Transcript Depression & Anxiety Intervention

Session # B4b
October 12, 2013
Depression & Anxiety
Intervention
Christine Garcia, BA, Research Assistant
Rachael Meir, PsyD, Director of Health and Wellness Services
Rachel Speer, LCSW, Behavioral Health Clinician
Marisa Taylor, LPC, Behavioral Health Clinician
Collaborative Family Healthcare Association 15th Annual Conference
October 10-12, 2013 Broomfield, Colorado U.S.A.
Faculty Disclosure
We have not had any
relevant financial relationships
during the past 12 months.
Learning Assessment
A learning assessment is required for CE credit.
Presenters Will:
Incorporate audience interaction through a
brief Question & Answer period during or at the
conclusion of our presentation.
Objectives
• Identify benefits of telephonic counseling as an
adjunctive treatment for depression and anxiety
• Explain specific skills and techniques taught by this
counseling intervention
Overview
• Introduction to Telephonic Counseling
• Past Research
• Current Practice
• Specific Interventions
• Case Presentation
• Conclusion & Future Directions
• Q&A
Telephonic Counseling
Intervention Benefits:
• To provide adjunctive treatment for the reduction of
anxiety and depression symptoms
• To provide counseling to populations that may
experience many barriers to participating in
traditional treatment
• To be a cost-effective intervention
Benefits: Enhancing Treatment
Our overall aim is to enhance PCP’s treatment of
depression and anxiety by:
(1) Providing evidence-based psychotherapy
(2) Improving adherence to antidepressant medications
(3) Improving depression and anxiety outcomes
(4) Identifying previously undiagnosed psychiatric
comorbidities
(5) Providing feedback to PCPs on depression and anxiety
outcomes, skills learned, and other recommendations
Benefits for Patients
Telehealth benefits patients by:
☺Eliminating need for transportation and childcare
☺Increasing access to care through lower costs,
provider availability, extended coverage to
underserved populations and underserved
geographical regions.
☺Reducing stigma associated with being seen in a
mental health clinic
☺Facilitating willingness to disclose personal
information
Benefits for Healthcare Institutions
Telehealth allows institutions to offer
more cost-effective care by:
• Lowering costs of administrative and
reception personnel, waiting areas, and
patient care rooms.
• Reducing problematic no-show rates
Research
DH conducted a depression study from 2009-2013, including 300 participants…
Control Group:
Enhanced Usual Care (EUC)
 Psychiatric assessment
 3 outcomes monitoring calls
Experimental Group:
Telephone Counseling (TC)
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Psychiatric assessment
3 outcomes monitoring calls
Behavioral Activation Therapy
Medication adherence
monitoring
 Relapse prevention counseling
Findings:
*TC had statistically significant
reductions in levels of
depressive symptoms at 6, 12,
and 24 weeks
*TC had increased depression
remission rate at 24 weeks
Steps in Treatment
1.
2.
3.
4.
5.
6.
7.
Referrals & Outreach
Consent, Disclosures, Initial Assessment
Patient chooses 3 module topics
Complete module calls
Final call: Self-Care Plan
Update providers about patient’s progress
Research assistant tracks progress
Referrals & Outreach
Referrals:
• Self
• PCP
• Other Staff
• Pharmacy
Outreach:
Highlights include:
• free service
• how it benefits the
patient
• module choices
• can opt-out at any time
• monetary incentive.
*English and Spanish
Initial Assessment
PHQ-9 to assess
Depressive
Symptoms
GAD-7 to assess
Anxious Symptoms
Mini International
Neuropsychiatric
Interview (M.I.N.I.)
to assess additional
diagnoses
Module Choices
Patients can chose
at least 3 call topics
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Getting Going
Grief and Loss
Healthy Eating
Healthy Relationships
Improve Sleep Patterns
Manage Stress Better
Mind Tricks for Pain
Overcoming Illness
Physical Activity
Positive Thinking
Problem-Solving
Worrying Less
Our Database
Anxiety Module: Call 1
Anxiety Module: Call 1
Anxiety Module: Call 1
Belly Breathing Activity
(Audience participation recommended!)
More Skills
Guided
Imagery
Motivational
Interviewing
Progressive
Muscle
Relaxation
CBT
Pacing
SelfManagement
Action Plan
Gate
Control
Theory
DEAR MAN
Sleep,
Eating,
Exercise
Habits
Last Call: Self-Care Plan
Updating the PCP
Our practices:
– Emails to PCPs at initial enrollment, and 6, 12, and 24 weeks,
including symptom severity, medication recommendations, and
comorbidities
– Enter notes into medical records
• 80.5% of PCPs noted reviewing our emails and/or medical
record notes
– Provide recommendations for PCPs to reinforce patient
goals/skills learned
– Encourage three-way communication between PCP, telehealth
clinician, and patient
– Schedule follow-up appointments with PCPs if needed
Tracking Progress:
Reduction in Depression Scores
Tracking Progress:
Reduction in Anxiety Scores
Patient Testimonials
“I feel she really cares. When you have a sickness like cancer, everybody cares
about you but when you have a mental illness, people flee and run away. So
when you find somebody who really cares, it gives you that positive
boost. I’m a private person so how she got me to talk about my feelings is a
miracle.”
“If it wasn’t for her, I don’t know where I’d be.”
“I’ve met with other people before and they were so stuffy and used big words
and I didn’t feel comfortable. It’s hard for my feet to get goin’ and I like that I
don’t have to go anywhere to talk with her.”
“I don’t know if it’s the deep breathing exercises or the medication or talking
with her but I have noticed a definite positive change.”
Case Study
• Demographic
• Presenting problem
• PHQ-9/GAD-7 scores
• Module work
• Skills learned
• Outcome
• PHQ-9/GAD-7 scores
Future Directions
FUTURE
Trauma work
Interactive
videos
Motivational
texts/emails
Sustainability
Conclusions
♥ Enhances depression and anxiety treatment
♥ Benefits to patient & healthcare institution
♥ Evidenced-based treatment
♥ Future developments & applicability
Questions & Comments
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!