Engaging ConsumersEngaging Consumers

PanelistsPanelistsDr. Robert Freeman, St. Vincent’s Services and Dr. Robert Freeman, St. Vincent’s Services and

Tony Trahan, NYS OMHTony Trahan, NYS OMHwith Celia Brown and with Celia Brown and Dr. Anthony Salerno Dr. Anthony Salerno

NYS Office of Mental Health NYS Office of Mental Health

IntroductionIntroduction St. Vincent’s ServicesSt. Vincent’s Services Wellness/Recovery OrientationWellness/Recovery Orientation Engaging ConsumersEngaging Consumers

Shared decision making & motivational interviewingShared decision making & motivational interviewing Conversations about coping & how to talk about Conversations about coping & how to talk about

medicationsmedications Questions for consumers to askQuestions for consumers to ask Webinar Q&AWebinar Q&A

Setting the StageSetting the Stage

Wellness and Recovery OrientationWellness and Recovery Orientation

St. Vincent’s ServicesSt. Vincent’s Services

Wellness Center Initiative IdeasWellness Center Initiative Ideas Fitness DayFitness Day Heart Healthy ClinicHeart Healthy Clinic Cholesterol/Lipid Screening DayCholesterol/Lipid Screening Day Blood Glucose LevelsBlood Glucose Levels Trendy TopicsTrendy Topics

Wellness PerspectiveWellness Perspective Learning about recovery and what it can

mean for you Fostering hope in wellness rather than Fostering hope in wellness rather than

maintenancemaintenance Start with consumers goals and hopes, not Start with consumers goals and hopes, not

with their symptomswith their symptoms Fostering a healthy lifestyleFostering a healthy lifestyle Resources: Wellness Self-Management Resources: Wellness Self-Management

WorkbookWorkbook

Wellness Self-Management Talking Wellness Self-Management Talking PointsPoints

Making the best use of your mental and physical health services

Staying well by decreasing symptoms of a mental health problem

Learning how to manage day-to-day stress and prevent relapse

Staying well by connecting with others Staying well by living a healthy lifestyle Recognizing and building on your cultural values and

experiences to support your personal recovery

*Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, *Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.

Engaging ConsumersEngaging Consumers

Shared Decision Making Shared Decision Making Motivational InterviewingMotivational Interviewing

Shared Decision MakingShared Decision Making

Institute of Medicine’s Rules for Patient-Institute of Medicine’s Rules for Patient-Centered CareCentered Care Customize patient needs and valuesCustomize patient needs and values Patient is the source of controlPatient is the source of control Shared knowledge and free flow of Shared knowledge and free flow of

informationinformation Need for transparencyNeed for transparency Anticipation of needsAnticipation of needs

Motivational InterviewingMotivational Interviewing

What is Motivational Interviewing?What is Motivational Interviewing? The Principles of Motivational InterviewingThe Principles of Motivational Interviewing

Express empathy Express empathy Develop discrepancy Develop discrepancy Avoid argumentation Avoid argumentation Roll with resistance Roll with resistance Support self-efficacy Support self-efficacy

Principles of MIPrinciples of MI Express empathyExpress empathy

Goals are to build trust & supporting clientGoals are to build trust & supporting client Active and reflective listeningActive and reflective listening

Develop discrepancy Develop discrepancy Clarify client’s goals that are both feasible and healthyClarify client’s goals that are both feasible and healthy Identify steps to reach goalIdentify steps to reach goal

Avoid argumentation Avoid argumentation focus on discrepancy, or ambivalence, within the focus on discrepancy, or ambivalence, within the

client's thinking vs. discrepancy between the client client's thinking vs. discrepancy between the client and the counselorand the counselor

Principles of MI cont.Principles of MI cont. Roll with resistance Roll with resistance

If a client doesn't want to go in a certain direction, If a client doesn't want to go in a certain direction, don’t fight it/roll with itdon’t fight it/roll with it

Encourage the client to explore all the possible Encourage the client to explore all the possible answers to his own questions and concerns answers to his own questions and concerns

Support self-efficacy Support self-efficacy Demonstrate optimism and belief in the client's ability Demonstrate optimism and belief in the client's ability

to change to change Help client achieve success on small, realistic goalsHelp client achieve success on small, realistic goals

Engaging ConsumersEngaging Consumers

Conversations about CopingConversations about Coping Talking about MedicationsTalking about Medications

Conversations about CopingConversations about Coping

Coping with StigmaCoping with Stigma Coping with StressCoping with Stress

Identifying personal stress triggersIdentifying personal stress triggers Strategies for preventing stressStrategies for preventing stress

The illusory quest for chemical balanceThe illusory quest for chemical balance Coping with Side Effects of MedicationCoping with Side Effects of Medication

MedicationMedication

Recovery vs. Maintenance (Pat Deegan)Recovery vs. Maintenance (Pat Deegan) Any changes can create some anxiety Any changes can create some anxiety

which can be used for positive changewhich can be used for positive change How to discuss side effects with How to discuss side effects with

consumers –(refer to NMHA brochure)consumers –(refer to NMHA brochure) Resources: Wellness Self-Management: Resources: Wellness Self-Management:

Personal Workbook and National Mental Personal Workbook and National Mental Health Association brochures (NMHA)Health Association brochures (NMHA)

Medication Discussion PointsMedication Discussion Points

Purposes of Medication*Purposes of Medication* Reducing current symptomsReducing current symptoms Reducing the chances of having symptoms in Reducing the chances of having symptoms in

the futurethe future FDA oversight and current issuesFDA oversight and current issues

AntidepressantsAntidepressants

*Wellness Self-Management: Personal Workbook (January 2008), NYS *Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.Andrew Cleek, Psy.D.

Medication Discussion Points cont.Medication Discussion Points cont.

What is a cross taper?What is a cross taper? Risks and benefits of medicationRisks and benefits of medication

Side effects (NMHA brochure)Side effects (NMHA brochure) Effective use of medicationEffective use of medication

Making an informed decisionMaking an informed decision Identifying barriers to effective useIdentifying barriers to effective use Strategies to overcome barriersStrategies to overcome barriers

St. Vincent’s ServicesSt. Vincent’s Services

Medical Staff MeetingsMedical Staff Meetings Needed changes discussed at every meetingNeeded changes discussed at every meeting Involve each medical staff memberInvolve each medical staff member Risk management and liability assessmentRisk management and liability assessment

ToolsTools Medical/Psychiatric Assessment MonitorMedical/Psychiatric Assessment Monitor Chart Review FormChart Review Form Wellness Materials and TipsWellness Materials and Tips

SVS: “Medicalize” Office SpaceSVS: “Medicalize” Office Space Media: bulletin boards, literature displays, Media: bulletin boards, literature displays,

internetinternet Forms: family medical history, symptom Forms: family medical history, symptom

checklist, compliance tool, medication checklist, compliance tool, medication consents & side effectsconsents & side effects

Tests: physical exam, labs, consultsTests: physical exam, labs, consults Keeping appointments “on time”Keeping appointments “on time” Able to be reached to discuss problems Able to be reached to discuss problems

with medicationswith medications

SVS: Issues/Approach for SVS: Issues/Approach for Successful Medication ChangeSuccessful Medication Change

Engage consumer around problems of Engage consumer around problems of medicationmedication

Development of medical/psychiatric special Development of medical/psychiatric special review formreview form

Change through the prism of lifestyle Change through the prism of lifestyle enhancementsenhancements

Non-compliant or is something else happening?Non-compliant or is something else happening? Concept of medical traumatic stress disorderConcept of medical traumatic stress disorder EncouragementEncouragement

Questions for Consumers to AskQuestions for Consumers to Ask NMHA “Fostering a Dialogue for Recovery” brochure – NMHA “Fostering a Dialogue for Recovery” brochure –

how doctors can enhance communication with how doctors can enhance communication with consumers (consumers (http://www.mentalhealthamerica.net/go/dialogueforrecovhttp://www.mentalhealthamerica.net/go/dialogueforrecoveryery for resources) for resources)

http://http://www.fda.gov/Drugs/ResourcesForYou/Consumers/defauwww.fda.gov/Drugs/ResourcesForYou/Consumers/default.htmlt.htm for questions for consumers to ask about medications for questions for consumers to ask about medications (Food and Drug Administration)(Food and Drug Administration)

http://www.aacap.org/cs/root/facts_for_families/talking_thttp://www.aacap.org/cs/root/facts_for_families/talking_to_kids_about_mental_illnesseso_kids_about_mental_illnesses for parents to talk about mental illness with their children for parents to talk about mental illness with their children (American Academy of Child and Adolescent Psychiatry)(American Academy of Child and Adolescent Psychiatry)

Webinar Q&AWebinar Q&A

Please feel free to type any questions you Please feel free to type any questions you may have regarding any of the topics we may have regarding any of the topics we

discussed today. discussed today.

Thank you for your participation.Thank you for your participation.

SummarySummary

Thanks to panelists and participants.Thanks to panelists and participants.PSYCKES website will be updated for your PSYCKES website will be updated for your

reference.reference.PSYCKES-PSYCKES-Help@omh.state.ny.usHelp@omh.state.ny.us for any for any

additional questions or comments about additional questions or comments about today’s webinar. today’s webinar.