keeping the body in mind: a lifestyle intervention …...keeping the body in mind: a lifestyle...
TRANSCRIPT
Keeping the Body in Mind: A lifestyle
intervention program for people with
Severe Mental Illness.
Andrew Watkins
On Behalf of Keeping the Body in Mind (KBIM) team
South East Sydney Local Health District
Clinical Nurse Consultant, Clinical Lead KBIM Team
PhD Candidate, University of Technology, Sydney
Equally Well Symposium, March 2019 @iphYs_YMH
Keeping the Body
in Mind YMH
https://www.seslhd.health.nsw.gov.au/keeping-body-mind
iphys.org.au
Research evidence
evidence
implementation
THE
ROLLOUT
EXTENDING THE KBIMPROGRAMME DISTRICT WIDE
4 CENTRES IN SESLHD
KoSiM
PHASED
IMPLEMENTATION OF
KBIM PROGRAMME
Bondi
Sutherland
St George
KBIM TIMELINE
2013
KBIM initial evaluation for
FEP clients
KBIM teams employed
- 9 clinicians- 3 peer
workers
2014
KoSiMWave 1
Phase 1 rollout:
FEP clients
KBIM Maroubra employed
2016
KoSiM Wave 2
Phase 2 rollout:
Clozapineclients
Phase 3 rollout:
LAIclients
20172015
Projects:-y-QUIT;
-headspace Active;-OSA;
-oral health;-peer health
coach
2018
kg
Months 12 240 4836
Established psychosisRCTs
Established PsychosisRCTs
10
5
20
15
12 kg
4 kg
3 kg
Alvarez-Jimenez et al; CNS Drugs, 2008
Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal
First episode of psychosis RCTs
NEUTRALITY
WAIST (CM) PRE AND POST KBIM
INTERVENTIONN = 67
86
87
88
89
90
91
92
93
Male Female TotalBaseline Follow-up
↓ 1.20cm p=0.41
↓ 1.36cm p=0.10
↓ 1.31cm, p=0.07
KBIM TIMELINE
2013
KBIM initial evaluation for
FEP clients
KBIM teams employed
- 9 clinicians- 3 peer
workers
2014
KoSiMWave 1
Phase 1 rollout:
FEP clients
KBIM Maroubra employed
2016
KoSiM Wave 2
Phase 2 rollout:
Clozapineclients
Phase 3 rollout:
LAIclients
20172015
Projects:-y-QUIT;
-headspace Active;-OSA;
-oral health;-peer health
coach
2018
Overview – What is KoSiM?
A brief staff physical health intervention delivered by a CNC, dietitian and exercise physiologist.
WHY?
Create a shift in organisational culture towards one that is inclusive of physical health
Enable mental health staff to confidently address the physical health needs of consumers
Give staff an understanding of the role of EPs and dietitians in mental health.
(n=212)
Qualitative feedback
Working with consumers
Family
Personal health improvements‘I now know how to have basic conversations about
food with my clients which in the past I got stuck at’‘My doctor called me in after
my blood tests… He said all of my results had improved and
asked me what I was doing differently!’
Workplace culture
Morale
Productivity
‘The environment changed completely, because there’s more people around taking
care of themselves’
‘I really, really value that NSW Health gave us the
opportunity, a perk in the job is just marvellous…It is, hard
to come by’
KBIM TIMELINE
2013
KBIM initial evaluation for
FEP clients
KBIM teams employed
- 9 clinicians- 3 peer
workers
2014
KoSiMWave 1
Phase 1 rollout:
FEP clients
KBIM Maroubra employed
2016
KoSiM Wave 2
Phase 2 rollout:
Clozapineclients
Phase 3 rollout:
LAIclients
20172015
Projects:-y-QUIT;
-headspace Active;-OSA;
-oral health;-peer health
coach
2018
NEEDS ANALYSIS
301 on LAI & 416 on Clozapine
64% 36%
Mean Age ~ 44 years
Primary diagnosis – schizophrenia or schizoaffective disorder
7% ATSI
CARDIOMETABOLICRISK FACTORS
Cardiometabolic Risk Factor LAI Clozapine
Overweight or Obese (BMI) 75% 80%
Waist Circumference at RiskMale (mean, SD)Female (mean, SD)
79%105cm, 17.0102cm, 19.4
85%109cm, 16.6 104cm, 17.7
High Risk of Type 2 Diabetes 65% 68%
Smokers 62% 44%
Metabolic syndrome 43% 58%
• Diet
• PhysicalAssessment
• Behaviour change
• Self management
• Goal setting
Health Coaching
• Practical life skills
• Social connection
• Self esteem
Group
THE PROGRAM• Clozapine and LAI clients
• 12 weeks
SITE PARTICIPATION
Total
First timers 133
Repeats 64
Total 197
0
10
20
30
40
50
60
< 35 35 to 44 45 to 54 55 to 64
Age Category62% 38%
• Waist reduction ↓ 1.9cm
• Sit time ↓ 5.9 hours per week
• Food and drink energy intake ↓ 17%
• Carbon Monoxide score of participating smokers ↓ 16.8ppm (71% reduction)
COMPLETERS RESULTS
would suggest the program to someone else
“Everyone was spot on, thank you for your help.”
“You got me out of the house, thank you KBIM.”
“I liked we had some people in group each week as I got to
know them.”
“I have so much more energy now- I never want to go back to how I was.”
KBIM TIMELINE
2013
KBIM initial evaluation for
FEP clients
KBIM teams employed
- 9 clinicians- 3 peer
workers
2014
KoSiMWave 1
Phase 1 rollout:
FEP clients
KBIM Maroubra employed
2016
KoSiM Wave 2
Phase 2 rollout:
Clozapineclients
Phase 3 rollout:
LAIclients
20172015
Projects:-y-QUIT;
-headspace Active;-OSA;
-oral health;-peer health
coach
2018
QUIT
y-QUIT toolkit
y-QUIT intervention
(12-25 yrs)
evaluation
Interventions
41 young people commenced a harm reduction smoking cessation intervention.
12, 29%
9, 22%
20, 49%
Incomplete Full Completed Full
Completed Brief
0
2
4
6
8
10
12
14
16
18
Cigarettes Exhaled CO
Smoking-related measures
Pre Post
Full Intervention
y-QUIT: Smoking Prevalence, Engagement and Effectiveness of an Individualized...Jackie Curtis,Charry Zhang,Bernadette McGuigan,EstherPavel-Wood,Rachel Morell,Philip B. Ward*,Andrew Watkins,Julia M LappinFront. Psychiatry - Schizophrenia, DOI: 10.3389/fpsyt.2018.00683
Raising Expectations
www.seslhd.health.nsw.gov.au/keeping-body-mind
www.iphys.org.au
https://www.equallywell.org.au/
Andrew WatkinsOn behalf of the Keeping the Body in Mind teamSouth East Sydney Local Health District