Peer-Delivered Health Self-Management: Development and National Implementation of Whole Health Action Management (WHAM)

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Peer-Delivered Health Self-Management
Development and National Implementation of Whole
Health Action Management (WHAM)

• Judith A. Cook
• University of Illinois at Chicago Medical Center
• Sherry Jenkins Tucker
• Georgia Mental Health Consumer Network

Presented at University of Illinois at Chicago,
State-of-the-Science Summit on Integrated Health
Care Chicago, IL October 17, 2014
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Supported in part by the University of Illinois
at Chicago National Research and Training Center
on Psychiatric Disability and Co-Occurring
Medical Conditions through funding from the U.S.
Department of Education, National Institute on
Disability and Rehabilitation Research and the
Substance Abuse and Mental Health Services
Administration, Center for Mental Health
Services, under Cooperative Agreement Number
H133B100028.

• Acknowledgement of Funders

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Todays Agenda

• Welcome and Introduction
• What is WHAM?
• WHAM Implementation
• Outcomes
• Sustainable Funding

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Whole Health Action Management, known as WHAM, is
a peer-led intervention to activate whole health
self-management in community mental health
centers, federally qualified health centers,
health homes, and Veterans Administration
programs.
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• More than 1700 peers in 25 states have
  participated in the WHAM training delivered by
  the National Council for Behavioral Health.
• The Georgia MH Consumer Network has trained 334
  Georgia Peer Specialists to become Whole Health
  and Wellness Coaches using WHAM.
• WHAM is also available in Spanish.

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WHAM Core Beliefs

• People cannot be forced or coerced to change
  their unhealthy life-style habits PSWHR training
  needs to be voluntary
• Participants must acknowledge having health
  issues they wish to address.
• People are more likely to create a healthier
  life-style when the focus is on their interests,
  strengths, supports what they see as possible
  PSWHR training helps people focus on what they
  want to create in their lives, not on what they
  need to change.
• People find it easier to create new habits than
  to change old ones PSWHR training focuses on
  creating new habits or disciplines on a weekly
  basis, monitoring how well they are doing, and
  accepting support from their peers.

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WHAM 5 Keys to Success

• A person-centered goal built on 10 evidence-based
  whole health and resiliency factors
• A weekly action plan that breaks the goal into
  small, achievable successes
• A daily/weekly personal log
• One-to-one peer support
• A weekly WHAM peer support group

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IMPACT Planning Process

• Helps peer identify a whole health goal that
• Improves health quality
• Is Measurable
• Is Positively stated
• Is Achievable
• Calls forth actions
• Is Time limited
• Weekly Action Plan breaks goal into small steps
  achievable in 7 days (eat 2 servings fruit 3 X
  week)
• Confidence Scale (0none, 10total) allows peers
  to rate whether they can complete the step that
  week

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WHAMs 10 evidence-based health and resiliency
factors

• Stress Management
• Healthy Eating
• Physical Activity
• Restful Sleep
• Service to Others
• Support Network
• Optimism Based on Positive Expectations
• Cognitive Skills to Avoid Negative Thinking
• Spiritual Beliefs and Practices
• Sense of Meaning and Purpose

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Relaxation Response

• Taught as an essential resiliency tool
• Can attenuate the stress-induced, fight-or-flight
  response.
• Counters unremitting stress that can negatively
  impact genetically vulnerable areas of our bodies
  to promote mind/body illness and premature death

(Benson et al., 1974, Lancet)
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Optimism Based on Positive Expectations -
Resiliency Research

• 15-year study of 2,800 patients who had undergone
  coronary angiography at Duke University Medical
  School
• Found that patients with positive expectations
  about recovery were 27 less likely to die from
  heart disease over the next 15 years, controlling
  for confounds like disease severity depression

(Barefoot et al. 2001, Arch Intern Med)
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Randomized Controlled Trial Study of WHAM
Study Collaborators
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Random Assignment to One of Two Conditions

• PSWHR delivered by Certified Peer Specialists in
  Georgia and Illinois
• Services as Usual plus a health manual and a 25
  gift card to use toward pursuing a health goal

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Initial Study Findings

• 100 percent reached their whole health goal
  (N24)
• From baseline to 3-month follow-up, participants
  reported sig. increases in hopefulness sig.
  decreases in bodily pain (plt.05)
• 78 very satisfied 22 somewhat satisfied w
  WHAM (N9)
• 100 liked getting support from peers (N9)
• 89 very satisfied, 11 somewhat satisfied w
  group mtgs (N9)
• 89 reported improvement in their whole health,
  11 percent reported whole health about the same
  (N9)
• 100 liked programs focus on a simple health
  goal (N9)
• Average of 3.8 health conditions, most common
  were hypertension, asthma, arthritis (N9)

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WHAM in the State of Georgia
Skilled Workforce
Individual Need
Sustainable Mechanisms (Funding,
Billing) Billable Service
WHAM
Lived Experience Peer Certification Health
Skills Training
(Tiegreen, 2014)
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Want to find out more?

• For information about WHAM
• http//www.integration.samhsa.gov/health-wellness/
  wham
• For information about GA MH Consumer Network
• http//www.gmhcn.org/ACG/index.html
• For information about the UIC Center
• http//www.gmhcn.org/