1 Integrating Health & Wellness & Peers in Clubhouse Programs Colleen McKay, M.A., C.A.G.S. Program for Clubhouse Research Systems and Psychosocial Advances Research Center University of Massachusetts Medical School Mary Quill, A.A. Systems and Psychosocial Advances Research Center University of Massachusetts Medical School And Genesis Club, Inc.
2 Extent of the Problem Many people diagnosed with Severe Mental Illness (SMI) use smoking to manage symptoms, stress, or increase social contact and consume nearly half of all tobacco sold in the United States 1. Compared with the general population, individuals with SMI are at greater risk of co-morbid health problems and premature death Lasser, K., Boyd, W., Woolhander, S., Himmelstein, D.U., McCormick, D., & Bor, D.H. (2000). Smoking and Mental Illness: A population based prevalence study. JAMA, 284, National Association of State Mental Health Program Directors. Morbidity and Mortality in People with Serious Mental Illness. Thirteenth in a Series of Technical Reports. Alexandria, VA: 2006.
3 Peers as Providers A growing body of evidence suggests that peer-provided, recovery-oriented mental health services produce outcomes as good as and, in some cases superior to, services from nonpeer professionals. Cook, J. A. (2011). Peer-delivered wellness recovery services: From evidence to widespread implementation. Psychiatric Rehabilitation Journal, 35(2),
4 Peer Supports Involvement of consumers or peers in addressing tobacco use in mental health settings is a relatively new approach that has not been widely developed or disseminated
5 Peer Supports Advantages of engaging peers as providers: Peers can provide support and experiential knowledge Cost effective Serve as role models and/or advocates Peers may seem less threatening Peers may share a common language & culture with other peers
6 Background: Literature Review Examined literature describing peer delivered supports for tobacco cessation for adults diagnosed with serious mental illness Seven articles describing four interventions with peer providers McKay, C. & Dickerson, F. Peer supports for tobacco cessation for adults with serious mental illness: A review of the literature. Journal of Dual Diagnosis, 8(2), April-June 2012, pp
7 Literature Review Primary roles of peers: Co-leaders of educational group Providers of additional support to clubhouse members as part of a multifaceted smoking cessation program Outreach workers delivering presentations about smoking & brief feedback sessions McKay, C. & Dickerson, F. Peer supports for tobacco cessation for adults with serious mental illness: A review of the literature. Journal of Dual Diagnosis, 8(2), April-June 2012, pp
8 Needs, Barriers, & Activities Examined if and how ICCD Clubhouses promote practices that improve the physical health of clubhouse members. Four main questions: What is the clubhouse director s perception of the need for health promotion activities and practices for clubhouse members? What health promotion activities and practices are currently offered in clubhouses? Do clubhouses plan to initiate any health promotion activities in the next 12 months? Are there any barriers to health promotion activities for clubhouses and/or their members?
9 Perception of Need for Health Promotion Activities for 3 Members Needed Intervention/Activity US (N=110) Nutritional education 4.29 Weight loss programs 4.25 Smoking cessation 4.23 Dental care 4.13 Stress management 3.96 Substance use awareness or reduction 3.90 Health screening & risk assessment 3.85 Supervised exercise 3.70 Non-supervised exercise 3.65 Improving sleep habits 3.59 Primary medical care 3.59 McKay, C.E. & Pelletier, J.R. (2007). Health Promotion in Clubhouse Programs: Needs, Barriers, and Current and Planned Activities. Psychiatric Rehabilitation Journal, 31,
10 Genesis Club: Existing Health Promotion Activities Gym Memberships - YWCA Walking Group Noon Walks Running Team Falmouth Road Race, Worcester Fireman s Run, etc. Health Promotion Toolkit Wellness Wednesdays Nutritional Meals/Healthy Food Choices Dual Recovery Anonymous Wellness Fairs/Information Table Two Plots in a Community Garden
11 The Promoting Health Lifestyles Clubhouse Toolkit Developed to help clubhouses and other agencies with peers better address health & wellness. Focuses on tobacco cessation integrating nutrition, exercise, improving sleep, & stress reduction.
12 The Promoting Health Lifestyles Clubhouse Toolkit Provides a model in which peers or clubhouse members and staff colead educational meetings and organizational change within an agency. Focuses on the relevance of health promotion and tobacco cessation to help employment, housing, and recovery in general.
13 Sample Pages
14 Toolkit Personal Narratives Member & staff experiences in quitting tobacco use, exercising, and eating healthier. Narratives provide: An understanding of the experience of unhealthy living and/or tobacco addiction Successful strategies that people diagnosed with serious mental illness have used to quit tobacco and live healthier lives. Inspiration, hope, and commitment to adopting wellness and recovery in all our lives, as they become a way of life.
15 Toolkit Personal Narratives I smoked cigarettes for over thirty years and for the most part, I enjoyed them but down inside, I wanted to quit. I started to play a game in my head where I told myself that every pack that I bought would be my last. After punishing myself with the side effects from smoking cigarettes for thirty years, I was determined to quit. After six tries, I quit going cold turkey and have virtually no desire to pick up a cigarette again. I feel better now than I did 20 years ago because I have quit smoking and I am exercising.
16 Toolkit Personal Narratives I have to admit exercise was never on top of my to do list, so it is safe to say the past few years were more of a sedentary lifestyle, considering the medications I've been on. It's proven with all the added benefits prescriptions have, they are not without their side effects, and the leading downside to the meds is weight gain and being lethargic, and in some cases diabetes! So, there is only one cure as which we all know, is exercise. I joined the Genesis Wellness team in an attempt to tone up, trim down, and most importantly get myself on the right track, and I did that. This left me feeling grateful and proud that I could be a part of something so helpful.
17 Integrating Tobacco Cessation & Health Promotion Interventions Focus Groups Assess program needs, Identify barriers, Explore strategies, Develop resources, & Tailor interventions.
18 Focus Group Participants - Members Baseline: Thirteen (nine females, four males) Follow-up: Five (three females, two males) Approximately (range 19-68) years old. All focus group participants were Caucasian.
19 Focus Group Themes - Baseline Theme Staff Members Importance of organizational/culture change with regard to tobacco use Integration of health & wellness Effective communication about the new supports How tobacco affects recovery (e.g. employment or housing) Education with regard to health promotion and tobacco cessation Tailoring supports for the clubhouse Ways to engage smokers & be supportive
20 Member Focus Group Themes - Baseline The importance of: 1) Organizational/culture change with regard to tobacco use; 2) Having a multi-faceted approach that addresses tobacco, exercise, & nutrition; 3) Effective communication about the new supports; 4) Tailoring supports, & 5) Ways to engage smokers & be supportive.
21 Member Focus Groups - Baseline Within the clubhouse the culture is changing to a better mode of living. More people are health conscious because it is discussed The culture of change is happening here. People are becoming more aware that they can do something about their physical condition, and they can do something about their smoking problem.
22 Staff Focus Group Themes - Baseline The importance of: 1) Organizational change with regard to tobacco use; 2) Integrating health & wellness activities; 3) Effective communication about the new supports; 4) Addressing how tobacco affects other areas of recovery such as employment; & 5) Providing education with regard to health promotion & tobacco cessation.
23 Focus Groups - Staff I feel obligated in a sense of knowing about it [tobacco cessation]; say I m doing a goal plan with someone. That [tobacco cessation] should be an option as much as employment should be having discussions with members about how to be a successful employee is really to take care of your health.
24 Focus Groups - Staff We started thinking about exercise because people could not sustain a four hour work day because of cardiac issues & lung capacity. It [health promotion] should support the core things we do, which is better employment, better housing, better quality of life.
25 Focus Group Themes: Follow-Up Sixth Month Follow-Up Theme Staff Members Integration of health & wellness activities How tobacco affects other areas of recovery such as employment or housing Changes in social acceptance of smoking Awareness of consequences of tobacco use Awareness of resources (educational meetings, health promotion toolkit, etc.) Tailoring supports for the clubhouse Ways to engage smokers and be supportive
26 Member Focus Group Themes Follow-up Five primary themes: 1)Integration of health & wellness activities; 2)Tobacco affects other areas of recovery such as employment or housing; 3)Changes in social acceptance of smoking; 4)Awareness of consequences of tobacco use; & 5)Awareness of resources (educational meetings, toolkit, etc.)
27 Follow-up - Members Just because it [wellness] is becoming part of our culture, the proper diet, and the not smoking or using tobacco products. I ve noticed over time that smoking is not as much of a friendly get-together it is not as much of a social gathering as it used to be.
28 Staff Focus Group Themes Follow-Up The importance of: 1) How tobacco affects other areas of recovery such as employment or housing; 2) An awareness of consequences of tobacco use; 3) An awareness of resources; 4) Tailoring supports for the clubhouse; & 5) Ways to engage smokers & be supportive.
29 Staff - Follow-Up It s hard enough to make the decision to quit, and once you do, you want to have the support of others and the tools to do so. What kinds of supplies do you need? [Nicotine] patches?. I think if you want to help them [members] quit you have to go all the way.
30 Contact Information Colleen McKay, M.A., C.A.G.S. The Program for Clubhouse Research Systems and Psychosocial Advances Research Center Department of Psychiatry University of Massachusetts Medical School Mary Quill, A.A. Systems and Psychosocial Advances Research Center Department of Psychiatry University of Massachusetts Medical School And Genesis Club, Inc.
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