Modality (face to face, webinar, etc.) For Each workshop: Duration & frequency if series of training sessions

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1 Health Sciences Institute Chronic Care Professional (CCP) Certification. : Vanesa Cascino; hsisupport@healthsciences.or g Reference: healthsciences.org/informatio n_about_ccp_certification.htm l; HealthSciences Overview th-coaching-and-motivational- Interviewing-Certification- Program-Overview-Chronic- Care-Professional-CCP.html 1. Prepare the interdisciplinary primary care team in the core competencies identified by Institute of Medicine, clinical studies, and three CCP state pilots, and evaluation programs with organizations including Kaiser Permanente to be linked with improvements in patient-level clinical outcomes and reduction of avoidable hospitalization. 2. Build beginning proficiency in the application of brief motivational interviewing demonstrated in over 300 clinical studies to support behavior change and disease self-care, adherence, and lifestyle management. 3. Provide multimedia resources and access to a monthly national learning community to reinforce and advance proficiency. Health Care and Chronic Care Quality & Improvement, Wellness and Disease Prevention, Chronic Disease Management, Case Management Health Improvement Foundations, Outcomes Evaluation, The Big Five Chronic Diseases, Key Chronic Diseases, Age-Related Conditions, Issues of Late-Life, Self-Care and Adherence Support Steps, Whole Person Care, Health Literacy Improvement Cultural Competence, Motivational Interviewing-Based Health Coaching, Orientation to Health Behavior Change, MI-Based Health Coaching Approaches, Five-Step Brief Coaching Model, Health Promotion and Coaching, Health Coaching for Diet and Nutrition, Obesity and Weight Management, Physical Activity and Fitness, Self-Care for Caregivers hour online learning modules, 2.Largest online MI video learning library for clinicians (10 hours), 3. Library of over 20 hours of additional skill-building archived programs and learning materials from the Population Health Improvement Learning Collaborative, 4. Optional online exam that must be completed within oneyear for certification, page learning and reference manual with job tools, 6. Free monthly skill-building webinars via the Population Health Improvement Learning Collaborative, provide all CE required for recertification (15 hours every three years) CCP web-based learning, forum, video vignettes, and monthly skillbuilding webinars. 1. Self-directed CCP program (40 hours). Online certification exam may be completed for national CCP certification. 2. National Population Health Improvement Learning Collaborative Library (20+ hours), 3. MI skill-building library with Miller and Rollnick, MINT experts (10 hours) Web-based Open-enroll ent, ongoing Expert panel Yes, clinician advisory board must complete a that includes national exam. motivational interviewing network of trainers (MINT), and NIH-funded health behavior change and medicine specialists: iences.org/abo utus_healthsci ences_advisor y_board.html CCP is Both preapproved for 40 CE hours for nurses, case managers, physicians and pharmacists. Standard tuition fee is $1,295, Michigan demonstration program staff receive 35% tuition waiver by entering code MPCC during registration ($841.75). Page 1 of 6

2 Health Sciences Institute Motivational Interviewing Health Care Certification (MIHC) Program : Vanesa Cascino; hsisupport@healthsciences.or g Reference: th-coaching-and-motivational- Interviewing-Certification- Program-Overview-Chronic- Care-Professional-CCP.html 1. Build clinician proficiency in MI-based health coaching for clinicians who serve patients at risk of chronic disease or chronic disease related complications or rehospitalization. 2. Assess the proficiency of the learner in MI, provide objective skill-building feedback, and 3. measure the impact of training via pre/post assessment using a standardized and validated health coaching proficiency tool. Advanced MI-based health coaching 1. Motivational program targeting brief, validated approaches for engaging patients and improving disease self-care, adherence and lifestyle management, rehospitalization outcomes. Content based on a program that has been delivered to over 100 US health care organizations. Builds on MI content in the CCP program. PLEASE NOTE: CCP is a prerequisite for this advanced program. Interviewing in health care manual, 2. MI Health Coaching DVD training video, 3. Three HCPA health coaching proficiency and skillbuilding feedback reports by MINT/MITI/HCPA certified professional. 1. Onsite actionlearning program, 2.Monthly Case Review Calls, 3.Assessment of health coaching work samples using HCPA (see nces.org/hcpa- Information.html ) 1. Two-day live program delivered On-site, to organization or regional teams. phone and PLEASE NOTE: Minimum web-based. enrollment is 50 participants. 2. Monthly case review conducted via phone (10-12 hours), 3. submission and review of work samples and feedback using HCPA (5 hours). Open enrollment, ongoing MINT trainers Yes, clinician only. Team led must by twice NIH demonstrate funded MI proficiency in MI authority Dr. before awarded. Susan Butterworth and Dr. Blake Andersen, post doctoral trained in medicine. Varies Both Cost based on team size, but tuition ranges from $1,000 to $2,000 per participant. Health Sciences Institute Population Health Improvement Learning Collaborative : Vanesa Cascino; hsisupport@healthsciences.or g Reference: ulation_health_improvement_ Learning_Collaborative.html 1. Build new skills and provide updates on best practices and innovations in chronic care improvement, chronic disease care, and health coaching. 2. Encourage interdisciplinary collaboration and knowledge transfer through online community. NOTE: This is available to individuals that complete the Chronic Care Professional Certification Topics have included medication adherence, MI-based health coaching, comorbid chronic illness and depression, chronic disease treatment updates, electronic medical records, chronic pain management, transitional care and rehospitalization avoidance, among others. Webinar-based training events. Webinar One-hour per month, ten months. Webinar Monthly Faculty presenters from Mayo Clinic, Harvard, Cleveland Clinic, Kaiser Permanente, Oregon Health & Science University. No CE Statewide certificate and CE hours preapproved for CCP recertificatio n. No Cost Page 2 of 6

3 Care Management 101: Foundational Skills/Self Management Training : Lynn M Klima MSN, RN, FNP-BC LKlima0514@gmail.com; Applies the 5 step care management process to common chronic conditions within primary care. 2. Demonstrates assessment skills to determine patient readiness for behavior changes. 3. Demonstrates foundational skills utilized with motivational interviewing to assist patients making behavior changes. 4. Identifies barriers to self management through the application of advanced assessment strategies/tools available for primary care. 5. Develops disease care maps to support short term and long term interventions that are evidence based to faciliate patient engagement and cost-effective care. 6. Incorporates interventions that are appropriate for subpopulations (ie chronic disease, at-risk for chronic disease, acute care follow-up, medically complex, socially complex) into care mapping process. 7. Develops shared partnership goals using SMART goal setting. Role of the Care Manager within a PCMH Developing the CM/Patient relationship to support selfmanagement Developing Care Maps on common chronic conditions Advanced assessment tools to identify barriers/ambivalence to participate in goal-setting Communication skills to enhance patient engagement- MI, OARS, Teachback, shared decision making Identifying patients that would benefit from CM CORE CM interventions for success Helping patients navigate health care transitions Assessing Health Literacy and Cultural Competency Care Mapping using the current evidence based guidelines Care Coordination aimed at newly diagnosed oncology patients with interactive case studies. Daily practices... 5 steps in 8 hours Care Mapping tools Reference materials Online live forum, one Faceto face Capstone Didactic session and monthly skillbuilding webinars. Course includes all of the following to achieve outcome completion: 1.Online training (8 hours). 2. Traditional Capstone Session (Live classroom format)- (8 hours) hour follow-up web consultations/ problem-solving Online/web call with one traditional classroom session Monthly Instructors are Yes, at program experienced completion Care Managers, program developed for NIH study on implementatio n in Primary Care; CNP, CDE and MSW. Geisinger trained care managers. CM is Both approved for 10 hours continuing education for Michigan Nurse relicensure 450 per person; group rates available, contact Lynn Klima Page 3 of 6

4 Empowerment- based case management and skills training Martha Funnell, MS, RN, CDE, Robert Anderson, EdD, UMHS This program offers three levels of sequential training designed to address different levels of case management and patient complexity and a train the trainer program. Each of the programs in person with follow-up through video or telephone group conferencing. Lecture/discussion/powerpoint slides/video Level 1: Empowerment-based case-management training for medium complexity patients. This one-day course is designed for case managers who will be working with medium complexity patients to help them make lifestyle and other changes. This empowerment-based training includes communication skills related to responding to emotional concerns and setting selfdirected goals. Level 2: Empowerment-based case-management training for high complexity patients. An additional one-day course designed for case managers who work with high complexity patients. This course would build on the skills of the Level 1 course for the medium complexity case managers. It would include reinforcement of skills taught in the one-day course, and add facilitation skills for group visits and additional communication skills, such as the Motivational Interviewing OARS approach Lecture/discussion/powerpoint slides/video Lecture/discussion/powerpoint slides/video Level 3: Train the Trainer. A two-day train the trainer course that would include reinforcement of the skills taught in the Level 1 and 2 courses for invited participants, as well as advanced facilitation and training skills. Participants will have an opportunity to practice facilitating all activities in the Level 1 and 2 courses. At the end of the this course, those who achieved the desired level of would be certified as trainers for Level 1 or Level 2 training. I-SMART Goal setting form; Concerns Assessment Form; Book: 101 Tips for Behavior Change Book: 101 Tips for Diabetes Educators; Tracking form for topics covered; Diabetes Empowerment Survey Book: Patient Empowerment: The Art and Science of Diabetes Education Face to face with online or telephone followup 1 day training as requested locations with at least 10 participants Face to face with 1 day training (Level 1 training a on-line or prerequisite) telephone followup Face to face with 2 day training (Level 1 and 2 on-line or trainings a prerequisite telephone followup location with at least 10 participants As needed As needed See attached CVs: Certificate Marti Funnell, of MS, RN, CDE, 8 Cecilia Both Sauter CDE, $500 Bob estimate Andersen See attached CVs Statewide As needed See attached CVs Certificate of Certificate of 8 Both $500 estimate 16 Both by inviting previous regional participants $1000 estimate Page 4 of 6

5 Learning Action Network, Moderate Care Manager program, Ruth Clark Integrated Health Partners, Begins in Learning Session B - Week 2 of Phase 1 Phase 1: 6 week intensive training of core principles for MiPCT Moderate Care Managers; Pre-work Phase 1: Chronic Care Model. Core topics: Overview of the MiPCT program and care management model, PCMH overview, Coordination of care, Medical Neighborhood, Referral tracking specialist, community resources, Community linkages Basics of care management, Risk stratification Managing workflow Maintaining healthy care management relationships with patients Webinar/on-line Learning throughout six weeks: Evidence Based care clinical guidelines DM, Asthma, CAD, HF, COPD, HTN, depression, psychosocial assessment, health literacy and cultural, teach back. Face-to-face didactic; development; demonstration; selfdirected on-line research per assignment Face-to-face; webinar and/or conference call follow up Phase 1, Session A, Week 1 - Full Calhoun day face-to-face session; one - County; may two hour webinar/conference call conduct onsite at other locations if desired To be Varies by topic - Certificate of determined; first cohort will begin mid-to physician, nurse, Admin. Lead, completion end of February community (need participants to schedule training), agency, health, consultants Will apply for CEUs for face-to-face Negotiable Page 5 of 6

6 Learning Action Network, Self management training Moderate Care Manager program, Ruth Clark Integrated Health Partners, Define the term "self-management support" List at least one resource for obtaining selfmanagement support tools and/or training Describe two differences between traditional medical advice and/or patient education and selfmanagement support List at least one skill needed for effective selfmanagement support Demonstrate ability to conduct a selfmanagement goal-setting session Describe appropriate follow up needed on selfmanagement goals Develop plan to integrate self-management goalsetting with patients in the practice Describe the impact of depression on patients' ability to self-manage Identify general principles and key strategies of motivational interviewing Describe key differences in traditional health care discussions with patients and motivational interviewing Demonstrate ability to conduct effective motivational interviewing session Explain how improved health literacy and clear health care communication enhances patient outcomes Identify strategies for effective health care communication Identify resources for improved health care communication Define teach back and its purpose Demonstrate ability to conduct effective teach back Learning Session B - F (Half Days) Interactive assessment of the comprehension of webinar/on-line training from previous learning session(s) Self-management support Motivational interviewing Setting goals and determining patient confidence Teach back interactive learning session PCMH overview Medication Reconciliation Transitions of care Conflict Resolution Managing workflow Resiliency Change fatigue Measurement of Care Management effectiveness Webinar/On-line Learning Sessions B - F Evidence based Care Clinical Guidelines DM, Asthma, CAD, CHF, COPD, HTN, Depression Guidelines, Protocols, Identifying Red Flags, Advance Directives Face-to-face didactic; development; demonstration; selfdirected on-line research per assignment Face-to-face half day weekly for five weeks; weekly webinars and/or conference calls Phase 1, Sessions B - F Weeks 2-6 Half day face-to-face ; one - two hour webinars/conference calls each week Calhoun County; may conduct onsite at other locations if desired To be Varies by topic - Certificate of determined; first cohort will begin mid-to physician, nurse, Admin. Lead, completion end of February community (need participants to schedule training). agency, health, consultants Will apply for CEUs for face-to-face Negotiable Learning Action Network, Self management training Moderate Care Manager program, Ruth Clark Integrated Health Partners, ClarkrU@bronsonhg.org Objectives for Phase 2: Sharing best practices of care management from the cohort of learners Identifying measures of the effectiveness of the care manager in his/her role Sharing of data and collegial support/feedback Using coaching model for sustaining self growth in the care management role Facilitating group learning on challenges and solutions of workflow of care management Phase 2: Developing a Community of Collegial Care Managers Face-to-face didactic; sharing of best practices; development Quarterly face-toface half-day ; quarterly webinar or conference calls (contact every six weeks Quarterly face-to-face half-day ; quarterly webinar or conference calls (contact every six weeks Calhoun County; may conduct onsite at other locations if desired To be Varies by topic - Certificate of determined; first cohort will begin mid-to physician, nurse, Admin. Lead, completion end of February community (need participants to schedule training) agency, health, consultants Will apply for CEUs for face-to-face Negotiable Page 6 of 6