Behavioral Activation: Techniques for Transition Planning

1. Behavioral Activation Presented by: Diana Hope-Baker Michelle Dattada July 31, 2018 7/19/2018 1

2. Behavioral Health Team Stacy Hull, LPC MAC Behavioral Health Task Manager, GA and NC My experience working with severe persistent mental illness and substance use provides me with the insight and knowledge needed to help primary care practices and inpatient psychiatric facilities address the behavioral health challenges they face. Melanie Akin, CRC EDS, Behavioral Health Technical Advisor, GA and NC Inpatient Psychiatric Facilities My previous work as a social worker in the acute care setting combined with my clinical experience on an inpatient psychiatric unit for adults, has given me a unique perspective on all of the aspects that go into a successful discharge transition following hospitalization.

3. Behavioral Health Team – Primary Care Practices Diana Hope-Baker, LCSW Behavioral Health Technical Advisor, Georgia My clinical background as a  behavioral health clinician in both the collaborative care and integrative care settings has provided me with the skill set to effectively promote behavioral health screenings in primary carepractices. Michelle Dattada, LCSW Behavioral Health Technical Advisor, North Carolina With 20 years of experience in providing clinical services to those coping with severe mental illness and substance use disorders, I have the skills to navigate the spectrum of treatment needs that patient’s experience and the ability to promote this understanding to primary care physicians. 

4. Today’s Objectives • Introduce Behavioral Activation(BA) • Explore the benefits of using Behavioral Activation • Develop understanding of the techniques in Behavioral Activation • Identify strategies to align transition planning with Behavioral Activation skills

5. Cycle of Depression

6. How Did We Get Here? • Cognitive Therapy: Beck and Ellis1960’s • Merged with Behavioral Therapy to form CBT • Popularity increased with positive outcomes and Cognitive Therapy became the treatment of choice • Research showed that outcomes gained were clinician dependent • Behavioral Activation: Peter Lewison’s functional approach to depression • Support for use independently was reduced with positive CT and CBT outcomes • Growing research with focus on quality, outcomes and brief interventions in healthcare • Research showed that outcomes were based on the patient’s use of skills and motivation

7. Effectiveness of Behavioral Activation BA is effective across a variety of settings and populations in treating depression Behavioral Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis. David Ekers , Lisa Webster, Annemieke Van Straten, Pim Cuijpers, David Richards, Simon Gilbody Published: June 17, 2014 https://doi.org/10.1371/journal.pone.0100100

8. Behavioral Activation Overview • Evidenced based intervention to treat depression • Structured • Brief and easy to use • Patient driven process • Helps patients increase positivereinforcement in their lives • Patients are asked to act according to a plan or goal rather than a feeling • Targets patterns of avoidance, withdrawal, and inactivity

9. Step 1: Help patients gain an understanding of depressive symptoms and impact on functioning • Ongoing opportunities from intake, evaluations and transition to discharge • Patient education focus: depression symptoms and medication impact on functioning • Transition Tool Options: Alliant Quality Depression Zone Tool for self symptom management *include depression zone tool representation http://www.alliantquality.org/content/orders

10. Step 2: Explain the link between mood and behavior • Opportunities during intake, ongoing evaluation and transition to discharge • Patient Education Focus: Mood monitoring and resources available (Mood Coach app from VA Department, web based tracking, journaling) • Use of activity and mood trackers http://www.alliantquality.org/?q=content/orders

11. Step 3: Increase identification of acting from “outside in” rather than “inside out” • Re-establish routines and strategies to continue at home • Meeting self-care needs, social, physical • Develop and reinforce scheduling and planning skills • Plan for activities that are pleasurable and/or promote mastery • Identify change potential, easier to start small “Little Fun” versus “Big Fun” • Map the course from action or inaction to outcome achieved • Start from where you want to end. How do you want to feeland what can you do to make that happen?

12. Step 4: Help identify behaviors that fit with life goals and values • Consistently have patient identify values and interests • What did you like doing that you are not doing now? • Connect discharge planning goals, objectives and interventions to patientvalues and personal goals • Examples: Taking medication respects your want to stay out of the hospital, walking your dog makes you happy and that’s important to you

13. Step 5: Support the patient in setting specific goals and behavioral steps to achieve • Reinforce daily recognition of ALL accomplishments • Engage familyand supports in the community, build in reinforcement, affirmation and incentives • Address barriers to achievement • Define SMART goals in transition planning • Specific • Measurable • Attainable • Realistic • Time Limited

14. Activity List

15. Helpful Tips for Patients Take ACTION A– Assess what is causing the depressed feeling C– Choose to self-activate T– Try the new behavior I – Integrate the behavior into a routine O– Observe the results N– Never give up

16. Resources • Behavioral Activation for Depression: A Clinician’s Guide (Martell, Dimidjian, Herman-Dunn, 2013) www.guilford.com/p/martell2 • Behavioral Activation: CBT Distinctive Features Series (Kanter, Busch, and Rusch, 2009) • Mood Coach (app by US Dept. of Veterans Affairs) in Apple store

17. This material was prepared by Alliant Health Solutions, for Alliant Quality, the Medicare Quality Innovation Network – Quality Improvement Organization for Georgia and North Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-AHSQIN-G1-18-41