IMPACT: An Evidence-based Approach to Integrated Depression Care Beth Israel Medical Center New York, NY. Day One: June 8, 2011

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1 IMPACT: An Evidence-based Approach to Integrated Depression Care Beth Israel Medical Center New York, NY 8:00 Registration & Continental Breakfast 8:30 Welcome & Introductions Day One: June 8, :45 IMPACT: A Practical Approach to Team-Based Depression Care What is depression and why treat it in primary care? Overview of the IMPACT model of depression care Summary of the evidence supporting IMPACT Description of the stepped-care treatment algorithm for depression The value of a team approach to depression 10:00 Break 10:15 Key Components of Depression Care Management Key components of the IMPACT program as they are implemented by the care manager Methods for identifying depression Initial session / patient education / treatment options and planning Follow-up contacts / PHQ-9 / symptom tracking Relapse prevention Care manager role in supporting medication therapy 12:00 Lunch on your own 1:15 Antidepressant Medications Key principles of antidepressant therapy and types of medications commonly used in primary care Patient education about antidepressants When to initiate, titrate, and switch antidepressants Combination therapy and drug interactions 2:30 Challenging Cases and Psychiatric Consultation The role of the consulting psychiatrist and how it differs from traditional consultation Difficult cases that may benefit from psychiatric consultation: persistent depression, comorbid medical conditions or chronic pain, comorbid psychiatric conditions, comorbid alcohol/substance abuse Managing patients at risk for suicide

2 3:15 Break 3:30 Behavioral Activation The role of behavioral activation in managing depression Ways to encourage behavioral activation Integrating behavioral activation into depression care management 4:30 Homework Assignment 5:00 Adjourn Day 1

3 IMPACT: An Evidence-based Approach to Integrated Depression Care Beth Israel Medical Center New York, NY 8:00 Continental Breakfast 8:30 Review of Day One, Q & A Day Two: June 9, :15 Integrated Care with Diverse Populations The intersection of depression and medical illness: diabetes, congestive heart failure, coronary artery disease The interaction between depression and chronic pain Care management for both depression and chronic pain Impact of maternal depression on child mental health and development 10:30 Break 10:45 IMPACT Implementations Adaptations of the IMPACT model for diverse practice settings Adaptations of the IMPACT model for diverse populations 12:00 Lunch on your own 1:15 Implementation Planning and Team Building Implementation process and timeline Building the team Clinical tracking systems Action planning for implementing IMPACT in your setting 2:00 Financing IMPACT Care: Overview Start-up costs for providing IMPACT care Long-term financing of IMPACT care Cost effectiveness of IMPACT Developing a business case for IMPACT Medicare hierarchical condition coding for care management 2:30 Billing and Reimbursement for IMPACT Care Financing IMPACT care in various settings (e.g. FQHC, school health centers) State variations in funding structures and options Sustainability planning for implementation Resources for billing and reimbursement information Diane Powers, MA Diane Powers, MA Diane Powers, MA

4 3:15 Break 3:30 Introduction to Problem-Solving Treatment The theoretical model and evidence base for PST Key steps of problem-solving treatment Discuss key elements of initial PST session Observation of initial PST session 5:00 Adjourn Day 2

5 SPEAKERS Clinical Nurse Specialist, Kaiser Permanente Southern California, San Diego, CA Ms. Haverkamp is a psychiatric nurse clinical specialist. She has her masters degree in psychiatric nursing from the University of Cincinnati. She has been ANA certified as an advanced practice psychiatric nurse/ clinical specialist since She has worked for Kaiser Permanente for the last 21 years as an outpatient therapist. She has previous experience as an inpatient head nurse and a manager for multiple psychiatric units. She was a depression specialist in the original IMPACT depression care research. The last 11 years she has been providing IMPACT depression care within her role at Kaiser. She currently does consulting with the IMPACT Implementation Center. She is a frequent speaker presenting on the IMPACT model, problem solving treatment and cognitive therapy. She provides PST-PC supervision to depression care managers. Consultant and Senior Trainer, IMPACT Implementation Center, Seattle, WA Ms. Little is responsible for the administration of 150 staff and delivery of behavioral health, community and grant funded programs in a community health center network throughout New York City and New York States Hudson Valley Region. Ms. Little is also responsible for many of the services the organization provides to the uninsured. Ms. Little has extensive experience providing behavioral health services in healthcare settings as well as developing and operating community programs. Ms. Little has knowledge of special populations such as HIV/AIDS, homeless and substance abuse and the chronically medically and mentally ill. Ms. Little has worked both nationally and internationally helping organizations develop integrated models of care. Ms. Little is a member of the consulting team for Project IMPACT providing assistance to organizations and communities seeking to implement the IMPACT model of care. Ms. Little has assisted in the development of a suboxone treatment programs and provided assistance for organizations wishing to develop a suboxone program. Before joining the Institute, Ms. Little provided social services at the Department of Corrections and was a Domestic Violence Coordinator chosen by the Mayor s office to promote family violence identification and prevention in New York City and Health and Hospital Corporation. Ms. Little is certified in rational emotive behavioral therapy and trained in other modalities such as problem solving and cognitive therapy. Ms. Little has received advanced training in working with trauma survivors, disaster mental health and critical incident debriefing. Ms. Little is a Department of Transportation and federally certified Substance Abuse Professional and a certified New York State Mandated Reporter child abuse trainer. Ms. Little has her doctoral degree in psychology along with a masters in social work and bachelors degree in both psychology and social work. Ms. Little has received awards for her work in behavioral health including the Eleanor Clarke award for innovative programs in healthcare (2004) and the National Association of Social Workers Image award (2006). Ms. Little is a member of and on the national committee of the Society for Social Work Leaders in Healthcare, a member of the National Association of Social Workers, the Community Health Care Association of New York State, the American Play Therapy Association, The National Council for Community Behavioral Healthcare Providers. Presently Ms. Little services on the board of the Association of Clinicians for Underserved, New York Association for Play Therapy and the Reproductive Health Access Project.

6 Diane Powers, MA Program Manager, Psychiatry & Behavioral Sciences, UW, Seattle, WA Ms. Powers manages the AIMS Center (Advancing Integrated Mental health Solutions) at the University of Washington. The AIMS Center is part of the UW Department of Psychiatry & Behavioral Sciences and provides research, training, and technical assistance focused on evidence-based, integrated mental health care programs. IMPACT is one of the programs that is part of the AIMS Center. Ms. Powers has over eighteen years experience as manager of a wide range of public health and health services research projects and programs. She also has more than eight years experience providing mental health services in both inpatient and outpatient settings. Ms. Powers received a BA in Psychology and English Literature from Gonzaga University and a master s degree in Psychology from Seattle University. Professor and Vice Chair, Psychiatry & Behavioral Sciences, UW, Seattle, WA Dr. Unützer is Professor and Vice-Chair of Psychiatry & Behavioral Sciences at the University of Washington (UW) and Chief of Psychiatric Services at the UW Medical Center. He is also an Adjunct Professor of Health Services at the UW School of Public Health and an Affiliate Investigator at the Group Health Research Institute in Seattle, WA. Dr. Unützer is an internationally recognized health services researcher who works with national and international organizations to improve health care for individuals with common mental disorders. Dr. Unützer s research focuses on innovative models of mental health care in general medical settings and on translating research on evidencebased mental health treatments into effective clinical and public health practice. He has published over 175 articles in peer reviewed medical journals and he is the recipient of numerous federal and foundation grants and awards for his pioneering research on integrated mental health care. At the University of Washington, Dr. Unützer directs the AIMS Center (Advancing Integrated Mental Health Solutions) and the IMPACT Dissemination Program (www.impact-uw.org), which supports diverse health care organizations in integrating evidence-based depression treatment into primary care.

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