2. Partners in Care Foundation Self-Management Technical Assistance Center Supported by:

3. Partners in Care Who We Are Partners in Care is a transforming presence, an innovator and an advocate to shape the future of health care We address social and environmental determinants of health to broaden the impact of medicine We have a two-fold approach, creating and using evidence-based models for: health system practice change and enhanced patient self- management Changing the shape of health care through new community partnerships and innovations Partners in Care Who We Are

4. Health Self-Management Services Partners in Care Foundation Technical Assistance Center Licensing & Quality Assurance Data Entry & Management Training Communication Materials Coalition Administration Partnership Development New System Partners

7. HEALTHIER LIVING / CHRONIC DISEASE SELF-MANAGEMENT PROGRAM Program Overview

8. California Chronic Disease Self Management Education Workshops (2012-2015)

9. What is Self-Management? The actions that individuals living with chronic conditions must do in order to live a healthy life. Physical Activity Medications Decision Making Action Planning Breathing Techniques Understanding Emotions Problem-Solving Using Your Mind Sleep Communication Healthy Eating Weight Management Working with Health Professionals

10. Target Population People with at least one chronic condition – OR – A family member, friend or caregiver of someone with a chronic condition Stamina to attend 2 ½ hour session Cognitive function to participate

11. Self-Management Programs Chronic Disease Self-Management* Arthritis Diabetes HIV/AIDS Chronic Pain Tomando Control de su Salud (Spanish) Arthritis (Spanish) Diabetes (Spanish)

12. Healthier Living (CDSMP) Award-winning evidence-based program developed by Stanford University 12 -16 participants & 2 Trained Leaders People with different conditions or their caregivers  Six-week Program  2 ½ hours, one day a week  Includes:  Group discussions  Activities  Short lectures  Workshop Materials:  Healthier Living Book, Relaxation CD, & Charts

13. CDSMP Leader Training 4 day training (6-8 hours per day) Facilitated by two certified Master Trainers for groups of 10- 20 new leaders License from Stanford University is required to train or offer CDSMP

14. A note on CDSMP Leaders… Ideal Abilities/Values of a Leader: Has a chronic condition or life experience as a caregiver Possesses good listening skills, is non-judgmental Understands the importance and purpose of fidelity (following the curriculum) Possesses good communication and interpersonal skills Exhibits enthusiasm Is dependable and consistent Education or health care experience a plus Provide own transportation to workshop sites as scheduled Training Expectations: Ideally has attended a 6-week workshop Will attend 4-day training taught by 2 Master Trainers, 24 hours total Will facilitate a 6-week workshop within 6 months of training Will facilitate 2 or more 6-week workshops per year

15. PROGRAM ACTIVITIES & CONTENT

16. Session Structure Welcome Feedback & Problem Solving Activities & Education – Brainstorming – Discussion – Demonstration & Practice – Lecturette Making an Action Plan Closing

18. Week 1Week 2Week 3Week 4Week 5Week 6 Intro to Workshop & Group Introductions Feedback & Problem Solving Dealing with Difficult Emotions Making Decisions Better Breathing Making Health Food Choices Working with Health Care Providers & the Health Care System Pain & FatigueHealthy Eating Medication Usage Mind-Body Connection Weight Management Making Informed Treatment Decisions Getting a Good Night’s Sleep Physical Activity Endurance Exercise Commun- ication Looking Back & Planning for the Future Depression Management Preventing Falls RelaxationProblem Solving Positive Thinking Making An Action Plan

19. OUTCOMES & EVALUATION Participant Health & Healthcare Utilization Savings

20. Participant Health Outcomes CDC Meta-analysis of 20 studies show that CDSMP contributes to improvements in: Psychological status Physical health status Self-efficacy and Selected health behaviors Brady, Teresa J. Executive Summary of ASMP/CDSMP Meta-Analyses. CDC, May 2011. http://www.cdc. gov/arthritis/docs/ASMP-executive- summary.pdf

21. Participant Health Outcomes 2013 National Study found IMPROVEMENTS in: Ory, Jiang, Lorig, Laurent, Whitelaw, and Smith, 2013. 21% Depression 16% Managing Sleep Problems 13% Physical Activity 10% Fatigue Management 11% Pain Management 12% Medication Compliance 9% Communication with Physicians Reduction in ER and Hospital Stays, resulting in $714 of savings per person

22. Evaluation Attendance Log

23. Evaluation Cover Sheet

24. Evaluation Participant Questionnaires Session 1 and Final Session

25. Fidelity Monitoring http://patienteducation.stanford.edu/licensing/FidelityManual2012.pdf

26. MATERIALS & COSTS

27. Program Licensing Costs Sub-license from Partners in Care *prices subject to change Up to 8 workshops per year (Multiple Programs)$150 Up to 16 workshops per year (Multiple Programs)$300 Single-Program License Fees from Stanford *prices subject to change 30 or fewer workshops, 6 Leader trainings$500 90 or fewer workshops,12 Leader trainings$1000 Multiple-Program License Fees from Stanford *prices subject to change Up to 75 total workshops and 6 Leaders trainings$1000 Up to 120 total workshops and 12 Leaders trainings$1500

28. Training Requirements and Costs Attend a 4-day training taught by two Master Trainers Facilitate a 6-week workshop within six months of training Facilitate two or more 6-week workshops per year to maintain fidelity Leader Training Local Training – 4 full days$800 - $1600/person Stanford Training – 4 to 5 days$900 - $1600/person + Travel Costs

29. Workshop Materials and Fees Workshop Materials Price for one Number Needed for Workshop Total PriceOngoing Price Pencils $0.1020$2.00 Kleenex $1.491 Dry Erase & Flip Chart Markers $18.581 Workshop Charts Printing $97.001 Dry Erase Easel Pads (or White Board) $40.001 $40.00 or $0.00 Blank Easel Pads (paper) $23.001 Easels $74.992$149.98 Folding File Cart with wheels $24.991 CD Player $40.001 Book & CD $24.0020$480.00 TOTAL $877.04 $63.00

30. Other Potential Program Costs Volunteer Leader Stipends (optional) Food & Refreshments (optional) Mileage (as needed) Staffing  Program Coordinator ─ Schedule and coordinate workshops ─ Coordinate & Manage Fidelity Monitoring ─ Outreach and registration ─ Identify and support implementation sites ─ Collect data and reporting  Volunteer Coordinator ─ Recruit and orient volunteers ─ Provide volunteer appreciation ─ Monitor volunteers, provide fidelity checks

31. TITLE III-D Potential Models & Additional Considerations

32. Potential Ways to Move Forward Provide & Coordinate EB Programs Use IIID Funding to provide all or a portion of EBP Implementation in your Service Area – Contribute towards materials, licensing, leader stipes, etc. – Contract with Agency to serve as ‘Central Hub’ that administrates program & maintains a cadre of trained Leaders that travel throughout service area – Other Network Models

33. Additional Evidence-Based Programs PHYSICAL ACTIVITY Arthritis Exercise Program Walk With Ease MEDICATION MANAGEMENT HomeMeds FALL RISK REDUCTION A Matter of Balance DEPRESSION MANAGEMENT Healthy Ideas PEARLS CAREGIVER PROGRAMS Powerful Tools for Caregivers Savvy Caregiver

34. Creating Pathways to Health Develop referrals among/between evidence-based programs CDSME MOB Tai Chi Cartoon Images developed by Preston Blair. Source: https://cdn.tutsplus.com/vector/uploads/2013/12/cartoonmovements-18a.gif

35. *Program can be facilitated in Chinese, Portuguese, Vietnamese, and Russian. Research by the Roybal Center for Enhancement of Late-Life Function at Boston University Designed to benefit community-dwelling older adults who: Are concerned about falls Have sustained a fall in the past Restrict activities because of concerns about falling Are interested in improving flexibility, balance and strength Are age 60 or older, ambulatory ( able to get to a class) and able to problem-solve Class size 8-12 participants During 8 two-hour classes, participants learn: To view falls and fear of falling as controllable To set realistic goals for increasing activity To change their environment to reduce fall risk factors To promote exercise to increase strength and balance

36. WHAT PARTICIPANTS ARE SAYING

37. Testimonials “Because I have been afflicted with Parkinson’s for over 20 years, I have suffered a great deal of depression. The skills you've taught me in maintaining positive thinking and combating depression have really helped to improve my condition.” - John, age 69 “I found the interaction with the other students in the class to be most enlightening. I realized that although I have a chronic illness I am not alone. Thank you for all the lessons in helping me to deal with this.” - Suzanne, age 57 “The workshop put me back in charge of my life, and I feel great. I only wish I had done this sooner.” - Robert, age 68

38. Thank you! Dianne Davis, MPH, Senior Director Health Self-Management Services Partners in Care Foundation 818.837.3775 116 ddavis@picf.org www.picf.org WWW.CAHEALTHIERLIVING.ORG