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Work­shop: Best prac­tices to nav­i­gate and imple­ment the emerg­ing brain health toolkit

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

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Work­shop: Best prac­tices to nav­i­gate and imple­ment the emerg­ing brain health toolkit

  1. 1. Best practices to navigate and implement the emerging brain health toolkit
  2. 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. 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, M.D., M.P.H. Professor and Chairman Department of Psychiatry UMass Memorial Medical Center/ University of Massachusetts Medical School
  4. 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. 5. UMass Psychiatry Wellness Initiative
  6. 6. The program has five (5) main components: myStatus myPlan myLifestyle myFitness myNutrition
  7. 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. 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. 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. 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. 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
  12. 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. 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. 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. 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. 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. 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:
  18. 18. The UMass Psychiatry Wellness Initiative Web-Based Resources • Wellness Web-Based Toolkit - • Mindfulness in Psychiatry – • Tobacco Consultation Service- consultation-service/ • Mindful Physician Leadership Program •
  20. 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. 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. 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. 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. 24 Photos Courtesy of WRNMMC/NICoE Selection is based on rehabilitation goals, challenge level and patient decision. Program Choice
  25. 25. 25 Photos Courtesy of WRNMMC/NICoE Education tools and progress reports vary among programs. Clinician Tools
  26. 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. 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. 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. 29 Additional Education and Therapy LTC Annie Fox: the BFC’s newest variable Brain Health Initiatives
  30. 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 Best practices/lessons learned to navigate and implement the emerging brain health toolkit
  31. 31. Watercooler chats: Time to meet 
  32. 32. To learn more, visit