Bounce Back: Reclaim your Health

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Bounce Back Reclaim your Health

• CMHA National Conference
• August 2008

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Grant Overview

• 6M awarded from BC Ministry of Health to CMHA
  BC Division in March 2007
• Purpose to build capacity within the community
  sector to provide mental health support to
  primary heath care patients with focus on those
  living with chronic physical disease and chronic
  pain.

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Grant Overview cont.

• Ministry of Health Primary Health Care Investment
  in Community Agencies
• Alzheimers Society 1 million
• Arthritis Society 1 million
• Heart and Stroke Foundation 2.5 million
• Healthy Heart IMPACT BC 5 million
• Canadian Mental Health Association
• 6 million

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BC Ministry of Health

• Role of mental health in overall health
  importance of community sector in responding.
• Subsequent shift of CMHA BC Division to meet the
  need of patients with chronic illness who have
  mild moderate low mood and depression.
• Opportunity to join the dialogue in primary
  health care

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Leadership

• Minister of Health
• Ministry of Health Primary Health Care Staff
  Val Tregillus
• Primary Health Care Planning Table
• Leads from each health authority and BCMA
• Other Reforms
• New funding formula for physicians
• GPSC Mental Health Advisory Committee
• Practice Support Program

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Project Advisory Commitee

• Members represent Ministry of Health, Regional
  Health Authorities, Patient with Chronic Illness,
  IMPACT BC, BC College of Family Physicians, UBC
  Dept of Family Practice, GPSC, UVic
  Self-Management program, etc

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Objectives

• To develop community capacity to deliver
  low-intensity CBT-based interventions and
  self-help for patients with chronic
  illness/chronic pain experiencing
  anxiety/depression, contributing to
• Improved emotional well-being and quality of
  life,
• Better engagement in disease management
  activities,
• Improved health outcomes,
• Fewer complications resulting from chronic health
  conditions, and
• Reduced use of hospital and/or emergency
  departments.

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Effective Self-Help

• Based on principles of CBT
• Guided better than pure self-help
• Similar effects for professional versus
  paraprofessional coaching
• Guidance in the form of monitoring and support
  sufficient
• From Gellaty et al. (2007). What makes self-help
  interventions effective in the management of
  depressive symptoms? Meta-analysis and
  meta-regression. Psychological Medicine 1-24.

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Key Features

• Immediate access to some form of intervention
• Support for primary care practitioners
• Coaching not counselling or therapy
• Protocol driven

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The Program

• Based on the work of
• Dr. Chris Williams at
• the University of Glasgow
• and Dr. Patrick McGrath at
• Dalhousie University

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The Five Areas Approach

• Developed by Chris Williams at the University of
  Glasgow
• Accessible, practical product line addressing
  anxiety and depression
• Living Life to the Full DVD
• Self-help workbooks including self-assessment
  module (language used is the most accessible of
  commonly offered CBT self-help books)
• Web-based versions
• Lower literacy booklets

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The Interventions

• Living Life to the Full
• DVD adapted for BC
• Distributed directly through PHC practitioners
• Suitable as a first-line intervention
• Provides psychoeducation and basic self-help
  strategies
• May be sufficient for some patients

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The Interventions (Contd)

• Guided Self-Help
• Structured self-help program with telephone
  support
• Utilizes Overcoming Depression, Low Mood and
  Anxiety workbooks
• Modular approach
• Negotiated targets for change
• Maximum 3 to 5 telephone sessions
• Requires referral from PHC provider

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The Individuals in Bounce Back

• Health Authorities
• Physicians
• Patients/participants - with at least one chronic
  physical health condition and depression, low
  mood or anxiety who have a regular family doctor
• CMHA Coaches
• CMHA Division Team

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Eligibility Criteria

• Adults aged 19 and older
• Experiencing mild or moderate symptoms of
  depression or depression and anxiety (score
  between 5 and 19 on the PHQ-9)
• Not cognitively impaired
• At a least a grade 6 literacy level
• Have a telephone
• No severe symptoms or suicidal ideation
• No alcohol/drug misuse
• No history of bipolar disorder or psychosis

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Branch Responsibility

• Determine extent of local demand/need
• Partnerships between HA, CMHA, IHNs, or other
  group practices, community partners
• Mechanisms for communication, planning and
  roll-out

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Coach Responsibility

• Encourage patients to use materials and retain a
  focus on established goals
• Offer guidance on which workbooks may be most
  helpful
• Help tackle obstacles in the materials
• Assist participants practicing what theyre
  learning
• Review progress and reinforce skills

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Allocation of coach time

• 80 time on patient services and 20 on community
  liaison and educational events
• Telephone delivery with group delivery possible
  where appropriate
• Estimated annual patient volume approx 400 to
  500 cases
• 2 hours per week to case consultation with
  registered psychologists

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Quality Control

• Oversight of coaching provided by CBT specialists
  including weekly group consultation sessions,
  review of recorded telephone sessions with
  patients, and routine individual feedback
  sessions.
• Bi-weekly meetings of Branch Executive Directors
  and BB Team.
• ED monitoring and management of the program and
  supervision of the coach are shared by BC
  Division and branches.
• Different functions within one position (i.e.
  Coach) are accountable to different parties.

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Phased Roll Out

• Phase 1 June/July 2008
• (Kamloops, Salmon Arm, Vernon, Kelowna, 100 Mile
  House)
• Phase 2 October/November 2008
• (White Rock/South Surrey, Victoria, Mid/North
  Island, Cranbrook, Prince George)
• Phase 3 February/March 2009

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Current Developments

• Working on cultural adaptation
• Early stages of evaluation with Evaluators
• Preparing for Phase II III
• Scope creep and responding to growing demand from
  various communities