1. Adult Mental Health Module
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Adult Mental Health Module
An Organized Approach to Mental Health Issues in Realistic Time
Learning Session 3

2. Housekeeping
Please put cell phones on vibrate or turn them off. Washrooms are here and there.
We’ll be taking a _______coffee break at ________
Lunch will __________

3. Welcome and Agenda Learning Session Activities Sharing experiences
Report from coach
More on CBIS skills (including SAQs)
Cultural modifications of CBIS
Physician and Advocate perspective
Break
Sustainability and improvement tips
Community Resource Café
.Sustainability plan
Wrap up, evaluations

4. Sharing our experiences
We have the next 20 minutes to hear from you about your action period
At your table Use these 6 questions to help you give us your feedback
After a spokesperson from each group will summarize key points and one burning question.

5. Questions to consider How are you using the tools?
Which have you found most valuable?
Has your prescribing pattern changed?
Any changes in patient visits? What are your patients saying?
Impact on MOA?
Burning question(s)?
Post small group discussion, spokesperson from each group will summarize key points and one burning question.

6. Participant Feedback CBIS Skills

7. Participant Feedback ASW

8. More on using the CBIS Tools
Or digging for clues…

9. Use of SAQ’s Click on SAQ and profile for anxiety
I use this for someone with a lot of anxiety when I have not got the time to really assess them. It is a quick resource to set up a short term goal in helpful behaviour for someone with anxiety and eg is a worrier or avoider or hard driver. I will go through the check list and confirm first if the profile applies to them, and they are then self-selecting which improves their buy in to the strategy. I will let them pick 3 strategies from the list of 6 to choose from, note of these in the management plan and check up with them in the next appointment.
The SAQ for depression can be used similarly. I use this for someone with depression when I have not got the time to really assess them. It is a quick resource to set up a short term goal in helpful behavior for someone with depression and eg is an over thinker. I will go through the check list and confirm first if the profile applies to them, and they are then self-selecting which improves their buy in to the strategy. I will let them pick 3 strategies from the list of 6 to choose from, note of these in the management plan and check up with them in the next appointment.

10. CBIS Skills Practice 3 different skills with a partner
Try one of these
Daily activities
Self talk mean talk
Grounding
Sleep hygiene
Abdominal breathing page
Anxiety-system wide explosion
Mindfulness
In reality you will rarely use all the tools on one patient. Most likely you will be selective and will choose your tools flexibly. Click on CBIS skills. Choose a partner, and choose 3 out of the above skills for practice. Follow the one page handouts exactly… they take you through the implementation easily. No study is required. Just choose your favourites. Remember the CBT education handout of the circle of depression. You decide when you need it to introduce CBT.

11. Common Steps to Using All Options
Identify appropriate case: PHQ9, GAD-7, DSM. PL, PLSP, SAQs
Bipolar? Possible comorbid confounders? Do the DAI
Explain the CBT Model – CBIS, ASW, Anxiety equation and explain SSM
Lets put it together. There are the common steps for all options CBIS, ASW or BB
First identify the appropriate case with the PHQ 9 and Gad-7 confirmed by the DSM. Next, perhaps Use the DAI, to pin down comorbid disorders you also need to pay attention to.
Then explain the Depression model using either the CBIS or ASW handout that explains the circle of depression or the anxiety equation that explains the model for anxiety…You could even use the SAQs relating behavior and thinking to depression or anxiety. Explain SSM- that this about a partnership with you coaching them in the use of skills that’ll help manage their depression and/or anxiety.
adult-mental-health/tools-resources 

12. CBIS Cultural Approaches
Work is being done to develop a location for the various cultural modifications to CBIS to help deliver the module to those populations.
At the present time we have
CBIS Indigenous Approach
Various translated but not modified CBIS manuals in Farsi, Punjabi, Korean, Chinese.

13. Dr. Egan’s Family Doc Perspective
How this module changed my life
Video of Frank

14. Perspective

15. Break
Teacup pig reminds us to have a break

16. Tips for Sustainability
(introduce yourself if you haven’t already presented). Acknowledge the completion of the module/series, and the trying of tools in practice.
It’s been our experience at PSP that if we don’t continue to support trying new things in practice, you will go through the process of learning, trying, even liking what you are doing, but not really figuring out how to make it the new norm.
Regional Support Team Coordinators/Coaches are available to help sustain change in a practice. This resource encourages / problem solves / connects / listens / reminds and sends gentle nudges.
No matter how valuable the information learned at the sessions, it’s recognized that as soon as you get back to your offices, reality and responsibilities take over. This is why you have some protected time now to think about how you can sustain this work
Add a personal story if you have one

17. Tips for Sustainability
The ability of something to be maintained at length without interruption
Derived from the Latin word “Sustinne” : to Hold
Read the slide…. The word Sustainability comes from the latin word “Sustinne”; to hold, and is defined as “the ability of something to be maintained at length without interruption”
In preparation for coming here today and over the past x months, along with visits and reminders from your coordinator, payment incentives, a general belief in the tools, or just needing a new resource, you’ve spent some time doing a few things…….. Trying the tools……….. and figuring out a workflow process for your practice
What you have actually been doing without realizing it is a series of PDSAs…… Plan…. Do …..Study…..acts to determine a few things……..
The validity of the tools as you see it
Your patient outcomes, responses, opinions, and progress
The tool accessibility and ease of use
And… what supports you need
You actually went through a PDSA series….seeing what worked, what didn’t work….uncovering the unexpected, studying some outcomes, and making adjustments around things, Such as:
The appt length
Appt time
Your approach to the patient
The pt response
The accessibility of the tools
AND incorporating this work into your EMR.
Throughout the process you would arrive at decision points, where you could either to give up or try again. The support and incentives etc, compels you to continue…. If you gave up, you would be exactly where you were when we met (month of LS1).
This what we at PSP call “quality improvement”.

18. Bike ride Improvement Ramp
Plan: Ride my bike to work
Done!!
Attempt # 3
Attempt # 2
Check google for bike time
Got poncho/glasses
Brought shampoo
Find straighter route
Leave earlier
Fix bike
Stretch
Leave early
Take clothes/shower at work
Attempt # 1
On time!!
Felt good!!
I Can do this!
Get up
Get ready
Get bike Go
Rain/wind
Forgot soap
Still late
Too many hills
This slide shows a basic improvement ramp around a plan to ride a bike to work.
The Quality Improvement process at its basic level is a series of Attempts, Studies, Tweaks, and Re-attempts of a plan, thought, concept or idea.
But what even makes us bother to re-attempt??? Easy!!!
The importance….. The thing that will be better!!
The series of re-attempts is what we call the improvement ramp
This slide shows an improvement ramp around riding a bike to work….. The importance is listed
Reduced gas
Reduced wear/tear on your car
Reduced weight
Improved health
Reduced car services
All good reasons that could easily be forgotten if we don’t consider the unanticipated- the triggers that make us go back to the way things were before such as
rain, being late, getting sweaty, a rusty bike, no soap, getting stiff and many others
This is why importance plays a big role in sustainability,
You came here back in (month of LS1) because something was important (pick from list or name others)
Learning about new resources for your patients
Improving your patient experience when in crisis
Improving your staff confidence in supporting a patient in crisis
Reducing follow up appts- from weekly to 1 or 2 times a month to improve your access for other patients
Reducing the appt length- your typical appts are probably 15 minutes and we know a patient in crisis will probably take up more than that time- resulting in a very busy day
Developing a proactive plan with your patients- increasing their ability to self- manage- we heard about Brief action planning in session 2 – helping your patients set goals- you can also set your sustainability goals using brief action planning
These good reasons, and along with measurement., are the best way to prove that this stuff works! If you attach baseline measures to some items on your “importance” list, seeing the trend towards improvement is very helpful.
For presenter…….below is the thought process around the 3 attempts…to be incorporated if needed.
These are all really good important reasons for a plan. What is missing in the plan is anticipation of what can go wrong.
In the bike ride example, I set off on attempt # 1 Where the plan was to ride my bike to work with no major thought involved, except to get up… get ready… get the bike….and GO!!!!
Well, as you can imagine some stuff happened, I was late, sweaty, my bike was rusty and was rusty and stiff.
Do I give up or refine my plan? This is when then I go back to why this is important.
So I make some changes, get my bike fixed, leave early, take clothes, and plan to shower at work.
Things improved, but more stuff happened; it was raining and windy, I forgot soap and there were too many hills.
Do I give up? Hopefully not because of why this was important.
So in my 3rd attempt I get googles and a poncho, I check google for a straighter, less hilly route, I check distance and time, and leave earlier.
Eventually everything works, and I reach enlightenment. I have proven to myself based on why it is important that you can ride a bike to work!
I was late
I was sweaty
Bike was rusty
I was stiff
Always go back to why is this important!
Get exercise
Save on gas & wear/tear on car
Contribute to carbon footprint
Promote exercise/wellness in community
Lessen traffic flow by one car…

19. What is your proof that this stuff works???
My communications with Mental Health and Addictions will improve
My income will increase
My patients will progress and respond to my approach
My MOA will have an enhanced role and a workflow in place
My appointments will be faster
Some of my patients may not need to see psychiatry
My appointments will be proactive
Every time you get a new plan, idea, tool or concept think about….
The importance
The improvement it will bring
Your baseline measure
….. Make a plan and give it a try!
If it doesn’t prove its worth right away, ask yourself why it didn’t work and actually study the reasons! Tweak your process, make slight changes and try again because of the importance. It takes multiple attempts to make a habit.
The model for improvement asks 3 questions:
The first is….. What are you trying to accomplish/achieve?
In this case at a high level: proactive care for your patients with Mental Health conditions
The 2nd questions is….. What changes can you make that will result in an improvement? ….. Well you are doing it….. You can attend a mental Health module and learn some new tools and resources to help you accomplish # 1
The 3rd question asks….. How will you know if what you did resulted in an improvement? Well… it could be any of these things listed or the ones I said earlier….. Or something else you are thinking about right now…..
You will know when the important things happen….
This stuff takes time but at the end is very valuable for your patients and your practice.
How will you know that what you are doing is an improvement???

20. Tips for Sustainability
Remember why you thought this was important
Remember what worked, what you liked, your quick wins
Remember your role in planning how to make this work in practice
Tips for Sustainability
Think of what your expected outcomes will be, pick 3 things
The tips are simple:
Remember why you thought this was important. Remember what you wrote down in session 1 on your plan sheet, or perhaps there are other reasons?
Remember what worked, didn’t work and your quick wins. We heard today about a lot of great wins from (name the coordinator and other presenters and discuss what they said)
Remember your role in planning. How to access the tools, which patients to engage, how to structure your appointment, how your team will help you.
Determine your expected outcomes for each tool. They don’t have to be many, even just 3. Think of just 3 things that will prove to you that the tool works and study the results over time.
Use some of the tools you used for your planning, do some brief action planning, set goals, and use the problem list and resource list. Write down the problems that you face in caring for your patients and then indicate the resources available to you. Hopefully these tools and resources will be on the list.
If you believe in the use of the tool because it has met your expectations, you will “hold it” as the definition says. When things are falling into place, your outcomes are materializing, your measures are improving, then you will be able to sustain the use of the tools, much like continuing to ride the bike to work.
If it has not met your expectations, remember it for another time or when you are ready. You may come across a patient or a situation in which that tool might be the perfect resource.

21. Community Resource Cafe
Sharing of Resource knowledge in small groups

22. Plan Your Pathway Survey - barriers, desires Orientation to Algorithm
Review use of MH Log Sheet
Location of tools on algorithm
Confirm use of EMR
Ongoing Support
CME
Post Module Reflective Questionnaire (mid-March)
Confirm patient population
Locate tools on algorithm
Begin trying out tools
Review use of MH Log Sheet
Confirm MOA role
Billing questions/tech assistance
Review Log Sheet progress
Use of DAI
Use of other resources
Discuss optimal office flow (include MOA)
Pre-visit
AP1
AP2
Sustain
Check date in sustainability section!!!
Month 0
Month 7-8
Overview of aims, CBIS, ASW
Bounceback and practice finding the tools (Scavenger Hunt)
Log sheet/AP requirements
Billing and EMR optimization
Develop an action plan
Share experiences (good & bad) w peers
DAI role play
Use of tools
Log sheet/AP requirements
Update action plan
Share experiences
Community Resource Cafe
Troubleshoot issues for sustainability & improvement
Sustainability Plan

23. Thank you
As you know the GPs get CME credits for this module, Main Pro C and Main Pro M1 23