Depression in Late Life Initiative - AIMS Center...• Coaching for interventions involving family...

Depression in Late‐Life Initiativemade possible by the Archstone Foundation

Depression in Late‐Life Request for Proposals (RFP)

Care Partners: Bridging Families, Clinics, and Communities to Advance Late‐Life Depression Care Phase 2, Cohort 2.

October 23, 2017

Care Partners Team• Laura Rath, MSG, Archstone Foundation

Senior Program Officer

• Jürgen Unützer, MD, MPH, MA, University of WashingtonInvestigator, Care Partners

• Ladson Hinton, University of California, DavisInvestigator, Care Partners

• Theresa Hoeft, PhD, University of WashingtonInvestigator, Care Partners

• Mindy Vredevoogd, University of WashingtonProject Manager, Care Partners

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Outline of Webinar• Background on Archstone Foundation and Depression in Late‐Life Initiative

• Need to improve late‐life depression care

• Collaborative care in primary care or out in the community

• Innovative approaches involving community partners

• Phase 2 RFP: Implementing innovative approaches to treating depression in older adults through the following three types of partnerships:

• Collaborative Care Primary Care Clinic – CBO Partnership

• PEARLS CBO ‐ Primary Care Clinic Partnership

• Collaborative Care Primary Care Clinic – Family Partnership

• Application Details

• Q & A

Archstone Foundation• The Archstone Foundation is a private

grantmaking organization whose mission is to contribute toward the preparation of society in meeting the needs of an aging population.

• http://archstone.org/

Depression in Late‐Life Initiative• Initiative to improve depression care in late‐life

• Phase 1, Cohort 1• Phase 2, Cohort 2

• Funding to UW and UC Davis to support:• Care Partners: Bridging Families, Clinics, and Communities

to Advance Late‐Life Depression Care

• Support from UW and UC Davis:• Developing the Request for Proposals (RFP) • Assistance in the selection process• Offering support to applicants and awardees• Fostering a learning community among awardees

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Jürgen Unützer, MD, MPH, MAUniversity of Washington

• Professor and Chair, Department of Psychiatry and

Behavioral Sciences

• Leader on the Improving Mood – Promoting Access to Collaborative Treatment (IMPACT) trial for late‐life depression in primary care

• Director, Advancing Integrated Mental Health Solutions (AIMS) Center

• Worked with > 1000 clinics to improve depression care

• Share with you background on:

• Need to improve late‐life depression care

• Collaborative care6

• Pervasive depressed mood/ sadness (or)

• Loss of interest / pleasureLack of energy, fatigue, poor sleep and appetite, physical slowing or agitation, poor concentration, physical symptoms (aches and pains), irritability, thoughts of guilt, and thoughts of suicide

• 5‐10 % of older primary care patients

• A miserable state that can last for months or years

Depression

Depression and mortality

How good is current depression care?

• Fewer than 2/10 see a psychiatrist or psychologist

• 5/10 receive treatment in primary care

• The “2 ‐minute mental health visit” (Ming Tai‐Seale, 2008)

• 4 ‐ 5 million older adults receive an antidepressant prescription, but only 20 % improve

• Few get effective psychotherapy

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Collaborative Care

Primary Care Practice with Mental Health Care Manager

Outcome Measures

Treatment Protocols

PopulationRegistry

Psychiatric Consultation

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Collaborative Care doubles effectiveness of care for depression

50 % or greater improvement in depression at 12 months

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20

30

40

50

60

70

1 2 3 4 5 6 7 8

Usual Care IMPACT

% im

prov

emen

t

Participating OrganizationsUnützer et al., JAMA 2002; Psych Clin NA 2004

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Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)• Collaborative care in the community• Highly effective method designed to reduce depressive

symptoms and improve quality of life in older adults – In‐home sessions with brief behavioral techniques– Part of existing community‐based program that already deliver care

and provide resources to clients– Incorporates current approaches to chronic illness care, including the

Chronic Care Model and Collaborative Care

• Evidence‐based: – PEARLS participants were more likely to have a significant reduction in

depression and an improvement in functional and emotional well‐being (JAMA. 2004 Apr 7;291(13):1569‐77)

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Ladson Hinton, MDUniversity of California Davis

• Professor, Department of Psychiatry and Behavioral Sciences• Developing family‐focused interventions for treating late‐life

depression• Coaching for interventions involving family as care partners• Involving families of older adults with chronic illness has

potential for improving care for chronic illness and depression (Wolff 2012; Hinton et al. 2014)

• Share background on:• Promise of involving care partners to improve care

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Promise of involving care partners to improve care

• Involving CBOs and family/friends can improve:• Access to care• Engagement in treatment • Patient care experience• Quality of care

• We know collaborative care is effective• Looking for ways partnerships between primary care clinics and

community resources can enhance collaborative care • Care partners might help with aspects of screening, diagnosis,

patient education, case management to address unmet needs, medication management and/or brief psychotherapy

• Additional support from care partners might be focused on more complex or vulnerable populations (e.g., home visits, case management) (See Resources section for background)

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Traditional Care

Primary Care Provider (PCP)

Patient

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Collaborative Care (IMPACT or PEARLS)

PCP

Patient CareManager

PsychiatricConsultant

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Engaging Family & Friends or CBO

PCP

Patient CareManager

PsychiatricConsultant

Family or CBO17

Phase 1 Partnership Examples• Primary Care – CBO

– Sonoma County Adult and Aging Services and FQHC clinic, Petaluma Health Center

– Enhancement to collaborative care in primary care: • Home visiting care manager from Sonoma Co. offers behavioral activation and case

management services in the home and by phone

• Care manager integrated into the clinic setting, EHR, and joins weekly case review calls with the psychiatric consultant

• PEARLS– El Sol Neighborhood Educational Center and Professional Family Counseling

– Implementing PEARLS program including more active collaboration with primary care (e.g., referrals and patient updates)

• Primary Care – Family– VA McClellan and Fairfield clinics are partnering with family care partners

– Enhancement to collaborative care in primary care:• Family are actively involved in helping with medication management, behavioral activation, etc.

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Quote“… actually offering those services really forces us to look around to say, are we the best person to do that, or is someone else in the community already doing it and really excelling at it? So this grant was really an opportunity for us to formally partner with a community agency that we knew was offering amazing services to our patients, actually, in somewhat of a silo. So we had communication with them around patients, but it was very limited. And we certainly weren't working together in a collaborative care model to include them.

I think the importance of community partnership really can't be overstated. So health centers are never really going to have the ability to offer every single service to our patients without having those collaborations are really critical for community health.”

‐ CMO at primary care clinic

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Theresa Hoeft, PhDUniversity of Washington

• Assistant Professor, Department of Psychiatry and Behavioral Sciences

• Health Services Researcher / Health Economist with degree more broadly in Population Health

• Community‐engaged research with clinics and communities• Share with you background on:

• RFP for Care Partners

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Care Partners Request for Proposals

• Care Partners: Bridging Families, Clinics, and Communities to Advance Late‐Life Depression CareFunding Opportunities:• Collaborative Care Primary Care Clinic – CBO Partnership • PEARLS CBO – Primary Care Clinic Partnership• Collaborative Care Primary Care Clinic – Family Partnership

• Developing innovative ways to share collaborative care tasks among partners and possibly across settings

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Funding Opportunity: CBO – Primary Care ClinicPrimary care clinic partnering with a CBO awards will be funded up to $150,000 per year for two (2) years and $75,000 in year three (3) for a total of $375,000 divided between the partners.

Collaborative Care Task Matrix - CBO and Primary Care Clinic

Identify Patients with Depression in CareTask 1. Identify people who may need help

Task 2. Screen for depression

Initiate and Provide Treatment for DepressionTask 3. Gather information to support a clinical assessment

Task 4: Diagnose depression

Task 5. Educate patient about depression

Task 6. Educate patient about treatment options

Task 7. Engage patient in depression treatment

Task 8. Develop and initiate a treatment / care plan

Task 9. Prescribe antidepressant medication, if indicated

Task 10. Educate patient about medications & other treatment side effects

Task 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment moda

Task 12. Provide evidence-based psychotherapy (e.g., PST, CBT, IPT), if indicated

Task 13. Provide case management or refer to social and other support services (e.g. housing, food assistance), if indicated

Task 14. Provide or refer to specialty mental health services outside primary care, if indicated

Track Processes of Care and Clinical OutcomesTask 15. Track treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatment

Task 16. Track delivery of care management support in a registry (e.g. follow-up calls to patients, clinic appointments, case reviews by psychiatric consultant, referrals)

Task 17. Reach out to patients not engaging in treatment

Adjust Treatment if Patients are Not RespondingTask 18. Regularly check treatment response and cue providers for possible changes in treatment, if needed

Task 19. Participate in regular (weekly) case review to identify patients who are not improving and provide treatment recommendations

Task 20. Ensure treatment recommendations get to provider and are enacted

Provide Administrative Support and Program SupervisionTask 21. Provide program support (e.g., scheduling, resources)

Task 22. Provide program supervision

Task 23. Attend regular planning meetings between the CBO and primary care clinic

Collaborative Care Team

Other Partners

Community-Based

Ogranization

Who will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone.

Primary Care ClinicPrescribing

Provider (PCP)

Non-Prescribing

Provider

Psychiatric Consultant

Patient

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Funding Opportunity: PEARLS CBO – Primary Care Clinic CBO delivering a PEARLS program partnering with primary care clinic(s) awards will be funded up to $150,000 per year for two (2) years and $75,000 in year three (3) for a total of $375,000 divided between the partners.

PEARLS Task Matrix - CBO and Primary Care Clinic





Task 5. Educate patient about depression

Task 6. Educate patient about treatment options

Task 7. Engage patient in depression treatment

Task 8. Develop and initiate a treatment / care plan in coordination with primary care

Task 9. Communicate with clinic provider and support antidepressant treatment, if antidepressant medication indicated

Task 10. Educate patient about medications & other treatment side effects

Task 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment moda

Task 12. Provide evidence-based PST/BA


Task 14. Provide or refer to specialty mental health services, if indicated

Track Processes of Care and Clinical OutcomesTask 15. Track treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatment





Task 20. Ensure treatment recommendations get to the PCP or other related provider and are enacted



Task 23. Attend regular planning meetings between the CBO and primary care clinic

Care TeamWho will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone.

PEARLS ProvidersPrimary Care

Clinic Other

PartnersPEARLS Counselor


Other Staff at CBO

Patient

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Funding Opportunity: Primary Care Clinic – FamilyPrimary care with family care partner awards will be funded up to $150,000 in year one (1), $100,000 in year two (2), and $75,000 in year three (3) for a total of $325,000.

Collaborative Care Task Matrix - Family InterventionFamily-focused Intervention





Task 5. Educate patient and family (as appropriate) about depression

Task 6. Educate patient and family (as appropriate) about treatment options

Task 7. Engage patient and family (as appropriate) in Collaborative Care for depression



Task 10. Educate patient about medications & other treatment side effects Task 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment modality




Track Processes of Care and Clinical OutcomesTask 15. Track treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatments)








Other Partners

Collaborative Care TeamWho will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone.


Provider (PCP)

Non-Prescribing

Provider


Family Member, Friend, or Significant Other

Patient

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Proposals with family members should include substantial family involvement

One example involving family members:

• Engaging patients in depression in care

• Facilitate evidence‐based depression treatment

• Track processes of care and clinical outcomes

Collaborative Care Primary Care Clinic – Family Collaborative Care Task Matrix - Family Intervention

Family-focused Intervention





Task 5. Educate patient and family (as appropriate) about depression

Task 6. Educate patient and family (as appropriate) about treatment options

Task 7. Engage patient and family (as appropriate) in Collaborative Care for depression



Task 10. Educate patient about medications & other treatment side effects Task 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment modality




Track Processes of Care and Clinical OutcomesTask 15. Track treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatments)








Other Partners

Collaborative Care TeamWho will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone.


Provider (PCP)

Non-Prescribing

Provider


Family Member, Friend, or Significant Other

Patient

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Eligible Criteria

• California non‐profit 501(c)(3) primary care clinics and non‐profit 501(c)(3) CBOs are eligible to apply if they have an established (i.e., existing) collaborative care program in primary care or PEARLS program in the community as defined by the description on page 3 of RFP

• Currently offer services to older adults (65 years of age and older)

• Have the capacity to offer partnered care to at least 100 older adults with depression over 3 years

• See RFP for complete eligibility criteria and list of special activities

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Collaborative Care• Collaborative care services must include:

– Screening for depression– Depression diagnosis– Patient education and engagement– Treatment, and treatment support, as appropriate to each patient (For examples, refer to the Collaborative Care Task Matrix and PEARLS Task Matrix appendices)

– Systematic tracking of depression outcomes using the PHQ‐9 depression measure (Patient Health Questionnaire – 9 item version) using a registry

– Regular psychiatric case review with recommendations for treatment adjustment if patients are not improving

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Budgeting Considerations• Budgets should reflect funding and project tasks for each

partner organization• A maximum of 10% is allowable for indirect costs• See RFP for other considerations such as travel to meetings,

including initial in‐person training

Applicants do not need to budget for collaborative care training and ongoing implementation support/coaching. This will be provided by UW and UC Davis if additional training is needed.

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Technical Assistance and Coaching to Awardees

• The team at UW and UCD will provide: – Collaborative care training and ongoing coaching to support projects (e.g., Problem Solving Treatment training as needed)

– Registry (i.e., Care Management Tracking System)

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Resources• Collaborative Care in Primary Care

– IMPACT: http://aims.uw.edu/impact‐improving‐mood‐promoting‐access‐collaborative‐treatment/

– Care Partners Website: http://uwaims.org/archstone/

• Innovations in Late‐life Depression Care – Partnering with CBOs – Community services for high‐need patients: https://nam.edu/effective‐care‐for‐high‐

need‐patients/– Community services for socially at‐risk populations:

http://www.nationalacademies.org/hmd/Reports/2016/Systems‐Practices‐for‐the‐Care‐of‐Socially‐At‐Risk‐Populations.aspx

• Innovations in Late‐life Depression Care – Partnering with Family – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324406/– New link to article: https://www.ncbi.nlm.nih.gov/pubmed/28962555

• PEARLS – http://www.pearlsprogram.org/

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Application Timeline

October 11, 2017 RFP/LOI Office Hours (11am‐12pm PST)October 23, 2017 RFP Webinar December 14, 2017 Letter of Inquiry (LOI) DueMarch 8, 2018 Full Proposals DueMarch‐June 2018 Review Process/Site VisitsJune 2018 Approval & Notification of AwardsJuly 1, 2018 Grant Period Begins

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Contact Information

• Laura Rath, MSG, Archstone Foundation• Application logistics and submittal • Email contact: [email protected]

• Mindy Vredevoogd, University of Washington• Application content areas (task matrices, eligibility,

resources, etc)• Email contact: [email protected]

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Questions and Answers

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