Wellness Is Where It’s AtWellness Is Where It’s At

Douglas Ziedonis, M.D., M.P.H. Douglas Ziedonis, M.D., M.P.H. Professor and Chairman Professor and Chairman Department of Psychiatry Department of Psychiatry

UMass Memorial Medical Center/ UMass Memorial Medical Center/ University of Massachusetts Medical School University of Massachusetts Medical School

Wellness & Health Promotion Wellness & Health Promotion for Everyonefor Everyone

Why now? Why now? – National, State, Local Awareness and National, State, Local Awareness and

CommitmentCommitment

We each must do our part as individuals We each must do our part as individuals and as teamsand as teamsUMass Department of PsychiatryUMass Department of Psychiatry– Wellness Interest GroupWellness Interest Group– Wellness InitiativeWellness Initiative

Need Personal & Organizational Change Need Personal & Organizational Change PlanPlan

Massachusetts DMH Data:Massachusetts DMH Data:Clinical Research in Our Clinical ProgramsClinical Research in Our Clinical Programs

26 years shorter life 26 years shorter life Leading causes of death: Leading causes of death: – Cardiovascular Cardiovascular – Cancer Cancer

Many other health risksMany other health risksNeed to link with wellness and recoveryNeed to link with wellness and recoveryAddress obesity, nutrition, exercise, stress Address obesity, nutrition, exercise, stress management, mood management, vocational management, mood management, vocational rehabilitation, relationship building, and rehabilitation, relationship building, and significant other risk factor reductionsignificant other risk factor reduction

Why address tobacco addiction in Why address tobacco addiction in Mental Health Settings? Mental Health Settings?

44% of all cigarettes consumed in the US are by 44% of all cigarettes consumed in the US are by smokers with a psychiatric disorder smokers with a psychiatric disorder Most individuals with mental illness are tobacco Most individuals with mental illness are tobacco dependent & 50% are heavy smokers (>25 cigs/day)dependent & 50% are heavy smokers (>25 cigs/day)

Increased health consequences, death, medication & Increased health consequences, death, medication & discretionary costs, housing issues, and other discretionary costs, housing issues, and other addictionsaddictions

Treatment can work – more intensive motivation Treatment can work – more intensive motivation based treatments & organizational changebased treatments & organizational change– Watch psychiatric medication side effects with abstinenceWatch psychiatric medication side effects with abstinence

Helping Staff who smoke: Adverse Helping Staff who smoke: Adverse Employment Outcomes Associated with Employment Outcomes Associated with

SmokingSmoking

Involuntary turnoverInvoluntary turnover

AccidentsAccidents

InjuriesInjuries

Discipline problemsDiscipline problems

Mean Absence RatesMean Absence Rates

17 workdays dedicated to smoke-breaks 17 workdays dedicated to smoke-breaks per yearper year

Economic Benefits to EmployersEconomic Benefits to Employers

Reduced AbsenteeismReduced Absenteeism

On-the-Job Productivity On-the-Job Productivity

Reduced Life InsuranceReduced Life Insurance

Reduced Medical ExpendituresReduced Medical Expenditures– workers, retirees, medicare, otherworkers, retirees, medicare, other

Benefit to Cost RatioBenefit to Cost Ratio– 1:1 3rd year & 5:1 10th year1:1 3rd year & 5:1 10th year

StigmaStigma

Misinformation / lack of information about Misinformation / lack of information about General Health Implications for this populationGeneral Health Implications for this population– Little data on why this group diesLittle data on why this group dies– Myths: “health risks exaggerated, just manipulating Myths: “health risks exaggerated, just manipulating

statistics, people are living longer, I don’t know anyone statistics, people are living longer, I don’t know anyone who died of smoking caused diseases” who died of smoking caused diseases”

Stigma, rationalization, and minimizationStigma, rationalization, and minimization::– ““other than increase morbidity and mortality why should other than increase morbidity and mortality why should

we address tobacco?” we address tobacco?” – OR “You are taking away their only pleasure in life - OR “You are taking away their only pleasure in life -

What else are they going to do?”What else are they going to do?”

                                                                                                                                         

                         

Behavioral Risk FactorsBehavioral Risk Factors– Heart diseaseHeart disease & Stroke & Diabetes& Stroke & Diabetes

Alcohol, tobacco smoking, other substance Alcohol, tobacco smoking, other substance abuse, exercise, obesity, and dietabuse, exercise, obesity, and diet

– CancerCancer Tobacco smoking, alcohol dependence, Tobacco smoking, alcohol dependence, obesity, dietobesity, diet

– Respiratory diseasesRespiratory diseases Tobacco smoking and other substance abuseTobacco smoking and other substance abuse

– Traumatic injuriesTraumatic injuries from Accidentsfrom AccidentsAlcohol and other substance abuseAlcohol and other substance abuse

Centers for Disease Control (www.cdc.gov/nccdphp/burdenbook2002/01_tables.htm)

WELLNESS WELLNESS ACADEMIC INTEREST GROUPACADEMIC INTEREST GROUP

UMASS DEPARTMENT OF PSYCHIATRYUMASS DEPARTMENT OF PSYCHIATRY

CONTACTSCONTACTSBetsy AustinBetsy Austin ––austine@ummhc.orgaustine@ummhc.org, ,

Paula Nims Paula Nims ––paula.nims@umassmed.edupaula.nims@umassmed.edu

Marie Hobart- Marie Hobart- mhobart@communityhealthlink.orgmhobart@communityhealthlink.org

Complete Wellness:Mental and Physical Health

CompleteWellness

HealthyFood Choices

DailyPhysicalActivity

BalancingRelaxation& Stress

Addressing Addictive Behaviors

RegularCheckups

MentalHealth &Recovery

Plan

Wellness InitiativeWellness InitiativeTargets for InterventionTargets for Intervention

Diet - NutritionExerciseStress Management Smoking cessationImproving integration with primary care and specialty providers– Minimizing drug interactions and side effects

& medications – Statins and other tools

Current ProjectsCurrent ProjectsInterests of AIG Participants Interests of AIG Participants

Caregiver and student health and Caregiver and student health and wellnesswellness

Tom Hopkins and Valerie Wedge- EAP, Tom Hopkins and Valerie Wedge- EAP, Brian Szetela, Mathieu Bermingham- Brian Szetela, Mathieu Bermingham- Physician Wellness, Mai- Lan Rogoff- Physician Wellness, Mai- Lan Rogoff- Medical Student WellnessMedical Student Wellness

Decreasing Morbidity and Mortality for Decreasing Morbidity and Mortality for Individuals with Serious Mental IllnessIndividuals with Serious Mental Illness

Sally Reyering- DMH Healthy Changes Initiative, Sally Reyering- DMH Healthy Changes Initiative, investigating “Fit Together” model health club in Hadley.investigating “Fit Together” model health club in Hadley.

Rob Karr - DMH/ Community Partnerships in areas of Rob Karr - DMH/ Community Partnerships in areas of diet, physical activity, and smoking cessationdiet, physical activity, and smoking cessation

Colleen McKay / Doug Ziedonis / Greg Seward - Colleen McKay / Doug Ziedonis / Greg Seward - Smoking cessation groups at Genesis Club- using the Smoking cessation groups at Genesis Club- using the “Learning about Healthy Living” . Legacy Foundation “Learning about Healthy Living” . Legacy Foundation funding to study and disseminate information.funding to study and disseminate information.

More ProjectsMore Projects

Marie Hobart , Sarah Guzofski- Wellness Intervention in Marie Hobart , Sarah Guzofski- Wellness Intervention in Assertive Community TreatmentAssertive Community Treatment

Alan Brown/ Rosalie Torres Stone CMHS - Addressing Alan Brown/ Rosalie Torres Stone CMHS - Addressing Health Care Disparities – proposed joint project with Health Care Disparities – proposed joint project with psychiatric providers and primary care in the Worcester psychiatric providers and primary care in the Worcester area. Cross Cultural issues. To look for new source of area. Cross Cultural issues. To look for new source of fundingfunding

Mike Archambault- CHL residential staff- Solutions for Mike Archambault- CHL residential staff- Solutions for Wellness- training for 50 staff to implement program. Wellness- training for 50 staff to implement program. Many already starting. Many already starting.

Improving health behaviors in those Improving health behaviors in those with chronic medical conditionswith chronic medical conditions

Betsy Austin and Jennifer Lauretti Betsy Austin and Jennifer Lauretti Health PsychologyHealth Psychology

Improving Health Status for those with Improving Health Status for those with Developmental DisabilitiesDevelopmental Disabilities

Carol Curtin and colleagues at the Shriver Carol Curtin and colleagues at the Shriver Center- Health U- a group model for teens Center- Health U- a group model for teens with Down’s syndrome and family with Down’s syndrome and family members. The focus is on healthy diet members. The focus is on healthy diet and physical activity.and physical activity.

Managing Chronic Illness and Managing Chronic Illness and AddictionAddiction

Monika Kolodziej- ADCARE- Group Monika Kolodziej- ADCARE- Group treatment for those in recovery from treatment for those in recovery from addiction with co-occurring Hepatitis C addiction with co-occurring Hepatitis C infection.infection.

Obesity and ADHDObesity and ADHD

Sherry PagotoSherry Pagoto

PCA tracking health measures, use of PCA tracking health measures, use of pedometers in outpatient mental healthpedometers in outpatient mental health

Mary Innis, Phyllis Wood- UMMHC OPDMary Innis, Phyllis Wood- UMMHC OPD

Smoking Cessation/ Prevention in Smoking Cessation/ Prevention in Adolescents, Improving Health Adolescents, Improving Health Behaviors in TeensBehaviors in Teens

Mathieu Bermingham- Child Psychiatry, Mathieu Bermingham- Child Psychiatry, Anne Lutz- CHL, Anne Lutz- CHL,

Carolyn McGrath- Westboro State HospitalCarolyn McGrath- Westboro State Hospital

Promoting Healthy Lifestyles at Genesis Club

•Structured and independent exercise:• Assumption College's Plourde Recreation Center• Daily walks and Team Genesis the club’s running team

•Tobacco Cessation (Organizational Change, Learning About Healthy Living and CHOICES)

•Nutrition meetings are held weekly to discuss meals and food choices, and research and write articles regarding nutrition.

•Dual Recovery Anonymous (D.R.A.) meetings:An independent, self-help organization that help men and women who have a dual diagnosis of mental illness and substance misuse achieve dual recovery

Wellness InitiativeWellness InitiativeTargeted OutcomesTargeted Outcomes

Wellness goals will be a standard part of all treatment plans.

Wellness resources will be readily available for all Routine measurement of weight, waist circumference, blood sugar, lipids, and other lab indices as appropriate to care will be obtained.

Personalized feedback: what Personalized feedback: what mattered mattered

Personalized feedback: what Personalized feedback: what mattered mattered

Carbon Monoxide Meter Carbon Monoxide Meter score and feedback (like an score and feedback (like an alcohol breathalyzer)alcohol breathalyzer)– Big impact on patientsBig impact on patients– Short & long term benefits Short & long term benefits

to quitto quitCost of Cigarettes for the Cost of Cigarettes for the yearyearMedical conditions affected Medical conditions affected by tobaccoby tobaccoLinks with other substances, Links with other substances, relapses, etcrelapses, etc

Carbon Monoxide Meter Carbon Monoxide Meter score and feedback (like an score and feedback (like an alcohol breathalyzer)alcohol breathalyzer)– Big impact on patientsBig impact on patients– Short & long term benefits Short & long term benefits

to quitto quitCost of Cigarettes for the Cost of Cigarettes for the yearyearMedical conditions affected Medical conditions affected by tobaccoby tobaccoLinks with other substances, Links with other substances, relapses, etcrelapses, etc

Wellness InitiativeWellness InitiativeTargeted OutcomesTargeted Outcomes

Culturally relevant resources regarding affordable healthy diet and accessible exercise options in the community will be available at each site.

Intervention focusing on health, wellness, smoking cessation and exercise will be available at all sites. This may include patient and family education, group programs or access to specialty services.

Wellness InitiativeWellness InitiativeTargeted OutcomesTargeted Outcomes

Clinical research studies will be ongoing addressing the effectiveness of interventions, education and practice standards.

Moving Toward Healthier BehaviorsMoving Toward Healthier Behaviors

Model healthy behaviorModel healthy behaviorHealth belief model: weigh benefits Health belief model: weigh benefits and risksand risks11

Most people move through Most people move through predictable stages in their efforts to predictable stages in their efforts to changechange22

The stages-of-change model can The stages-of-change model can be applied to most health related be applied to most health related behaviorsbehaviors2 2 Match clinician strategies to stage Match clinician strategies to stage of changeof change33

1. Rosenstock I, Strecher V, and Becker, M. (1998). Health Education Quarterly, 11, 403-418.2. Prochaska J, DiClemente C, Norcross, J (1992). Amer Psychologist, 47: 1102-11143. Miller W. & Rollnick S. (2002). Motivational Interviewing: Preparing People to Change Addictive Behaviors

 

LearningAbout

Healthy Living

TOBACCO AND YOU

Jill Williams, MDDouglas Ziedonis, MD, MPH

Nancy Speelman, CSW, CADC, CMSBetty Vreeland, MSN, APRN, NPC, BC

Michelle R. Zechner, LSWRaquel Rahim, APRN

Erin L. O’Hea, PhD

Mindfulness in Medicine, Mindfulness in Medicine, Health Care and SocietyHealth Care and Society

Full Catastrophe Living: Full Catastrophe Living: Using the Using the Wisdom of Your Body and Mind to Face Wisdom of Your Body and Mind to Face Stress, Pain and IllnessStress, Pain and IllnessMBSRMBSR

–Based on intensive training on meditation and yogaBased on intensive training on meditation and yoga–Notion of a Way (of Being); a Way (of Seeing)Notion of a Way (of Being); a Way (of Seeing)

What is mindfulness?What is mindfulness?

““Mindfulness means paying attention in a Mindfulness means paying attention in a particular way: on purpose, in the present particular way: on purpose, in the present moment and not judgmentally”moment and not judgmentally”

Practicing MindfulnessPracticing Mindfulness

The engagement in these stress reduction The engagement in these stress reduction techniques provides and/or increase:techniques provides and/or increase:

clarity of mind,clarity of mind,

sense of purpose,sense of purpose,

greater self-esteem, andgreater self-esteem, and

personal commitment,personal commitment,All important elements to make necessary All important elements to make necessary

changes in our liveschanges in our lives

From Automatic-Pilot to From Automatic-Pilot to IntentionalityIntentionality

Dis-AttentionDis-Attention

Dis-ConnectionDis-Connection

Dis-RegulationDis-Regulation

Dis-OrderDis-Order

Dis-EaseDis-Ease

““Only that day dawn to which we are awake”Only that day dawn to which we are awake”

H. Thoreau H. Thoreau

UMassMemorial Medical CenterUMassMemorial Medical Center

ATTOC: Agency Goals and ATTOC: Agency Goals and Accomplishments ToolAccomplishments Tool

Major goal for ATTOCMajor goal for ATTOC– Staff Training & Improving Clinical ServicesStaff Training & Improving Clinical Services– Program DevelopmentProgram Development– Supporting Staff RecoverySupporting Staff Recovery– Implement Policies for Smoke-free grounds Implement Policies for Smoke-free grounds

For StaffFor StaffFor PatientsFor Patients

Performance Measures MetricPerformance Measures MetricThreshold, Target, and Stretch Goals Threshold, Target, and Stretch Goals Importance of Communication (within Importance of Communication (within organization and with outside network)organization and with outside network)Tracking and Sustaining ChangeTracking and Sustaining Change

Organizational ChangeOrganizational Change

1. Establish preliminary organizational goals for 1. Establish preliminary organizational goals for change.change.– consulting team and “champions” consulting team and “champions” – articulate the organization’s vision of change, provisional goalsarticulate the organization’s vision of change, provisional goals– ensure leaders are supportiveensure leaders are supportive

2. Establish a leadership group and prepare for 2. Establish a leadership group and prepare for change. change. 3. Assess readiness for change3. Assess readiness for change– conduct strengths and needs assessmentconduct strengths and needs assessment

4. Develop a draft Change Plan4. Develop a draft Change Plan– Working documentWorking document

5. Develop and document a communication plan5. Develop and document a communication plan– determine how to initiate and maintain two-way communication determine how to initiate and maintain two-way communication

with stakeholders throughout the change processwith stakeholders throughout the change process– including how to communicate new policies and proceduresincluding how to communicate new policies and procedures

Organizational ChangeOrganizational Change

6. 6. Work area: Patients / Clients / ConsumersWork area: Patients / Clients / Consumers– The agency identifies opportunities to address wellness and health The agency identifies opportunities to address wellness and health

promotion, implements selected strategies, tracks and assesses promotion, implements selected strategies, tracks and assesses progress.progress.

7. 7. Work area: Staff / Faculty / Peer CounselorsWork area: Staff / Faculty / Peer Counselors– Based on an assessment of staff readiness to change, the agency Based on an assessment of staff readiness to change, the agency

implements selected strategies to help staff support clients in their implements selected strategies to help staff support clients in their recovery and to assist staff in their own recovery. Progress is recovery and to assist staff in their own recovery. Progress is tracked and assessed.tracked and assessed.

8. 8. Work area: ENVIRONMENTWork area: ENVIRONMENT– Based on its assessment of factors supporting and impeding Based on its assessment of factors supporting and impeding

environmental changeenvironmental change– EX the agency implements selected strategies to discourage or EX the agency implements selected strategies to discourage or

end smoking through environmental changes and policies (e.g., end smoking through environmental changes and policies (e.g., discouraging or ending smoking on the grounds).discouraging or ending smoking on the grounds).

Organizational ChangeOrganizational Change

9. Document changes in policies and 9. Document changes in policies and procedures. procedures. – After assessing the success of the intervention, the After assessing the success of the intervention, the

agency formally documents changes in policies and agency formally documents changes in policies and procedures and ensures they are reflected in agency procedures and ensures they are reflected in agency operations (e.g., training of new staff, performance operations (e.g., training of new staff, performance review). review).

10. Support, encourage, and sustain 10. Support, encourage, and sustain environmental change.environmental change.– The organization sustains change by publicizing The organization sustains change by publicizing

successes, maintaining an ongoing feedback loop, successes, maintaining an ongoing feedback loop, and ensuring the existing of an infrastructure within and ensuring the existing of an infrastructure within the agency capable of sustaining change.the agency capable of sustaining change.

Psychosocial treatment research Psychosocial treatment research issues:issues:

Cognitive, affective, and motivational issues Cognitive, affective, and motivational issues How modify and integrate tobacco dependence How modify and integrate tobacco dependence psychosocial treatments? psychosocial treatments? What medication platform?What medication platform?What length of time for treatment intervention?What length of time for treatment intervention?– number of sessions, length of session, etc number of sessions, length of session, etc

Adjunct Service versus Integrate Adjunct Service versus Integrate Component analysis of current approaches Component analysis of current approaches Role for Contingency Management? What Role for Contingency Management? What rewards?rewards?Involvement of significant others?Involvement of significant others?

ChampionsChampions

What is a Champion?What is a Champion?Assemble Leadership TeamAssemble Leadership TeamFacilitate leadership team activitiesFacilitate leadership team activitiesCan oversee our consultant activities and Can oversee our consultant activities and motivates the cultural change process.motivates the cultural change process.Criteria:Criteria:– Passion and commitment for the topicPassion and commitment for the topic– Leader in system Leader in system – Knowledge in topic areaKnowledge in topic area

Conclusion Conclusion

The Time is now to focus on Wellness and The Time is now to focus on Wellness and Health Promotions – for everyoneHealth Promotions – for everyoneLeadership & Organizational ChangeLeadership & Organizational ChangeMotivation Based Intervention Strategies are Motivation Based Intervention Strategies are needed needed Having the tools – education and trainingHaving the tools – education and trainingProgram and system changes are critical to Program and system changes are critical to the broad-based success the broad-based success