e-Solutions March 2014
Feature article: Self-Management Supports: The Ideal for Person-Centered Care
Grantee Feature: Center for Human Development
Quick Tips: 7 Self-Management Support Tasks for your Team
Featured Resource: Self-Management Resource Library
Defining self-management can be a bit of a complex conundrum. At the Self-Management Alliance, we’ve settled on a simple definition, where self-management encompasses tasks an individual must take to live well with one or more chronic conditions.
Self-management is about becoming an expert in “you” — understanding how you personally can best manage your goals and your triggers. Goals can sometimes focus on building upon strengths and sometimes on avoiding risks. It is about learning how to take care of your health during the 99% of time you are not in a doctor’s office.
A cultural understanding and focus on the use of self-management exists in the treatment of mental illness and substance use conditions. Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path to wellness. The integrated behavioral health workforce brings a tradition of building on people’s strengths to cope with adversity and adapt to change. Primary care providers are an important audience to share this self-management support approach with given their opportunities to reach individuals who are not activated or engaged in their health care.
Ultimately, self-management involves a complete reordering of the provider-client relationship. Just as creating an interdisciplinary team can be a struggle, adopting self-management supports can be an even bigger cultural shift.
Patient-Centered Medical Homes are well suited to bring a strong emphasis to self-management supports. Provider roles would focus on coaching, providing information, and problem-solving. Medical home practices must demonstrate a culture that recognizes individuals and families as core members of the care team and therefore fully informed partners in creating care plans.
At a conference recently, a physician told a story about an individual who wasn’t taking their recently-prescribed diabetes medication. It wasn’t until the physician took the time to problem-solve with the person that he found the reason for the compliance issues. The patient thought he had to inject insulin into his fingers, because that’s where you check your blood sugar. We can’t assume that people just know what to do; the care team must set aside time for patient education.
Even if healthcare providers had all the time, they would still have trouble reaching those who are not ready to self-manage their health. Self-management is about both an engaged client and an engaged provider. Health activation tools can help providers to measure the knowledge, skills, and confidence individuals have in playing an active role in their health. Providers then have a clearer picture of how to best use self-management supports.
A lot of decision-making support could be available for patients on their cell phone. With asthma, there are applications that monitor breathing patterns, and if you regularly monitor your breathing, you can know a day or two in advance of the likelihood of having an asthma attack. In behavioral health, these tools are still being developed and piloted. Together, technological decision support tools provide an opportunity to empower people to take preventative steps to improve their health and to reduce relapse.
Paraprofessionals, such as peer providers and community health workers, will be the backbone of the self-management support movement. We are heading towards a time when physicians are going to have panels of 5,000 patients, and only a small number — the most complex cases — will get a specialist’s attention. We need to move to a population health approach where we identify a stratification of who needs what and find the most appropriate member of the clinical team to help individuals meet those needs. Some people manage their care very well, and others need an enormous amount of help just to stay out of crisis. We can start by looking at low-hanging fruit —hospitalization or ER use — to begin to figure out how to cluster patients.
Integration is one of the most important things happening in healthcare right now. If you drill down to the core of person-centered care, it is about self-management supports. Whether it is patient education or technological tools, specific motivational support, groups, or one on one coaching — self-management should be at the heart of an integrated care system.
Jennifer Higgins, PhD, Health and Wellness Project Coordinator, Center for Human Development
The Center for Human Development in Springfield, Massachusetts implements self-management supports into every aspect of their integrated health program, starting with their organization’s culture to the way they provide treatment and offer enhanced wellness programs.
Long before their SAMHSA Primary and Behavioral Health Care Integration grant, CHD instilled a strong cultural philosophy among their staff and clients that the purpose of their services is to empower people to take charge of their own lives, to make their own choices, and to develop to their full potential.
As part of their integrated health and wellness program, they offer the Stanford Chronic Disease Self-Management Program. The program consists of six weekly structured workshops where people with different chronic health conditions attend. The program can be started at low cost, and CHD receives state-level reimbursement for each training they provide. Ultimately, the training is a way of self-sustaining their wellness programs.
Each week the program addresses different topics, including:
- Creation of a self-management action plan (focused on what a client wants to achieve), broken down into achievable steps
- Identification of techniques to deal with isolation, fatigue, and management of individual chronic diseases
- Development of realistic long-term fitness goals
- Education on appropriate exercise for maintaining flexibility, endurance, nutrition, and healthy eating
- Problem-solving and strategies to combat negative thinking
- Strategies for communicating and working successfully with your healthcare providers
CHD is making small modifications to best address the needs of individuals enrolled in the integrated care program. The sessions are co-led by a health professional and a peer. They also added more frequent breaks through the 2.5 hour sessions and more opportunities for participants to ask questions.
In addition to tracking key health indicators to evaluate health outcomes, CHD is also exploring how the self-management program affects client recovery goals and engagement with the agency’s other services. So far, participants in the self-management program have higher rates of participation in services like vocational programs, and show improvements in their recovery goals and social connectedness.
This type of intense program may not be appropriate for everyone, and health and wellness goals can be realized in other ways. For clients who choose not to participate in the program, health- and wellness-based self-management supports are being embedded throughout the organization. For example, they incorporate parts of the curriculum into health education resources disseminated to new patients as part of their initial intake/assessment. Employees are trained in motivational interviewing skills to help a larger portion of the organization work with clients on health goals. The program provides education resources on healthy eating and physical activities throughout the facility, and program staff focus on teaching clients how small changes in their health behaviors, like reducing the number of cigarettes, can improve fun activities like yoga and walking. CHD makes sure that health and wellness programs are active and visible in all parts of a community, holding activities in local YMCAs and recreational facilities, and bringing clients to the open groups that include the general public and other clinicians.
By focusing on self-management as a critical component of their wellness activities, CHD is identifying growing opportunities to work with community partners like public health and reducing the stigma of mental health by helping clients to live fully in the community.
Have an example of how your center embeds self-management support strategies into your services? Share your story, email firstname.lastname@example.org.
What can you do to operationalize self-management supports? Here are seven types of tasks (and related resources) to help you ensure self-management support is central to your service delivery.
- Introduce the concept of self-management support to clients and staff. Educate your team on the approach, provide resources or training such as those outlined on our Consumer Engagement page, and provide/display information for clients on self-management throughout your organization.
- Set visit agenda. The more time a visit can spend on self-management, the closer a provider can get to the ideal of person-centered care. Determine what the visit can focus on, including goal-setting and coaching, and what can be addressed before the visit begins.
- Collaboratively set goals. Goals should be set based on the individual’s interest and confidence in changing their behavior.
- Provide information and training to clients. Whether in wellness groups or through organized training programs such as Whole Health Action Management, Health and Recovery Peer or the Stanford Chronic Disease Self-Management Program, offer tools and support for clients to build self-management skills.
- Create an action plan. Work with individuals to set a reasonable plan for when, how, and where they can achieve their goals. The plan should list specific goals in behavioral terms, strategies to address potential barriers, and a follow-up plan.
- Link clients with system and community resources. What partnerships does your organization have or what resources exist in the community that can support individual health and wellness goals?
- Be proactive about follow up. This may include having peer providers, community health workers, and other staff check in on discussed goals and plans with clients in-between visits.
AHRQ’s Self-Management Support Resource Library helps providers teach people how to take informed responsibility for their own healthcare. Resources include 22 key change concepts and core competencies for delivery system design, decision support, clinical information systems, provider organizations, and the community. Tools include practice plans and a chart to organize staff roles and tasks.
The National Committee for Quality Assurance released updated 2014 Patient-Centered Medical Home standards, including heightened standards for behavioral health integration and collaboration with mental health and substance use providers.
Partnering with Community Health Centers on Outreach and Enrollment Activities provides tips for how organizations can partner with health centers on outreach and enrollment activities, how to help people learn more about affordable insurance options, and how to enroll through the Health Insurance Marketplaces.
The Practical Playbook supports increased collaboration between primary care and public health organizations by guiding users through the stages of integrated population health improvement. The guide provides success stories from across the country, lessons learned from existing partnerships, and guidance from industry experts.
Robert Wood Johnson Foundation’s Reducing Health Care Disparities: Where Are We Now? gives a general overview of healthcare disparities and identifies emerging perspectives, progress, and outstanding needs.
The National Behavioral Health Barometer provides data about key indicators of behavioral health problems including rates of serious mental illness, suicidal thoughts, substance abuse, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows these data at the national level, and for each of the 50 states and the District of Columbia.
Join Recovery to Practice on April 10 for The Role of Self-Management in Using Medications, a webinar to explore the topic of self-management and medication use. Recovery requires hard work on the part of both persons in recovery and practitioners, and practitioners will need to play an increasingly important role in educating people about their own role in their recovery and in supporting them in their efforts to manage their conditions and recover as fully as possible.