In January, WIPHL trained seven new health educators to deliver behavioral screening and intervention (BSI) at five Wisconsin clinics. The training consisted of more than 60 hours of learning and practicing Motivational Interviewing, screening, brief assessment, behavioral activation, and care coordination skills. The health educators also learned about evidence-based tobacco cessation approaches, collaborative care for depression and information on how alcohol and drugs impact health. This training met the criteria to bill Wisconsin Medicaid for SBIRT services, and at the end of the two-week training program, all seven health educators passed written and simulated patient exams.
Health educators meet with patients who screen positive on questionnaires for alcohol, drug use and other behavioral risks and conduct further assessment to deliver interventions or make referrals, as appropriate.
This new group of health educators will be working at:
- Family Health / La Clinica, Wautoma
- Sargeant Internal Medical Clinic, Medical College of Wisconsin,Wauwatosa
- Richland Medical Center, Richland Center
- University Health & Counseling Services, University of Wisconsin-Whitewater, Whitewater
- Watertown Area Cares Clinic, Watertown
By Laura Saunders, MSSW
When behavioral screening and intervention (BSI) becomes routine in healthcare settings, where will the new workforce of trained health educators come from to provide these services? Luckily, Dr. Gary Gilmore is helping take care of just that.
At the University of Wisconsin – La Crosse (UW-L), Dr. Gilmore and his colleagues are preparing the university’s community health education students for the future task of delivering BSI in general healthcare settings.
With help from WIPHL and funding from the UW School of Medicine and Public Health’s Wisconsin Partnership Program, UW-L faculty developed the curriculum for the initial course and was trained in Motivational interviewing (MI). MI is an evidence-based approach to facilitating conversations that help people recognize and take action upon their internal motivation for change. The MI approach provides us with a method of communication that serves as a solid foundation for BSI.
Last semester, 10 students completed a 16-week, 3-credit course on a MI approach to delivering BSI. Feedback from the health education students indicates that this course is indeed a step in the right direction.
- “This (course) is an innovative and highly effective evidence-based technique that is applicable to almost every health topic. It is one of the best tools I’ve added to my professional toolkit.”
- “I believe this class is something that I can take with me no matter what I end up doing in my professional career. We have the opportunity to interact with people on a daily basis, having active listening skills are a valuable practice that not many people do well.”
- “This is exactly what we need as health educators. It teaches us that we can’t just fix people with education. I think this should be a mandatory class.”
- “I believe everyone working in health professions should learn MI.”
This semester, those students are delivering BSI in a 16-week preceptorship at various clinical sites. WIPHL’s Dr. Rich Brown and Laura Saunders are consulting with the sites about modifying patient flow to maximize BSI delivery. The UW-L faculty are conducting regular case teleconferences with their students, and reviewing and giving feedback on audiotapes of interviews between the students and actual patients.
The two-semester program will be revised, based on evaluation data, and offered to more students in the 2013-2014 academic year.
By Mia Croyle, MA
The third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013) is the authoritative presentation of Motivational interviewing (MI). This edition represents the latest in what is known about this powerful approach to facilitating change after 30 years of research and clinical experience.
One of the newest ideas introduced in this edition is that of the four processes which occur in a generally sequential, yet overlapping and recurring, fashion in the motivational conversation.
These four processes are:
- Engaging – building the relational foundation for a collaborative working relationship.
- Focusing – developing and maintaining a specific agenda.
- Evoking – drawing out the other person’s own motivation for change and his or her ideas about whether and why to make a change.
- Planning – partnering with the person to consider their thoughts about when and how they might want to go about making a change.
To be clear, MI is much more than a simple four-step checklist. It is a complex intersection of these four processes with our core set of skills and a specific style that helps us engage in purposeful conversations that can help people change.
For more information, buy the book here or contact us at firstname.lastname@example.org to learn more about motivational interviewing.
By Richard L. Brown, MD, MPH
While it has been clear for years that millions of Americans with mental health disorders have suffered terribly from poor access to services, it sadly took the killing of 20 school children in Connecticut to galvanize concern about the state of mental health care in our nation.
Wisconsin Governor Scott Walker has proposed nearly $30 million in increased funding to improve mental health services in Wisconsin. Funds would go to a new state office for children’s mental health, community-based services for seriously mentally ill adults and children, in-home counseling for children, and additional forensic units at Mendota Mental Health Institute. Clearly, these funds are needed.
But we should make certain we do not lose sight of the concomitant need to improve services for the majority of patients with mental health disorders who do not receive specialty-based services.
In typical primary care settings:
- Ten percent of patients have major depression, and about one-third to one-half go undiagnosed.
- Patients diagnosed with depression often receive suboptimal care – for example, inadequate doses of antidepressants or inadequate changes in treatment when patients do not attain full remission.
- Diagnoses of bipolar disease are often delayed for up to years while patients’ “inappropriate behaviors” wreak havoc on their lives and the lives of their family members and friends.
Research has shown we can do much better, and a large part of the answer is collaborative care. Dozens of randomized control trials show depressed patients who receive collaborative care for depression have quicker and more complete resolution of depression than those who only receive typical care in primary care settings. In nearby Minnesota, Project DIAMOND has found that collaborative care doubles treatment response (from 34% to 70%) and nearly doubles complete remission (from 30% to 53%) at one year. Some studies suggest that collaborative care can be helpful for anxiety disorders and psychoses as well.
Collaborative care requires expanding the healthcare team with individuals who can spend more time with patients than typical primary care providers. Those trained individuals (we call them “health educators”) administer standard questionnaires to gauge the severity of depressive disorders and assess for other mental health disorders. They educate patients about depression, explain treatment options and instill optimism. They deliver behavioral activation interventions, engaging patients in behaviors that lift depressive symptoms, such as exercising and socializing. They contact patients regularly to maximize engagement in treatment and reassess depression severity regularly and “pull the alarm” when insufficient improvement suggests a need to reconsider treatment plans.
A rigorous study, updated for inflation, concluded that a $900 investment in collaborative care for each depressed patient yields healthcare savings of $5200 over the next four years. That means for every dollar spent, net savings total $4.75. If 10% of Wisconsin’s 420,000 Medicaid recipients are depressed (most likely, an underestimation), collaborative care could save the state $180 million over four years – enough to fund Governor Walker’s initiative six times over!
That’s what WIPHL is all about – delivering behavioral screening and intervention (BSI) services that improve public health while decreasing costs. Please see www.wiphl.org for more information on how can make BSI routine in Wisconsin healthcare settings.