1. 1 Agenda 1.Introductions & Sharing Learnings (75 mins) Hand out evaluation forms at beginning of session 2.Yellow Flags & Mental Health Tools (30 mins) Break (15 mins) 3.Community Resources (30 mins) Describe local community resources and how teams can collaborate with them How to collaborate with your community to integrate changes 4.Sustainability (45 mins) Identify ways to sustain changes in practice 5.Wrap up and evaluations (15 mins)

2. 2 Faculty/Presenter Disclosure Faculty’s Name: Speaker’s Name Relationship with commercial interest: -Grants/Research Support: PharmaCorp ABC -Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd -Consulting Fees: MedX Group Inc. -Other: Employee of XYZ Hospital Group

3. 3 Disclosure of Commercial Support This program has received financial support from [organization name] in the form of [desribe support here – e.g. educational grant] This program has received in-kind support from [organization name] in the form of [describe the support here – e.g. logistical support] Potential for conflicts(s) of interest: -[Speaker/Faculty name] has received [payment/funding, etc.] from [organization supporting this program AND/OR organization whose products are being discussed in this program]. -[Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program. [Enter generic and brand name here].

4. 4 Mitigating Potential Bias [Explain how potential sources of bias identified in slides 1 and 2 have been mitigated]. Refer to “Quick Tips” document

5. 5 5 Report increased confidence in supporting patients that experience chronic pain Reflect on his/her delivery of Pain tools and develop a process improvement plan Learning Objectives – LS 3

6. 6 6 Yellow Flags

7. The information presented here is taken entirely, without any content modification from: Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition). Suggested steps to better early behavioral management of low back pain problems Psychosocial Yellow Flags: Helping Someone at Risk

8. 8 8  Psychosocial indicators suggesting risk of progression to long-term distress, disability and pain  Designed for acute low back pain  Can be applied more broadly to assess development of persistent problems Medical Practice Guidelines: Hunter Integrated Pain Services, Updated Nov. 2005, New Zealand Yellow Flags

9. 9 9  Can relate to patient’s behaviour, attitudes, emotions, beliefs, family and workplace  Behaviour of health professionals can also have a major influence Yellow Flags

10. 10 Key Factors:  Belief that pain is harmful or severely disabling  Fear-avoidance behaviour  Low mood and social withdrawal  Expectation that passive treatment rather than active participation will help Yellow Flags

11. 11 Mental Health

12. 12 Mental Health Algorithm

13. 13 Cognitive Behavioural Interpersonal Skills (CBIS) Manual

14. 14 Problem List

15. 15 Resource List

16. Activation Daily activities Energize Small goals Problem solving Chunking time Improving mood Self supportive

17. Cognition Changing behaviour Changing thinking Changing feeling

18. Relaxation Benefits Stress management Breathing Grounding Relaxation Mindfulness Meditation

19. Lifestyle Sleep Nutrition Substances Exercise Wellness

20. Navigating the Skills Manual Three ways to begin: Problem list action plan Symptoms Self-assessment questionnaire

21. Problem List Action Plan No job – I’m too old to retrain ACTIVATION RELAXATION COGNITION LIFESTYLE MEDICATION REFERRAL No job – job coach Bankruptcy – debt counselling I feel tired all the time Tired all the time I don’t want to do anything Irritable – tense Drinking more coffee Having a few beers Not interested in seeing friends I overreact I feel like a failure – I’ll never get a job Stay up late watching TV Sleeping during the day Arthritis – pain Arthritis – Bounce Back

22. Flow Chart Healthy Habits For Sleeping, pg 68 It’s True: You Are What You Eat, pg 69 Physical Activity, pg 71 The Wellness Wheel, pg 72 Anti-Depression Activities, pg 31 Depression’s Energy Budget, pg 32 Small Goals, pg 34 Problem Solving, pg 36 Opposite Action Strategy, pg 37 Chunk The Day, pg 38 Improve The Moment, pg 39 Appreciation Exercise, pg 40 ACTIVATION LIFESTYLE

23. Flow Chart NEGATIVE THINKING COGNITIVE DISTORTIONS COGNITION MODULE The Circle Of Depression, pg 42 Common Thinking Errors, pg 44 Thought Change Process, pg 45 Self Talk (Mean Talk), pg 47 Thought Stopping, pg 48 Good Guilt / Bad Guilt, pg 50 Is Anger A Problem For You, pg 54 PANICKY RELAXATION MODULE Abdominal Breathing, pg 57 Grounding, pg 58 Passive Relaxation, pg 61 Mindfulness, pg 64

24. Self-assessment Questionnaire 0 = never or rarely true to me; 1 = somewhat true; 2 = quite a bit true; 3 = very true of me 1.____ It’s hard for me to say no to people even if I don’t want to agree or don’t have the time or energy 2.____ I will do almost anything to avoid hurting people’s feelings, whatever the cost to myself 3.____ I do lots of things for others, even at the expense of meeting my own needs

25. Flow Chart ACTIVATION MODULE Anti-Depression Activities, pg 31 Depression’s Energy Budget, pg 32 Small Goals, pg 34 Problem Solving, pg 36 ACTIVATION OVER-THINKER PROFILE ASSESSMENT MODULE Over-thinker Profile, pg 24 RELAXATION MODULE Abdominal Breathing, pg 57 Grounding, pg 58 Passive Relaxation, pg 61 Mindfulness, pg 64 PANICKY

26. 26 “Is there anything you would like to do for your health in the next week or two?” Brief Action Plan “How confident (on a scale from 0 to 10) do you feel about carrying out your plan?” “Would you like to check in with me to review how you are doing with your plan?” Behavioral Menu If Confidence <7, Problem Solve Barriers Follow-up Elicit a Commitment Statement SMART Behavioral Plan

27. 27 BounceBack

28. 28 Antidepressant Skills Workbook