Wellness: eSolutions, September 2011
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
Feature Article: Whole Health, Wellness, and Resiliency Domains Promote Prevention
Grantee Profile: Trilogy, Inc — Bon Appétit!
Quick Tips: Five Simple Ways to Encourage Wellness among Patients
HHS Launches Million Hearts
Special Prevention Section
Larry Fricks, Deputy Director, CIHS
September 19-25 is National Wellness Week, a perfect time to ask, “What is wellness?” A vague term that may mean different things to different people, wellness is not something to take lightly. For many, it is one of life’s pillars, and has enormous influence on self-directed whole health and quality of life. In the context of behavioral health and primary care integration, CIHS promotes wellness as a personal awareness of creating a healthy lifestyle, understanding its role in mind-body resiliency and disease prevention.
“Resiliency” is a term usually associated with “bouncing back.” However, as science-based resiliency factors become better known, our understanding of its centrality to prevention grows. A key concept in healthcare reform, prevention is essential to people living with addictions and mental illness who can die decades before the rest of the population because of often preventable and untreated chronic illness such as diabetes, obesity, and heart disease aggravated by poor health habits, such as smoking and poor nutrition, and social determinants like poverty.
CIHS built upon existing research and information to develop 10 whole health, wellness, and resiliency domains. These domains are meant to inform patients and primary care and behavioral health providers as they develop treatment goals that address the “whole person” and promote prevention through resiliency. The 10 domains include:
- Stress management. Prolonged stress has an undeniable adverse effect on health. It can — and does — lead to illness. It can also precipitate relapse, both in mental illness and in addiction. The ability to reduce and/or counter stress is critical in dealing with behavioral health problems, as well in promoting health and wellness.
- Healthy eating. Most people have some idea of what foods are healthy, and understand that eating more calories than you use leads to weight gain. Developing personal eating habits that promote better health is important for everyone, especially people who have, or are at risk for, health problems like diabetes, heart disease, and high blood pressure. In the context of some chronic illnesses, eating healthy becomes vital to prevention and recovery.
- Physical activity. Exercise and other forms of physical activity not only help maintain a healthy weight, but also help improve overall health and behavioral health — and reduce stress, a daunting provocateur of poor health and wellness.
- Restful sleep. Getting adequate sleep is more important than many people realize. Long-term sleep deprivation is associated with many illnesses, including high blood pressure, heart attack, stroke, obesity, and behavioral health problems.
- Support network. Human connections — either through ensuring a robust “support network” or providing “service to others” — are integral to health and wellness. People with strong social ties have much lower rates of disease and premature death than those who feel isolated and alone. Living in isolation not only increases cellular wear and tear, but also paves a highway to super stress.
- Service to others. “Service to others” and “support network” are two sides of the same coin. We all need connectedness to survive. It’s no surprise that service to others and support networks play a major role in initiating and sustaining recovery.
- Optimism based on positive expectations. Personal hope that one’s life can be better encourages happiness and a sense of wellbeing. In fact, research has found that heart patients with optimistic recovery expectations are 30% less likely to die over the next 15 years than less optimistic patients, regardless of disease severity.
- Cognitive skills to avoid negative thinking. Whereas “optimism based on positive expectations” is based on attitude toward the future, “cognitive skills to avoid negative thinking” have to do with attitude toward oneself. A person increases their chance at happiness by telling his or her self a more positive story, rather than a miserable one. As Health Consultant and Writer Martha Beck stated, “Your situation may endanger your life and limbs, but only your thoughts can endanger your happiness.”
- Spiritual beliefs and practices. Spiritual beliefs are tremendously personal, and spirituality means something different to everyone. For some, spiritual beliefs are clear and concrete, and spiritual practices translate into specific religious rights, rituals, and ceremonies. For others, spiritual beliefs are vague and more mysterious. Regardless, for many, spirituality, meaning, and purpose are inseparable, and spirituality involves seeking meaning and purpose.
- A sense of meaning and purpose. Many people develop a sense of meaning and purpose through spirituality, ultimately converging a person’s beliefs and values. This sense of meaning and purpose helps a person weather life’s storms.
Caregivers — whether primary care, behavioral health, or peer support — are in an ideal position to educate people about wellness and resiliency, and the importance of both in prevention. People with addictions and mental illness must include wellness and resiliency in their overall treatment goals to achieve recovery, better health, longer life, and a greater sense of wellbeing.
For more information on wellness, visit CIHS.
CIHS provides training and technical assistance to the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration grantees. Each issue of eSolutions profiles a grantee’s work.
What’s cooking at Chicago’s Trilogy, Inc.? What isn’t! The Roger Park community behavioral healthcare organization has introduced a variety of wellness and healthy living activities for their clients, and has a pipeline full of new initiatives. The agency recently started the successful “Healthy Eating on a Budget,” which teaches enrolled participants about nutrition, portion sizes, grocery shopping, and budgeting so they can implement pragmatic changes into their lifestyle.
The success of Healthy Eating on a Budget has led to the development of another class, “Making Healthy Cooking Easy,” in which participants who have finished the first course (pun intended) will learn firsthand how to prepare and cook healthy meals. While Trilogy has encountered some barriers to beginning the program (e.g., finding an appropriate space, supplies, transportation), it is now prepared to start the ongoing class in November. In addition, the organizations plans to add another component – a community garden – to the mix, where consumers will help grow, tend, and reap the food that they will then cook and eat.
For more information on Trilogy’s health and wellness initiatives, visit www.trilogyinc.com and for more information on SAMHSA’s PBHCI Grant Program visit CIHS.
“What a great idea — we should do that!” “If we had the money, that would be a great program.” “I’d love to have a program like that at our clinic.” Ever said one of these phrases? Well, when it comes to wellness, there are simple ways to promote it among your patients without facing financial or clinical hurdles. Here are 6 ideas:
- Encourage patients to know their ABCs (A1c, blood pressure, BMI, and cholesterol levels). The National Council for Community Behavioral Healthcare developed ABCs of Wellness: Facts and Tips for Whole Health to encourage patients in primary and behavioral healthcare settings to prevent or improve chronic conditions like heart disease, obesity, and diabetes that are often associated with behavioral health problems. You can print the fact sheets and share with patients and others in your community.
- Start an informal, open “Wellness Chat” once a week. Have a staff member or nursing student run the event using a Q&A format and host it in a communal area where people already congregate. Trilogy, Inc. in Chicago started one called “Rush Hour,” run by Rush University nursing students. The informality puts participants at ease to discuss topics that they may not bring up with providers.
- Post wellness tips in communal spaces and exam rooms where people will read them often and internalize the concepts. Glenn County Health Care Collaborative developed a series. Check them out.
- Put a dispenser of SPF 50 at your center’s front desk with fliers or wallet cards that offer ways to prevent skin cancer. In that same vein, place a bowl of individually wrapped gum at the front desk, each affixed with the number for a tobacco quit line.
- Get involved in SAMHSA’s 10x10 Wellness Campaign to promote wellness and increase life expectancies for people with mental health and substance use problems by 10 years, in 10 years. The campaign provides myriad materials for you to use in your community.
- Replace three items in your vending machines, like soda, chips, and candy, with healthy alternatives such as water, nuts, and juice.
For more information or technical assistance, visit www.centerforintegratedhealthsolutions.org or call 202.684.7457.
The U.S. Department of Health and Human Service, launched Million Hearts, an initiative that aims to prevent 1 million heart attacks and strokes over the next 5 years.
Million Hearts is focused on two goals:
- Empowering Americans to make healthy choices such as preventing tobacco use and reducing sodium and trans fat consumption. This can reduce the number of people who need medical treatment such as blood pressure or cholesterol medications to prevent heart attacks and strokes.
- Improving care for people who do need treatment by encouraging a targeted focus on the "ABCS"—Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation—which address the major risk factors for cardiovascular disease and can help to prevent heart attacks and strokes.
"Heart disease causes one of every three American deaths and constitutes 17 percent of overall national health spending," said HHS Secretary Kathleen Sebelius. "By enlisting partners from across the health sector, Million Hearts will create a national focus on combating heart disease."
Cardiovascular disease, diabetes, and obesity are associated with mental illness, and treatment of the mental illness can reduce the effects of these disorders. Up to 83 percent of people with serious mental illness are overweight or obese, and 44 percent of the U.S. tobacco market is composed of individuals with a mental or substance use disorder. All too often, after overcoming an addiction or mental illness people with these disorders suffer from premature morbidity and mortality as a result of poor diet, and lack of exercise and primary prevention services.
Building on SAMHSA’s work to promote wellness, the Agency has committed to aligning all available resources to support improved outreach and provision of comprehensive health care to people with mental and substance use disorders.
Visit the website for further information on the public and private support of the Million Hearts initiative, and to access cardiovascular disease risk assessment tools.
Coordinated Care for Homeless Populations
Date: September 22, 12:00-1:30
Presenters: Health Care for the Homeless and behavioral health providers
Approximately 46% of America’s homeless have a mental illness, and when substance abuse is accounted for, the number skyrockets. This webinar will feature services available through community behavioral health and Health Care for the Homeless providers. Participants will learn best practices in integrated settings and hear examples of integrated partnerships that work. Visit www.centerforintegratedhealthsolutions.org to register.
Visit www.centerforintegratedhealthsolutions.org regularly for updates and registration.
Check out recordings and presentations for recent CIHS webinars:
Brief Behavioral Health Interventions in Primary Care
Recorded: September 14, 2011
Presenters: Parinda Khatri, PhD, director of integrated care, and Ken Mays, MD, director of primary care services, Cherokee Health Systems
Brief behavioral health interventions in primary care offer clinicians a viable option to improve the health of patients with both behavioral health and general health needs. This webinar discussed evidence-based brief behavioral health interventions for common conditions seen in primary care offices and the rationale and framework for brief interventions, as well as shared real-life applications.
Establishing Smoking Cessation Initiatives in Health Centers
Recorded: August 15, 2011
Presenters: Chad Morris, PhD, director, Behavioral Health & Wellness Program, University of Colorado; Bettie Blackmon, FNPC, family nurse practitioner, Primary Care Providers for a Healthy Felciana, Inc.
Healthcare providers fully comprehend the impact of tobacco use on health. However, expanding scope of services to include smoking cessation can seem burdensome. This webinar outlined the importance of tobacco control strategies in integrated care settings and provided practical strategies for implementation, including evidence-based clinical and administrative solutions. The speakers highlighted how to establish smoking cessation initiatives utilizing your existing workforce within regular day-to-day operations. The webinar also highlighted how tobacco prevention and cessation services align with quality improvement strategies.
Person-Centered Health Homes
Recorded: May 16, 2011
Presenters: Chuck Ingoglia and Larry Fricks, CIHS
This webinar provided an overview of the history and components of the person-centered Health Home model, including whole health and inclusion.
Introduction to Effective Behavioral Health Service Delivery in Primary Care Settings
Recorded: June 1, 2011
Hosted by: National Association for Community Health Centers, a CIHS subcontractor
Presenters: Dr. Alexander Blount, Dr. Miguel Olmedo
Looking for clarification on the differences between co-located behavioral health services and truly integrated care? This webinar provided an introduction for clinicians in Community Health Centers and Community Behavioral Health Organizations interested in evidence-based practices for integrating behavioral health into primary care.
THIS WEEK: National Wellness Week: September 19-25
It’s National Wellness Week, part of SAMHSA’s Recovery Month. The inaugural theme is “Living Wellness.” People with mental health and substance use disorders may die decades earlier than the general population, mostly because of preventable medical conditions. SAMHSA — in partnership with the Food and Drug Administration’s Office of Women’s Health — has created the 10x10 Wellness Campaign to promote wellness and increase life expectancies for people with mental health and substance use problems by 10 years, in 10 years. Visit www.10x10.samhsa.gov for more information and to get involved.
HRSA Announces New FQHCs, Includes Two PBHCI Grantees
HRSA has awarding 67 community health organizations with $28.8 million to establish new health service delivery sites, crowning them “FQHCs.” Two PBHCI grantees were among the chosen: Alaska Island Community Services and Southeast, Inc. The grants will enable these health centers to serve the community as full service delivery sites that provide comprehensive healthcare services, including behavioral healthcare. FQHCs are critical to improving the health of underserved and vulnerable Americans and decreasing health disparities, and they are an important player in healthcare integration.
CMS Launches New Integrated Care Resource Center for States
The Centers for Medicaid and Medicare launched the Integrated Care Resource Center. The resource is intended to help states learn about best practices for delivering coordinated healthcare to individuals receiving Medicaid benefits, including those with chronic conditions and eligible for both Medicare and Medicaid (“dual eligibles”).
CDC Reports New Mental Health Findings
Twenty-five percent of U.S. adults reported having a mental illness in the previous year, according to the new Centers for Disease Control and Prevention report that calculated the national burden of mental illness based on countrywide surveys. Mental Illness Surveillance Among Adults in the United States, a supplement to the September 2 Morbidity and Mortality Weekly Report, includes a variety of findings from CDC surveillance systems. CDC has also finalized a mental health action plan to be released soon.
Mental Illness Linked to Increased Tooth Loss
A new study published in the September 2011 issue of the British Journal of Psychiatry found that patients with a serious mental illness are three times more likely to lose their teeth due to poor oral health compared to the general population. The research was conducted at the University of Queensland.
NIMH Director Posts New Blog on Mortality and Integration
NIMH Director Tom Insel posted a poignant new entry to his blog, “No Health Without Mental Health,” that discusses mortality data and the importance of primary and behavioral healthcare integration.
Primary Care Providers to Converge on Integration and Medical Homes
The National Center for Primary Care at Morehouse University will host the 11th Annual Primary Care and Prevention Conference in Atlanta on September 22-23, 2011. This year’s conference theme is “Integration of Behavioral Health and Primary Care in the Patient Centered Medical Home.” For additional details or to register, visit www.primarycarematters.org.
Training Curriculum Address Psychiatrists’ Role in Integration
Through support from CIHS, the AIMS Center at the University of Washington has developed a training curriculum, “Integrating Mental Health and Primary Care: Practical Skills for the Consultant Psychiatrist,” to teach psychiatrists about their role in integrated behavioral health. The first presentation will occur on October 29, 2011 in San Francisco during the 2011 Institute on Psychiatric Services. Among other ambitions, the training will identify the major components of the IMPACT model of care; identify the basic skills necessary for the primary care psychiatrist; and highlight how to scale IMPACT to meet the needs of healthcare reform. For additional information, visit www.psych.org/ips.
Taking a Cue from Communicable Disease Advocacy
Ron Manderscheid, PhD, Executive Director, National Association of County Behavioral Health and Developmental Disability Directors
As summer heat gives way to cool fall breezes, dialogue around the future of disease prevention and health promotion has grown no less incendiary. On one side are those advocating prevention and health promotion as a panacea for stemming the growing tide of chronic non-communicable diseases (NCDs) — mental illness, diabetes, high blood pressure, heart disease; on the other side are those who see prevention and promotion as a category where financial cuts can save healthcare dollars. Who is right?.
HIGHLIGHTED REPORT: Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
Preventing Mental, Emotional, and Behavioral Disorders Among Young People updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing special attention on the research base and program experience with younger populations that have emerged since that time. Read more.
When Adults Don’t Seek Help, Mental Health First Aid Can Help
Adults are reticent to discuss depression symptoms with primary care professionals, according to a recent study published in the Annals of Family Medicine — and interventions that encourage patients to talk to their physicians about depression are essential to prevention and early intervention efforts.
Mental Health First Aid improves identification and ensures appropriate intervention until a person receives specialty treatment. Find out how CIHS is using this program to prepare primary care professionals.
To receive this newsletter and other CIHS e-mail updates, click here to enter your e-mail address and select “News from the SAMHSA-HRSA Center for Integrated Health Solutions” from the options listed.
Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.centerforintegratedhealthsolutions.org, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; Editor, eSolutions: Heather Cobb
The SAMHSA–HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.