

17. Why It Works Support from peers address daily struggles Real-life examples based on common experiences Social and emotional issues discussed in deeper way Peers are accountable to each other Peers advocate and encourage each other

18. Program Staff Clinical Program Manager Communication with providers and clinic staff Implementation of program into new clinic sites Development and implementation of P&P Oversight of metrics and reporting Program evaluation and QI initiatives Staff training and development Oversight of budget, program expenditures

19. Program Staff 6 Clinical Educators Delivery of all classes and training Maintenance of curricula/modules Preparation of all class materials and handouts Identification and recruitment of Mentor and Mentees Continued support of Mentors –Monthly meetings –Ad hoc advice and guidance

20. Program Staff Clinical Program Coordinator Scheduling classes and coordinating logistics Maintenance of program calendar Scheduling patients into classes Scheduling background checks for potentials Mentors Liaison with clinics Data entry, metrics and reporting Submission of surveys for program evaluation

21. Preliminary Results Numbers at a Glance 15 clinics 9,297 Patients with Diabetes 485 enrolled in D101 53 Mentors 106 Mentees

22. Preliminary Results – Health Questionnaire Know what A1C is Know what individual A1C value is Improvement in A1C after 101? (self-reported on post surveys) Baseline51.2%36.4% PostD10192.8%79.4% Yes: 30.6% No: 13.4% Waiting for lab: 44.0% 6mosPost90.9%75.6% Yes: 54.1% No: 21.1% Waiting for lab: 14.4%

23. Preliminary Results – Health Questionnaire Days of testing blood sugar in last 7 days Days of high fat in last 7 days Days of five servings of fruit and vegetable in last 7 days Days of 30 minutes of physical activity in the last 7 days Days of planned exercise in the last 7 days Days checking feet in last 7 days Baseline5.05(2.57)2.97 (1.97)4.27 (2.27)2.87 (2.59)2.71 (2.55)5.12 (2.51) Post5.76 (2.03)2.62 (1.69)5.20 (1.74)4.12 (2.30)3.20 (2.56)5.72 (2.00) 6mos Post Mentee Mentor No Support 5.59 (2.11) 5.77 (1.12) 5.49 (2.04) 5.51 (2.58) 2.63 (1.74) 2.75 (1.92) 2.02 (1.44) 2.82 (1.70) 5.16 (1.75) 5.16 (1.89) 5.52 (1.50) 5.00 (1.74) 3.56 (2.40) 3.87 (1.97) 4.11 (2.17) 3.10 (2.42) 2.62 (2.46) 2.86 (2.57) 3.33 (2.48) 2.14 (2.31) 5.66 (2.07) 5.48 (2.18) 5.75 (1.89) 5.73 (2.10)

24. Our Diabetes Peer Volunteers at WellMed will be Called… WellMed Care Companions

25. Join the conversation! Our Twitter hashtag is #CPI2011. Selecting Mentors

26. Join the conversation! Our Twitter hashtag is #CPI2011. Selecting Mentors

27. The Model Strength Based Approach Basic skills same across the board Standardized processes, policies and procedures Defined Volunteer roles and responsibilities

28. Recruitment of Mentors Where do mentors come from? Planting the seed Inviting the mentor Stating expectations/purpose

29. Selecting the right Mentor Friendly Respectful Trustworthy Caring Compassionate Effective listener and communicator Responsible Willing to learn Characteristics to look for:

30. Considerations before training Background Check/Drug Check Clinic Orientation Volunteer Policy and Guidelines Safety Considerations Tracking Volunteer Hours Evaluation Tools

31. Conduct Needs Assessment What, Where, Who? –What is the business Goal? – end in mind –Where? - Training site –Who? – Who’s going to do the training?

32. Creating the Training Program Develop Learning Objectives –need to know, nice to know, where to go Plan the Activities – get them engaged Plan the Presentation – use images, colors, metaphors, stories, analogies, props, games, and food

33. Join the conversation! Our Twitter hashtag is #CPI2011. Training the Mentors 33

34. IT’S ALL ABOUT THEM

35. How do adults learn? Adults are independent, have accumulated experience Group activities –Activities are purposeful and participatory Empowering others Focus on similarities Connecting w/ a person’s strengths When learning can be applied to a variety of situations When treated with respect

36. Designing the Presentation Audience - Size and Age Time - 20 minute chunks - mix it up Set for Up for Success – Availability of material, equipment, resources and personnel

37. Tool Kit Props Story Telling Games Written Materials Evaluations Lectures

38. Examples of Training Activities Rhyme and Reason (Ice Breaker/ Communication) Interview and Introduction (Ice Breaker) Elephant in the Room (Communication) Robot (Communication) Fat and CHO (Nutrition) Label Reading (Food Labels) Problem Solving Health/Self Management Interviews

39. Comments from our Trainees Thank you! It was wonderful and so helpful. Wonderful - I'm pleased to be with WellMed Companions! What else can I do? Any cooking demos? Call me Please. I'm very happy I was referred by my Doctor to take this course. The best. Very rewarding. Wonderful! So excited. At this point, no improvements are necessary to course. It is perfect. Talking to the group about their complications was a good way to inform each other about our diabetes. Before this class I was not well informed, I will now keep track of my lab numbers.

40. Comments from our Trainees We interacted with each other to help understand the information. The family we became. A most instructive session with so much that I can use for me and others. It's like sharpening your tools before carpentry. I like the experience with the different mentors and learning all the experiences of everybody else. It feels like a big family knowing and discussing our diabetic issues.

41. CELEBRATE

42. Matching Mentors to Mentees Cultural Similarities/Influences Age Interests Needs Geographical Location Agreement

43. Lunch and Learn Purpose is to build esprit de corps across all mentors To support idea exchange among mentors Create a learning community of mentors Provide additional training on a variety of chronic disease issues Inspire, motivate and celebrate the mentors Obtain suggestions from mentors for improving the program.

44. Bottom Line It’s all about commitment! To provide the knowledge, skills and support that patients need to become managers of their own care. “The aim of education is not knowledge but action” - Herbert Spencer

45. Something to think about… What does the idea that patients spend 8,900 hours managing their own health vs. 6 in the health care practice mean for your patients? What are your own personal experiences dealing with these 8900 hours managing your or your family’s own health care challenges outside the health care setting? Are there things that helped you in navigating these 8900?

46. Questions to ask… What are the goals for the program? What is the goal of the organization? Is organization prepared to make the investment in resources? Training- commitment to do this Defining the community

47. What is the benefit for YOU? Provides and additional level of support Improved diabetes control – improved quality metrics and outcomes Better managed patients – reduced resource utilization Higher patient satisfaction – improved retention Utilizes peers in the patient’s community/environment

48. What can the right Mentor do? Things Mentors in Care Companions have done for their Mentees: Provide Support - listen Provide information Provide encouragement Taken to grocery store, helped in reading food labels, monitoring blood sugars, coached

49. WELLMED CARE COMPANIONS WELLMED CARE COMPANIONS “ People do not decide to become extraordinary. They decide to accomplish extraordinary things.” Sir Edmund Hillary

50. “Alone we can do so little; together we can do so much”. Helen Keller.