Two well-recognized prac­ti­tion­ers, at UMass and Wal­ter Reed, will describe their respec­tive well­ness and rehab ini­tia­tives, focus­ing on the prac­ti­cal con­sid­er­a­tions to nav­i­gate, select, and imple­ment the grow­ing array of technology-enabled brain health and behav­ioral health assess­ments and interventions. -- Chair: Dr. Majid Fotuhi, Chair­man of the Mem­o­syn Neu­rol­ogy Institute -- Dr. Dou­glas Ziedo­nis, Pro­fes­sor and Chair of the Depart­ment of Psy­chi­a­try at the Uni­ver­sity of Mass­a­chu­setts Med­ical School -- Kate Sul­li­van, Direc­tor of the Brain Fit­ness Cen­ter at Wal­ter Reed National Mil­i­tary Med­ical Center Presentation @ The 2015 SharpBrains Virtual Summit http://sharpbrains.com/summit-2015/agenda

1. Best practices to
navigate and
implement the
emerging brain
health toolkit

2. Workshop: Best practices to navigate and
implement the emerging brain health toolkit
Chaired by: Dr. Majid Fotuhi,
Chairman of the Memosyn
Neurology Institute
Dr. Douglas Ziedonis
Professor and Chair of the
Department of Psychiatry at the
University of Massachusetts Medical School
Kate Sullivan,
Director of the Brain Fitness Center
at the Walter Reed National
Military Medical Center

3. Douglas Ziedonis, M.D., M.P.H.
Professor and Chairman
Department of Psychiatry
UMass Memorial Medical Center/
University of Massachusetts Medical School
Douglas.Ziedonis@umassmemorial.org
Douglas Ziedonis, M.D., M.P.H.
Professor and Chairman
Department of Psychiatry
UMass Memorial Medical Center/
University of Massachusetts Medical School
Douglas.Ziedonis@umassmemorial.org

4. Wellness Initiatives at University of Massachusetts
Medical School & UMass Memorial Health Care
Department Level - Psychiatry
All employees – faculty, staff, and trainees
ACOs – 3 for Patients
Mindful Physician Leadership Program

5. UMass Psychiatry Wellness Initiative

6. The program has five (5) main components:
myStatus
myPlan
myLifestyle
myFitness
myNutrition

7. Mindful Physician Leadership Program
 Mindfulness creates space to be more focused, clear,
creative and compassionate leader
 Three practices of the mindful leader:
 Reflections, Purposeful pauses, Mindful meditation
 Physicians Foundation grant
 AAMC & Massachusetts Medical Society
 Year long program - retreats, webinars, and
community meetings
 Mindful Coaching

8. Factors in Decision Making
 Value- cost/quality ratio
 Ease of use
 How Use – short term help versus long term?
 Compatibility with online portal or other IT barriers
 Privacy issues
 Pilot Test - is there an opportunity to interact with the
technology before purchase?
 Which technology options work for whom?
 Training clinicians and other leaders on use of apps to
scale up mindfulness

9. Step 1-Conduct effective needs assessment
 Use evidence based tools in line with strategic priorities/plan
 Maximize penetration in survey participant population
 Access to assessment
 Ease/ability to complete
 Analyze results
 Prioritize findings based on value & strategic plan
 Share results of needs assessment with participant group

10. Wellness Objectives
 Modify the work environment to support behavior
change efforts
 Appeal to all employees, not just a “fitness” program
 Engage employees in adopting healthier lifestyle
choices
 Improve the overall health of our population

11. Developing the Capacity for Mindful Practice
Amongst Ourselves & in Organizations
 Being present
 Attentiveness
 Situational awareness
 Mindful communication
 Team work
 Self-awareness and monitoring
Center for Mindfulness in Medicine, Healthcare, and Society – UMass Medical
School
www.umassmed.edu/cfm/

12. Step 2-Review assessment findings to
determine programs/services
 Review existing offerings and ability to meet
current needs
 Look to maximize effectiveness of existing
offerings if they have the capacity to meet the
needs
 Determine gaps in existing offerings or inability to
effectively meet need

13. Step 3-Conduct market analysis to fill gaps
 Analysis to find solutions to address gaps in current offerings
 Vetting process
 RFP/RFR
 Literature review
 SME network outreach
 SWOT, Decision Matrix or other analysis to include
 Ability of solution to effectively address needs (evidence based)
 Access/ease of adoption of solution for end user
 Logistical viability
 Life cycle of solution
 Ability to protect participant information/security
 Budgetary constraints
 Request additional information from top selections
 Review analysis, make selection, and negotiate

14. Pricing Considerations
 Cost Structure-Access
 Individual User (self pay)
 Subscription Service
 One Time Fee
 Company
 Per Member, Per Month (Range: $1-4 PMPM)
 Per Enrollee (Range: $50-200 ea)
 Per Completer (Range: $150-500 ea)
 Capitation (purchase of 20-40% of participant population access)
 Cost Structure-Implementation/Maintenance/Reporting
 One Time Fee
 Monthly
 Annually

15. Fee Based Apps/Devices
 Wellness Portal
 Limeade
 Virgin Pulse
 Provant
 Weight Management
 Weight Watchers
 Healthy Wage
 ShapeUp
 Disease Management
 Livongo (Diabetes)
 Thrive 4-7 (Depression/Anxiety)
 Orcas (Moodhacker, CoachHub, FitBack, etc.)
 Craving to Quit (Tobacco Cessation)

16. Using Technology in a Wellness
Initiative• Wearable devices
• Fitbit
• Virtual Reality Headsets
• Apps
• Craving to Quit
• My Fitness Pal (free)
• Zazen Lite- Mindfulness bell and timer (free)
• Interactive websites
• Beating the Blues, treats depression and anxiety by
using Cognitive Behavioral Therapy (CBT).
• CBT-I, a 5-week, 5-session online cognitive-behavioral
therapy program for insomnia that was developed by Dr.
Gregg Jacobs.

17. Addressing Why Through Organizational
Change (AWTOC)
 Identify the “Why” which links the “Identified
Problem” to the Culture’s Mission and Desired
Change
 Use AWTOC to structure the process of change
 3 Phases & 10 Steps
 Leadership: Roles & Responsibilities
 Importance of Communication
 People & Technology
 Training, Apps, websites, MP3s, etc
 Tracking and Sustaining Change
 EX: http://umassmed.edu/psychiatry/resources/Tobacco/attoc/

18. The UMass Psychiatry Wellness
Initiative Web-Based Resources
• Wellness Web-Based Toolkit -
www.umassmed.edu/psychiatry/resources/wellness/
• Mindfulness in Psychiatry –
www.umassmed.edu/psychiatry/resources/mindfulness/
• Tobacco Consultation Service-
www.umassmed.edu/psychiatry/resources/tobacco/tobacco-
consultation-service/
• Mindful Physician Leadership Program
• http://www.umassmed.edu/psychiatry/MindfulLeadership/

19. THE NATIONAL INTREPID CENTER OF EXCELLENCE
BRAIN FITNESS CENTER
WALTER REED NATIONAL MILITARY MEDICAL CENTER
BEST PRACTICES TO NAVIGATE AND
IMPLEMENT THE EMERGING BRAIN HEALTH TOOLKIT
Kate Sullivan M.S., CCC-SLP
Director, Brain Fitness Center
Katherine.sullivan.ctr@mail.mil

20. 20
Disclosure
The reviews expressed in this presentation are those of the
presenter and do not reflect the official policy of
The Department of Defense or the U.S. Government.
The description of programs in this presentation is for
descriptive purposes only and not intended to promote
any individual program.

21. 21
Brain Fitness Center
Clinical
Education
Research
 Started in 2009 for any patient complaining of
cognitive dysfunction. The BFC expanded to
FBCH in February 2012.
 Help patients establish brain-healthy habits to
help decrease long-term risk factors.
 Provide tools to complement rehabilitation
goals. Over 850 patients of varied dx have been
seen in the BFC; program choice and length of
participation varies widely.
Photos Courtesy of WRNMMC/NICoE
 Conduct research to
investigate the feasibility
and effectiveness of the
programs provided in the
BFC.

22. 22
Training
 Unless specified by referring provider, patients choose their own program
 Patients are encouraged to engage with a program that will keep them
challenged but entertained at the same time
 If need help choosing, we discuss cognitive complaints, ANAM findings,
neuropsychological assessments
 On average patients engage in the BFC
2x week for approximately 45 days
 Patients are given a computerized
cognitive assessments and symptom
self-report measurements at the initial
visit and every 6-8 weeks.*
* Mayo-Portland Adaptability Inventory-4 (MPAI-4) ; Military version recently added (MPAI-M); Neurobehavioral Symptom
Inventory (NBSI); Satisfaction with Life Scale (SWLS) ; Headache Impact Test – 6 (HIT-6); Post-Traumatic Stress Disorder
Checklist – Civilian Version (PCL-C); Response to Stressful Experience Scale (RSES); Automated Neuropsychological
Assessment Metrics (ANAM)

23. 23
Choosing a Library of
Brain-Training Tools
Adaptability
Intensity
Engagement
 Cross-trainers and domain
specific options
 User friendly and
accessible
 Realistic dosing
 Scientific backing
 Patient and provider
(remote) feedback
 Evolve with population
needs and new science
and technology
 Independent use, a
clinical tool and a
research project
 Enhance normal
cognition, maintain or
slow down decline, and
remediate impaired
cognition
 Provide training as
adjunct to rehabilitation
and maintenance of care

24. 24
Photos Courtesy of WRNMMC/NICoE
Selection is based on rehabilitation goals,
challenge level and patient decision.
Program Choice

25. 25
Photos Courtesy of WRNMMC/NICoE
Education tools and progress reports
vary among programs.
Clinician Tools

26. 26
Evolving Population Base
0
10
20
30
40
50
60
70
2008 2009 2010 2011 2012 2013 2014 2015
NumberofPatients
Year
Brain Fitness Center
Patient DX Trends
(Through October 2015)
TBI DX
PSYC DX
Comorbid Patients with
PSYC & TBI DX
Neurological DX
(e.g. ABI, CVA, MS)
Cancer Related
Cognitive Dysfunction

27. 27
Evolving Patient Needs,
New Science and Technology
Program Choice Example
 Research protocol with bio
and neurofeedback
 Led to clinical interest and
use in these tools
 HRV biofeedback available
+ growing number of
patients who may benefit
 Initiated Mind-Body classes
to maximize effort
 Evolution with Neurofeedback

28. 28
HRV Training and
Mind Body Classes
0
10
20
30
40
50
60
70
Case 1 Case 2 Case 3
TotalScore
MPAI-4
0
10
20
30
40
50
60
70
Case 1 Case 2 Case 3
TotalScore
NSI
0
5
10
15
20
25
30
35
Case 1 Case 2 Case 3
TotalScore
SWL
Symptom Self-Reports
0
20
40
60
80
100
120
Case 1 Case 2 Case 3
ANAM
AvgStTP
(Correctresponses/min)
Case #1
A 30 year old male US Army Sergeant and licensed nurse after a 1-year
deployment to Iraq, he received a diagnosis of PTSD, adjustment
disorder, depression, sensorineural hearing loss and chronic fatigue
syndrome.
Case #2
A 51 year old female US Navy Captain and executive leader with a
Master’s degree underwent a resection of a left lateral sphenoid wing
malignant meningioma in February 2014 followed by radiation therapy
5x/week for 6 weeks.
Case #3
A 35 year old male US Air Force Staff Sergeant and Signals Analyst with
a Bachelor’s degree deployed to Iraq five times in 3 years. He had a
history of multiple mild TBIs and was diagnosed with PTSD, sleep apnea,
an eating disorder and fibromyalgia.
Cognitive Assessment

29. 29
Additional Education
and Therapy
LTC Annie Fox: the BFC’s newest variable
Brain Health Initiatives

30. 30
 Understand the population, their goals and your goals
 Evolve as those change
 Consider scientific foundation, don’t be afraid to use tools
while science is still emerging
 Try many, use many
 One tool is likely not the answer but a piece to the puzzle
Summary
Katherine.sullivan.ctr@mail.mil
Best practices/lessons learned to navigate
and implement the emerging brain health toolkit

31. Watercooler chats:
Time to meet 

32. To learn more, visit sharpbrains.com