Bi Cycle Health Initiative

RUNNING HEAD: BI-CYCLE, A PROGRAM TO FIGHT BIPOLAR DISORDER

BI-CYCLE, A PROGRAM TO FIGHT BIPOLAR DISORDER
IN THE MISSOURI COMMUNITY
AMY ALEWEL
SIMONE BAKER
ASHLEY BURDOLSKI
CARRIE CALLICOAT
MAURICIO CABRERA
SYNN JOHNSON
UMKC UNIVERSITY
HEALTH PROGRAM MANAGEMENT

BI-CYCLE A PROGRAM TO FIGHT BIPOLAR DISORDER1

TABLE OF CONTENTS

I.

Executive Summary…………………………………………………..4

II.

Rationale……………………………………………………………...5

III.

Logic Model………………………………………………………….10

IV.

Planning Committee………………………………………………….12

V.

Planning Model………………………………………………………16

VI.

Needs Assessment……………………………………………………18

VII.

Mission Statement, Vision Statement, Objectives, and Goals……….20

VIII.

Intervention-theoretical Framework………………………………….23

IX.

Resources……………………………………………………………..25

X.

Marketing Plan………………………………………………………..31

XI.

Implementation Strategy……………………………………………...34

XII.

Evaluation Strategy…………………………………………………...42

XIII.

References…………………………………………………………….45

XIV.

Appendices……………………………………………………………46


Frequently Asked Questions
What is BI-Cycle?
Good question! It is a program designed to add social support to bipolar sufferers. The typical
treatment for people with bipolar disorder is medicine which is quite effective, however very
little treatment programs offer social support to the extent that BI-Cycle intends to. (refer to the
Executive Summary and Rationale for more details)
Is there a need for BI-Cycle?
Absolutely! There are millions of people who suffer from this debilitating disorder in the U.S.
Unfortunately there are instances where extreme tragedies happen that could have been avoided
with quicker intervention, and BI-Cycle intends to solve this by encompassing those suffer with
constant social support (refer to Needs Assessment for more details)
How will BI-Cycle help those that it intends to serve?
BI-Cycle will offer a many services that intends to serve those with bipolar disorder, but first it
requires a logic solution that outlines it’s goals and purposes (refer to Logic Model for more
details)
Who will operate BI-Cycle?
Simply, the people that it intends to serve. The planners and operators of the planning committee
are plucked straight from the priority population (refer to Planning Committee and Planning
Model for more details)
Who will BI-Cycle serve and where?
BI-Cycle is a program built to serve the Missouri communities of St. Louis, Kansas City,
Columbia, and Springfield (refer to Needs Assessment for more details)
What is BI-Cycle’s purpose
BI-Cycle wants to help reduce mood cycling by helping diagnosing accurately, reducing
misdiagnosing, create better education, and offering social support (refer to Mission Statement
and Goals for more details)
What resources are required for BI-Cycle to work?
BI-Cycle is not an expensive program to implement, one of its selling points. It will however
require human resource to operate and run it (refer to Resources for more details)
How will BI-Cycle be evaluated?
Great question! The evaluation process will use resources from UMKC and/or KU med to
externally evaluate the program alongside periodical internal evaluation methods that will be
employed to make sure BI-Cycle hits is goals and objectives(refer to Evaluation for more
details)


How will BI-Cycle reach the masses?
Through a marketing program that intends on advertising after careful segmenting variables that
have been identified so that the campaign can reach the priority population(refer to Marketing
plan for more details).


I.Executive Summary
BI-Cycle is an intricate support system program that aims at the bipolar community of
Missouri. This program adds an extra twist to the main type of interventional treatment given to
those who are diagnosed with bipolar disorder. BI-Cyclerelies on a specific diagnostic tool,
family or friend support, healthy living, constant education, and constant report. The program is
meant to address the main issues with bipolar sufferers and those are: wrongful diagnosis,
medication adherence, mood cycling, and lack of social support. According to NIMH, the U.S.
is home to approximately 14 million bipolar sufferers. Bipolar sufferers in the Missouri
community stretches from Kansas City, to St. Louis, Springfield, and Colombia. There are over
400,000 poor souls that are struggling to cope with this debilitating disorder in Missouri alone.
(The National Institute of Mental Health (NIMH), 2009).
BI-Cycle hopes to change some of the tragic outcomes that happen to those who suffer
from bipolar disorder by making those individuals more informed, more educated, and more
supported to reduce suicide rates, depression, and many other issues resulting from the lack of
proper treatment. BI-Cycle will have a support staff and planning committee that come straight
from the priority population and who are specialist in mood disorders. The BI-Cycle Dream
Team is the name of the planning committee and most members have extensive knowledge about
the disorder and are even part of research teams that are looking for better therapies. BI-Cycle
has chosen a reliable evidence based measurement tool to help with diagnosis, along with an
education program that meant to inform the priority population as well as the creators and
planners of the BI-Cycle program. Proper evaluation is key to making sure the program is fresh
and on course for meeting its objectives and goals. Along with a marketing mix that includes
price, product, place, and promotion are essential to the success of the BI-Cycle program.


II. Rationale
A rationale for “BI-Cycle”: A campaign to create an effective encompassing treatment
program for bipolar sufferers in the state of Missouri.
Bipolar disorder (manic depression) is a lifelong mental illness that creates debilitating
episodes of mood swings that affect a person’s ability to function. Sufferers teeter back and
forth between “mania” and depressive moods, hence the term “manic depressive.” It is usually
diagnosed at around the ages 15-25 years old according to the Center for Disease Control (CDC,
2011). According to the World Health Organization, 35 million people suffer from bi-polar
disorder worldwide ("The global burden," 2002). The prevalence rate for bipolar disorder
worldwide is over 1.5% of the total population (The National Institute of Mental Health (NIMH),
2009). Approximately 1.5 in 100 people sufferfrom this disorder. Although globally the
disorder is not prevalent in all countries equally, where it does show up it has been shown to
follow the aforementioned prevalence rate (plus or minus 1%). It’s no coincidence that more
developed nations have the highest number of sufferers, both China and the USA contains the
largest bipolar populations in the world. With faster paced societies and increased workloads,
anxiety disorders such as bipolar disorder are starting to rise.
The United States has between 4-6 million bipolar sufferers and China has between 1014 million, according to the World Health Organization ("The global burden," 2002). According
to the CDC, “Bipolar disorder has been deemed the most expensive behavioral health care
diagnosis, costing more than twice as much as depression per affected individual. Total costs
largely arise from indirect costs and are attributable to lost productivity, in turn arising from
absenteeism and presenteeism. For every dollar allocated to outpatient care for persons with
bipolar disorder, $1.80 is spent on inpatient care, suggesting early intervention and improved
prevention management could decrease the financial impact of this illness “(CDC, 2011). In the


United States alone the estimated annual cost of treating and diagnosing bipolar disorder is over
$45 billion dollars a year (Hirschfeld & Lana, 2005)! If the numbers follow this trend, China
and the United States are estimated at easily spending more than $100 billion to combat bipolar
disorder.
Approximately 2.6% of the U.S. population suffers from bipolar disorder (Kesseler &
Chiu, 2005). That is an estimate of 1-3 people out of 10 or approximately 7.2 out of a 1000. In a
state such as Missouri that would mean that over 400,000 people would suffer from bipolar
disorder. Incidence reporting shows that about 40,000-80,000 U.S. citizens will be newly
diagnosed every year (CDC, 2011). Although that number does not seem intimidating, what are
intimidating are the symptoms of bipolar disorder. Those who suffer from it have extreme mood
fluctuations that can be dangerous to themselves or others. Even those that are diagnosed tend to
be diagnosed late in life, misdiagnosed, or sometimes fall through the cracks because of selfefficacy issues. There is also a high incidence of suicide among bipolar sufferers. Of the 400,000
Missouri sufferers of bipolar disorder almost half will contemplate suicide at least once in their
lifetime ("www.wfmh.org," 2006). That means that 200,000 current Missouri citizens will try to
take their life or contemplate it today or in the near future!
Why? There seems to be a break in the system. Although regimented medications are
extremely effective in controlling bipolar disorder, sufferers need support taking medications and
support in their day to day lives (Rogge, 2012). Without the support and just allowing the
sufferer to their own devices, sufferers tend to only take medications when they feel an episode
come on, or when depression sets in. This is a huge problem. Without a valid support system
50% of bipolar sufferers have more than 1 extreme episode every year ("www.wfmh.org," 2006).
In the case of an extreme episode deep depression or severe mania attacks cause debilitating


halts to life for an individual. Symptoms include: being easily distracted, little need for sleep,
poor judgment, poor temper control, reckless behavior and lack of self-control, binge eating,
drinking, and/or drug use, sex with many partners (promiscuity), spending sprees, very elevated
mood, excess activity (hyperactivity), increased energy, racing thoughts, talking a lot, very high
self-esteem (false beliefs about self or abilities), very involved in activities, very upset, agitated
or irritated (Rogge, 2012). These symptoms are dangerous because in “manic” or “depressive”
states, individuals who suffer have shown symptoms of temporary insanity and haziness.
There are two types of bipolar disorder and a hybrid called “mixed state” or cyclothymia.
Bipolar I is the most dangerous, sufferers swing between extreme high moods and extreme low
moods. Bipolar II sufferers typically do not experience mania or elevated moods, but they
experience something less extreme called hypomania, followed by extreme depression. Mixed
state or cyclothymiac sufferers alternate between depression and hypomania. Both Bipolar II
and cyclothymiacs are estimated to be misdiagnosed about 70% of the time (Hirschfeld & Lana,
2005). This is typically due to patients finally seeking help, but usually when they are suffering
from severe depression, which is what they are diagnosed with 70% of the time.
Several cases document infamous U.S criminals, including convicted murderers and
rapists, as diagnosed with bipolar disorder. Interesting enough these people include some of the
most notorious criminals of all time, Charles Manson, Ted Bundy, Jeffrey Dahmer, and BTK
killer Dennis Rader all had a form of bipolar disorder.
The World Health Organization (WHO) recommends a regimented medication plan that
is monitored by a licensed psychologist, psychiatrist or physician. WHO conducted several
studies and concluded using evidence based information that medication alone is not the most


effective treatment. Social support, licensed therapy, and physician or psychological care
together are extremely effective. They recommend that family or friends close to a bipolar
individual could help in social therapy for the individual. WHO recommends strongly that
someone close to the sufferer assist them with daily activities, which can become a strong
intervention with the disorder ("World health organization," 2012).
A proposed intervention program called “BI-Cycle,” could be an effective treatment
program that helps bipolar sufferers with the needed support system recommended by WHO.
BI-Cycle tries to create an effective ecosystem around a sufferer. First, a regimented medication
schedule is prescribed by a licensed physician or therapist. Secondly, the physician or therapist
creates a “dream team” with the sufferer using a family member or trusted friend that commits to
be an involved piece to the therapy of the sufferer. The entrusted person becomes very important
to the day to day life of the sufferer by being a support beam to him/her. This person will help
remind the sufferer to take medications, give emotional support, and be the eyes and ears for the
physician. BI-Cycle uses a special phone application to track daily, weekly, and monthly mood
levels, which can be in turn promptly emailed to physician or therapist to help keep track of
mood swings. This could help provide quicker and more detailed information to the physician or
therapist so if treatment adjustments need to be made they can be.
Thirdly, BI-Cycle intends to try to offer discount programs to local gym and fitness
facilities to encourage bipolar sufferers to get regular exercise. The CDC has documented that
studies show that exercise has been linked to reduce stress and regulate moods in people rather
they suffer from bipolar disorder or not (CDC, 2011). The dream team partner could help with
exercise by attending one low impact exercise class or routine offered by sponsoring gyms with
the sufferer. If there is not an available gym, the dream team partner could commit to a brisk


walk once a week with the sufferer. Finally, when the sufferer sees his/her physician or therapist
again, the therapist can count on being better informed because he/she would have gotten regular
status updates from the phone application to their email, and more valid information from the
dream team partner even if the sufferer can’t be counted on to do so by himself/herself. BICycle could also receive sponsorship help from drug stores. The drug stores would get a longterm customer in turn for offering a specialized discount to certain medications. Also BI-Cycle
could create a Facebook page that links the sufferer with social support. The page could be used
by other bipolar individuals who share their support, tell stories, and offer advice to each other.
Now that we understand bipolar disorder more than ever, it is time to accept that sufferers
in most cases are experiencing the symptoms of it by themselves and no real support system is
out there. There are support groups, therapy sessions, and even family advocacy programs, but
nothing that tries very hard to create a support bubble around those who suffer. The WHO
recommends this using evidence based information, but there is a huge need now for intervention
that is supported by social support and life style changes that could help those who suffer. Yes,
medication is an effective tool, but it is not the problem solver, it needs help and that help can
only come from people surrounding those who suffer, and that’s why BI-Cycle could and would
work. It builds on the effectiveness of medication and takes the social support to a level that
could make a real difference.


III. Logic Model
This logic model was built for the purpose of mapping out where BI-Cycle will start and
where it plans to ultimately be in the future. Logic models are important because:
They communicate the purpose of the program
Describe the actions expected and desired results
Used as a reference point for everyone involved
Help with planning, implementation, and evaluation
Involves all stakeholders
(McKenzie, Neiger & Thackeray, 2013)
The model created can be tweaked where needed, but is specific enough to specify BICycle’s roadmap. This will also allow the planners to create an solid implementation strategy
that is sure to increase the chances of a successful program. See next page for the logic model
map.
See next page for Logic Model Map.


IV.Planning Committee
Following the recommended guidelines outlined in a typically planning process regarding
creating and implementing a solid program. The planning members were selected under the
following criterion:
1. This committee is comprised of members who are readily available within the priority
population that the program BI-Cycle is geared towards serving. The committee
representatives were carefully selected by expertise first and if he or she lives, works, or
has a vested interest in the Missouri community that BI-Cycle intends on serving. These
members are well respected and trusted and already representatives to the target
population.
2. The committee will also include at least one “doer” that is someone who is diagnosed
with bipolar disorder and believes in the cause of BI-Cycle. This person will be sensitive
to this disorder and understand the importance of BI-Cycle’s mission to the priority
population it aims to serve.
3. The committee will comprise of a healthy mix of “doers” and “influencers.” BI-Cycle
intends on having specific members promote itself through political prowess, community
influence, and leadership capabilities. Other members will promote BI-Cycle’s cause
from within the community itself, by using BI-Cycle as an alternative available program.
Educating and promoting within the community will also be a task by those considered
“doers.”
4. The committee will also include at least two sponsors that may help share financial
support and help with the promotion and education as well. Sponsors will be able to not
only promote BI-Cycle but be allowed to partake in the residual promotion of their own


company or business by understanding that BI-Cycle and his or her business is a
partnership. BI-Cycle understands that any sponsor who believes in its cause has a
vested interest in the success of the program.
5. At this time BI-Cycle only seeks sponsorships from partners in the priority population
who are in the category of health awareness, which includes: those who sell and
distribute bipolar disorder medications, those who offer exercise programs that help
relieve stress and anxiety, and possible private sponsors that fall into one or more of these
categories.
6. BI-Cycle’s planning committee will meet at least once each quarter of the year to discuss,
evaluate, and select new members if necessary. The planning committee will discuss
new program details, progression details, adjustments to marketing campaigns, education
updates etc.
7. Each member can serve up to six years on the BI-Cycle committee board. There will be
a voting process that will determine new members. A member can serve up to two terms,
with one term being three years. Potential members will be voted in by current
committee members not up for re-election. A majority vote of over 50% will win a new
member a position on the committee board.
8. Each member must pledge into office once elected and take an oath of commitment to
BI-Cycles purpose, understanding that BI-Cycle only acknowledges those with the
highest ethically regard to its cause. BI-Cycle does not encourage fraternizing amongst
its members or biases.


9. BI-Cycle committee members will determine if more members are needed because of
population growths or more representatives are needed within the priority population. As
it stands BI-Cycle estimates it needs approximately 22 committee members now.
10. At the moment, there will only be one committee board located within a centralized
location within the target population. If there is a need for additional committee
members or subcommittees, that will be determined by the main committee members. It
is the responsibility of all BI-Cycle members to determine the number of group members
needed at a given time.
11. BI-Cycle will follow the formula below to guarantee a solid committee team:

+

+

+

=

+

+


Recognized members (BI-Cycle Dream Team):
1. Dr. Todd Schaible – Columbia, Missouri/ Burrell Behavioral Health Facility Influencer
has links to Governor Jay Nixon
2. Keith Schafer, Ed.D., Director – Missouri Mental Health Program Influencer
3. Jan Heckemeyer, Deputy Director- Missouri Mental Health Program Influencer
4. Mr. R. James Kelly, Director – Jackson County Health Department Influencer
5. Marguerite Grandelious – St. Louis Mental Health Board Influencer
6. Leon Ashford, Ph.D. – St. Louis Mental Health Board Influencer
7. Ted Brandt, Assistant Manager – University of Missouri Health System Influencer
8. Harry Veo, Regional President of Sales – 24 Hour Fitness Influencer
9. Charlotte Taff, Regional Manager – Anytime Fitness Influencer
10. CVS MemberSponsor
11. Walgreens MemberSponsor
12. Wal-Mart MemberSponsor
13. Also: 6-10 members from the priority population who are bi-polar sufferers that can help
advocate program, educate other sufferers and help implement program objectives in the
community. DOERS


V. Planning Model

The stakeholders of the BI-Cycle program will use the Generalized Model for planning
and evaluation. According to McKenzie, Neiger & Thackeray(2013), the Generalized Model
consists of five elements or steps: (1) assessing needs, (2) setting goals and objectives, (3)
developing interventions, (4) implementing interventions, and (5) evaluating results.
After careful pre-planning it has been determined that the stakeholders of BI-Cycle will
collect data in a few key categories: medication adherence, the amount of Missouri population
that suffers from bipolar disorder and manic/depressive incidence.


1. Assessing needs: Data was collected using the most recent statistics and information from
local state records, Center for Disease Control, and the World Health Organization. The
information complied has helped identify the priority population being located within the
Kansas City, Columbia, St. Louis, and Springfield zone.
2. Goals and objectives: Each goal set in BI-Cycle is meant to perpetuate an ongoing cycle
of support and growth within the program. BI-Cycle’s objectives are measurable and
benchmarks are set using statistical data from reliable sources.
3. Developing interventions: The intervention used will be BI-Cycle itself. It serves to solve
the problem of low social support among bipolar disorder sufferers and low medication
adherence.
4. Implementing interventions: BI-Cycle will be implemented using a strong committee
front that sets guidelines, education, and other information to be delivered. Strong
marketing will be required, and cooperation with key medical personal using the
STABLE measurement tool is key.
5. Evaluating results: BI-Cycle will be evaluated by a team of UMKC students, which will
allow them to be able to publish those results in the school journal for further research
purposes.


VI. Needs Assessment
The purpose of a needs assessment is many. First, it must be determined if the
community targeted has a need for a program such as BI-Cycle. Secondly, it will allow the
appropriate use of planning resources. Third, a solid needs assessment should prevent delays to
a more important issue. Fourth, the assessment can determine the capacity of the Missouri
community. Finally the key to this needs assessment can provide a focus on developing an
intervention to meet the needs of the priority population (McKenzie, Neiger & Thackeray, 2013).
Step 1: Determining the scope and purpose of this needs assessment
The purpose of this assessment is to determine the demographics of bipolar disorder
among those living in the cities of Kansas City, Columbia, St. Louis, and Springfield. The
information gathered will be used to map out if a need exists among this community and if the
BI-Cycle program can serve as a useful tool to it.
Step 2: Gathering data
The information gathered to determine the needs assessment will consist of primary and
secondary data. The primary data tool that will be used is an evidence-based assessment tool
called the Mood Disorder Questionnaire (MDQ) see appendix for reference. The MDQ is quite
accurate and has a specificity rate of 70/100 and a sensitivity rate of 90/100. It would be used as
a general assessment tool in hospitals, clinics, and any other setting that someone may go to seek
medical or psychological help. The secondary data collected is referenced from the Center for
Disease Control and Prevention (CDC), World Health Organization (WHO), Missouri State
Health website, National Institute of Mental Health (NIMH), and medical journals listed in the
reference page (see reference page).


The priority population will be surveyed using the MDQ in clinical settings which will
also serve as a self-report assessment that can be mailed or used on a telephone interview. This
survey will also be used along with current evidence research and information to come to a
consensus on the priority population needs. The secondary data collection concludes:
•Bipolar disorder is the sixth leading cause of disability in the world. (World Health
Organization)
•Bipolar disorder results in a reduction in expected life span of 9.2 years, and as many as
one in five patients with bipolar disorder commits suicide.
•Approximately 2.6%-5% of the Missouri population suffers from bipolar disorder
(Kesseler& Chiu, 2005).
•About 1 in 20 people in the U.S. have bipolar disorder, which approximately 400,000
Missourians have it as well.
•Only half of those who suffer stick to their regular medication regimen.
•50% of bipolar sufferers have more than 1 extreme episode every year
(“www.wfmh.org,” 2006).
•Both Bipolar II and cyclothymia are estimated to be misdiagnosed about 70% of the
time (Hirschfeld & Lana, 2005).

Step 3: Analyzing Data


The primary data currently has not been fully collected. The secondary suggests that the
priority population targeted does currently have a need for such a program like BI-Cycle. It’s
quite evident with the data collected thus far that there is a portion of the Missouri community
that suffers from lack of a support system in regards to bipolar disorder.
Step 4: Identifying the links that contribute to the problem
The links to the lack of self-efficacy regarding medication adherence and lack of social
support was recently documented by NIMH. NIMH recognizes that there is a stigma associated
with bipolar disorder. Sufferers tend to feel denial, depression, and outcasted. This creates
situations where sufferers don’t want to take medication, adhere to therapy intervention, and feel
like there is little social support because of being diagnosed with a chronic illness (NIMH 2009).
Step 5: Program focus identification
The primary focus of BI-Cycle is to work with the current recommended therapy
treatment (medication) for those with bipolar disorder, but emphasizing a stronger social support
system that is the foundation to all therapy treatments. In order to work, BI-Cycle will try to
emphasize better medication adherence, better diagnosis processes and a strong system of
support from family, friends and the local community.


VII. Mission Statement, Vision Statement, Objectives, and Goals
Mission Statement
BI-Cycle intends to educate, promote, and improve therapy intervention to those who
suffer from bipolar disorder by recommending treatments that encompasses mind, body
and social support, with social support being the foundation to all therapeutic
interventions. Bi-Cycle’s mission is to serve those who suffer from bipolar disorder
through organized social support as the foundation to therapy, with psychological and
medical support being relevant processes to recommended therapy.
Vision Statement
BI-Cycle wants to make itself a known valid therapy solution by year end 2015. It will
do this by clever marketing and offering information along with services to thefollowing
communities which includes: Kansas City, Columbia, St. Louis, and Springfield.
Impact Objective:
Behavior:BI-Cycle will discover if individuals have skills to adhere to medication and
therapy; 60% of those who participate will adhere compared to the 50% benchmark
currently reported by year end 2016.
Impact Objective:
Attitude: BI-Cycle seeks to create better education that will help with attitudes towards
taking medication and sticking to therapy. 6-10 participants will have a positive attitude
towards adherence and education by year end 2016.


Process Objective:
BI-Cycle suggests thatonly those who have the interest of bringing awareness and
advocacy to those affected by bipolar disorderserve on committee. 100% of allmembers
must be approved by a voting committee that is selected among the priority population.
Outcome Objective:
BI-Cycle recognizes that the best therapy is one that encompasses mind, body, and social
well-being. 100% of all therapy interventions will have social supporttherapy as the
foundation to all therapy regimes prescribed.
Impact Objective:
BI-Cycle chooses to use the STABLE diagnostic tool to increase correct diagnoses and
decrease the incidence of wrongful diagnosis. Using STABLE, BI-Cycle aims to reduce
wrongful diagnoses by 20%.

BI-Cycle goals:
*To promote healthy living that encompasses the whole individual.
*To increase bipolar awareness and education.
*To prevent misdiagnosis and create happier individuals.
*To improve social support to those who suffer from bipolar disorder.


VIII. Intervention-theoretical Framework: Theory of Planned Behavior (TPB)


The theory of planned behavior (TPB) expands on the theory of reasoned action by
including the concept of perceived behavioral control. It promotes self-efficacy (McKenzie,
Neiger & Thackeray, 2013). This theory is important to the implementation of BI-Cycle because
the program itself will require that bipolar disorder participants have a positive attitude towards
treatment, education, and support. This intervention theory works hand and hand with the social
support therapy that is needed for BI-Cycle to work. An element of this theory’s success is the
positive attitudes and feedback from the community. If used properly, the TPB model should
predict the following in regards to the BI-Cycle intervention results:


Bipolar sufferer should have a positive attitude about social support treatment
Sufferers receive understanding and encouragement from family and friends
Sufferers perceive that with the social support around them they are encouraged to adhere
to treatment and their therapy regimens
The TPB model is an intrapersonal level theory that invokes change and self-efficacy
from the individual. According to Neiger & Thackeray, the interpersonal level concept
influences behavior, knowledge, attitudes, and personality traits (McKenzie, Neiger &
Thackeray, 2013).


IX. Resources
There are some essential resources needed for the BI-Cycle campaign to be successful.
They are divided into the following categories: Personnel, Curriculum and instructional
resources, Space, Equipment, Supplies, and Financial resources.
Personnel
Advisory committee: Amy Alewel, Simone Baker, Ashley Burdolski, Carrie Callicoat, Mauricio
Cabrera, and Synn Johnson alongside the BI-Cycle planning committee will be responsible for
the program planning and supervision of implementation. Keith Schafer will be the committee
director.
Planning Committee: Will consist of BI-Cycle Dream Team members. These individuals are
responsible for program direction, networking, and are responsible for not just community
education, but also to make sure that all “foot work” is completed. Foot work tasks contains
community education, medical community education, political legislation, disbursement of
funds, program direction, committee elects, and overall program needs.
Evaluation team: An evaluation team will be set up at the UMKC campus. The team will
consist of research students in the Health Sciences Department. Results from the evaluation will
be used to tweak program needs and can be published for research purposes.
Main office team: There will be a need for 2-3 hired people to run office in the Health
Department location. This team will relay information to committee members, advisory
committee and all other personnel. They will also be responsible for appointment keeping and
standard office upkeep. Office hours would mimic the Health Department’s regular schedule.


Curriculum and other instructional resources
Curriculum: Although there will be no need for direct classes, there will be a need to educate the
planning committee about the program and its resources. The Black Dog Institute has created an
educational program that would be a useful program that BI-Cycle could use. This educational
program would include homework and study guides. This educational class will be given over a
9 week timeframe and is quite informative. This educational class is available online for quick
access to the public and can be taught via Facebook or through self-pace instruction. The course
will also be recommended as part of the treatment as well for newly diagnosed patients or even
currently diagnosed patients as well. See appendix for a breakdown of the weekly curriculum.
A perk of the chosen committee members is they all have an expertise with bipolar disorder and
other mood disorders. This expertise will be used to educate the priority population. The
planning committee will have to use their experience and expertise to “sell” the program. The
planning committee is a makeup of teachers, educators, psychologists, psychiatrists, directors,
and political leaders. Once a month a member of the planning committee will host an
educational blog and an online educational class on Facebook. Planning committee members are
also responsible for making sure that members in the Missouri medical community are educated
about BI-Cycle. We also want for those who can diagnose bipolar disorder use the STABLE
diagnostic toolkit only and recommend the BI-Cycle support system in treatment. The NIMH
bipolar pamphlet will also be distributed to the community and referenced to in education
sessions. The “doers” of the planning committee will be responsible for its distribution along
with promoting BI-Cycle. See appendix for STABLE toolkit and NIMH pamphlet.


Space
Space: The space needed for BI-Cycle will be a committee meeting room, an office in the
Missouri Health Department, and research room in UMKC. The meeting room will be the place
where meetings take place. The office will be the central hub for BI-Cycle, here we will house
all the information and education. The office can even be used as computer access area where
members can host online meetings along with conferences as well.
Equipment
Equipment: The only equipment needed for the BI-Cycle program is approximately 5 computers
that will be located in the main office for bookkeeping purposes, emailing, video conferencing
and resourcing. The main office will need a copier machine and fax machine as well. There may
be a use for a projector and screen to show presentations in meeting room. The meeting room
will need to be furnished with standard office necessities such as conference tables and chairs.
Phone Application: There will be a need to use a mood report phone application as part of the
self-reporting requirement for patients and clientele. This phone application can be piggybacked
from a current free application available on the Apple and Android phone application markets or
one could be built that is more specific to BI-Cycle. The benefits of creating one would include
being able to advertise BI-Cycle in the applications market, the BI-Cycle name would be
attached to it as well and offering a surcharge to use the application. The surcharge could help
fund or payback initial costs of creating the phone application.
Website Creation: Currently the easiest method of managing and creating a website which has
multiple benefits is using Face Book. Face Book offers features that the BI-Cycle program can
take advantage of. First, Face Book offers blogs, status updates, and free postings that could


help BI-Cycle advertise or constantly promote information regarding the program. Secondly,
creating friends lists will hopefully draw in those who suffer from bipolar disorder to visit our
site looking for information or networking, which in turn will build the effectiveness of reaching
our priority population. Third, BI-Cycle can take full advantage of the video conference feature
by allowing followers to reach out and offer social support, gain new knowledge or by just
staying connected with one another. Finally, BI-Cycle promoters can host classes using
Facebook or by posting new info the Facebook’s wall so that there is a constant flow of up-to date information to anyone who seeks it.
Supplies
Supplies: Standard supplies such as mailing stamps, envelopes, copy paper, etc. are needed to
run the main office. There will be a healthy need for resource material such as pamphlets and
brochures to promote the program. Current generation computers that can handle the latest
software to be able to run video conferencing and web surfing are required as well. Webcams
for each computer are needed as well.
Financial Resources:
Money: The financial support that BI-Cycle needs will come from a few sources. We would ask
that some money come from the state of Missouri to help promote BI-Cycle within the
community. Sponsorships could also generate additional funds through special events such as
educational classes, fun runs, awareness meetings and other events that sponsors want to
participate in. For example, we would partner with 24 Hour Fitness to host an exercise event and
we would help promote new memberships to their facilities. In turn we could share the funds that


come in from donations from fun runs and such. In the future BI-Cycle will explore additional
funds from new products and services that will help generate additional funds.
Grants: Grants are a wonderful way to network with other programs and institutions that have
similar causes. Grants can be sought from some highly recognizable source groups that can
supply funds and other resources to help operate BI-Cycle.
Budget Sheet for BI-Cycle
Revenue and Support

Amount

Contributions from sponsors

$500

Gifts (see financial resources
grants/gifts)

$1,000

Grants (see financial resources
grants/gifts)

$35,000

Participant Fee

N/A

Sale of Curriculum material

N/A
Total Income

Expenditures
Direct Costs
Personnel
Salary and Wages

$20,000

Fringe Benefits

N/A

Consultants

N/A

Supplies
Instructional materials
Incentives

$1500
$250
N/A

36,500


Meeting costs

N/A

Equipment

$4,000

Travel

$1,000

Postage
Advertising

$200
$1,000
Total of Direct

$27,150

Costs
Indirect cost (includes rent, insurance,
telephone & other utilities

$3500

Total of Indirect

$3500

Costs
Total

$30,650

expenditures

Balance

+$4100


X. Marketing Plan
Using the process of segmentation to identify the unique characteristics of our priority
population will insure that the marketing campaign to promote BI-Cycle is effective and
sensitive to the promotion of the program. After assessing the needs of the priority population
and focusing on BI-Cycle’s ultimate short, mid, and long term goals; the following is the
roadmap to a successful marketing strategy for BI-Cycle:
Geographic segmentation: The bulk of the marketing push will be linked between the Kansas
City to St. Louis area. These two key cities are important because they are home to a large
segment of the state population. 3.3 million (half of the state total) people live in these two
cities, so the marketing strategy to these areas will be essential.
Demographic segmentation (Age): Research has shown that three quarters of those who suffer
from their first mood cycling episode are around the age of 25. Although new evidence is
showing that earlier ages are showing precedence, early and mid-20 year olds are where
preventive measures can show benefit. BI-Cycle would prove rather effective in places such as
health clinics, hospitals and gyms. Posters, pamphlets, and word of mouth from doctors,
clinicians and other health care providers will be the most effective marketing techniques in
clinics and hospital settings. In gyms, a myriad of trainers, classes, poster, and pamphlets can
help promote the healthy living aspect of the BI-Cycle program. Keeping this age group healthy
and happy is very important.
Demographic segmentation (Health History): Research has also shown that “new sufferers” of
bipolar disorder come from “old sufferers.” Three quarters of those who suffer from the disorder
has or had a parent that suffer from unipolar or bipolar disorder. It is key to focus a great deal of


attention to the established population of bipolar disorder sufferers, by educating them at the
clinics and hospitals where they receive their treatment. Educating them about the chances of
passing on the disorder to their children and living a healthy lifestyle would be accomplished by
doctors, psychologists, psychiatrists, and other healthcare professions using educational
brochures, taking time to go through medicine regimens, and explaining the support system of
the BI-Cycle that would be available to them. BI-Cycle’s most important marketing strategy will
be by “word-of-mouth”. The word-of-mouth recommendations from the healthcare professions
within the priority population will help spread the program’s intention and goals. Those who are
suffering from bipolar disorder will trust the provider’s advice because of their position and
expertise; this is a great benefit of word-of-mouth spread from trusted people within the priority
population.
Demographic segmentation (Gender): Bipolar disorder does affect about an equal number of
men and women. But because of the emotionally makeup of women, they are more prone to
mood-cycling which means they are a higher risk category for severe mood swings. There will
be an extra push for the healthy living component of BI-Cycle for women. Staying fit (gym
membership), staying supported (family and friends), and the right diagnosis with the right type
and amount of medication (medical support), are where BI-Cycle could really shine. The
population of females in Missouri is just the right size for this program.
Income segmentation: There are no specific data on the limitations or barriers regarding
marketing to the priority population regarding bipolar disorder.
Race/ethnicity: There is significant data that shows that non-Hispanic whites shows more of
prevalence to bipolar disorder. This is important because it helps with identifying a core market


within the priority population to center the BI-Cycle campaign around. Bipolar disorder knows
no boundary regarding race and every race is affected. Creating an informative campaign that is
colorblind to this disorder will help unite the priority population, therefore optimizing the
program’s results and goals.
Psychographic segmentation (Attitudes): There has been a correlation between medication
adherence and the frequency of mood-cycling from those who suffer from bipolar disorder.
There will be an extreme push for medication adherence with the education program created by
the Black Dog Institute. This education program will educate bipolar sufferers on what the
disease is, the importance of living with the disorder, treatment adherence, and healthy living.
This educational program is meant to change attitudes not just from an individual level but the
community at large. The Black Dog Institute Bipolar Disorder Education Program will be
marketed in healthcare settings and educational institutions within the priority population target
that will allow it.
Behavioral segmentation (Health): One of the main purposes and goals of the BI-Cycle program
is to create positive behaviors towards bipolar disorder. Part of the campaign will also be geared
towards improving overall attitudes towards living with or knowing someone with a mood
disorder such as bipolar disorder. There is research that points to many stigmas and stereotypes
that are attached with bipolar disorder. BI-Cycle can be a positive force to the total community
member’s attitudes. It is socially important that the community is educated with regards to
bipolar disorder, and that they take part in being an intricate element to an encompassing support
system for bipolar sufferers that live among them.


XI. Implementation
BI-Cycle will be implemented carefully and efficiently. This program is intended to help
a specific population along with having a residual effect on the surrounding population as well.
This is where a well-planned implementation process is key to the program’s success. BI-Cycle
has to be implemented in a way that diffuses it into the healthcare system already in place among
those in the priority population. The acceptance and adoption of this program is a fundamental
requirement for its success along with a sustainability component that keeps the plan operational
for an extended period of time.
Phase 1: Adoption of the Program
The adoption process includes a marketing strategy that is specific for the marketing mix
that was outlined in the marketing section of this document, along with understanding the
segmentation that will come from figuring out the specific characteristics of the priority
population. One way to do that is using the diffusion theory process to interpret the results of the
segmentation process. Using the diffusion theory will allow the program planners to target the
early adopters first and piggyback them, allowing them to spread word-of-mouth promotion,
while the rest of the marketing plan works in different ways.
Phase 2: Identifying and Prioritizing the Tasks to Be Completed
An important aspect of the implantation of BI-Cycle includes assigning all tasks to our
planning committee and “doers” of the BI-Cycle program. Most of these tasks are outlined in
either the appendix or in the case of the operational tasks required to get BI-Cycle up in running.
Those tasks are outlined on the following Task Development Time Line in the following pages.
See next page for Task Development Time Line.


Phase 3: Establishing a System of Management
BI-Cycle’s management team is the planning committee. The members chosen come with a
slew of skills that include them being master managers. Most of the members run programs,
institutions, or departments for the state of Missouri. These members can make sure the program
is effective and efficient. So taking from the member list outlined in the planning portion of this
document, the committee members responsibilities are as follows:
1.

Dr. Todd Schaible will be responsible for heading the committee board. He will have

similar duties and responsibilities as a CEO, but will have to rely heavily on the other committee
members to make ultimate decisions.
2.

Keith Schafer, Ed.D will be responsible for the financial planning and budgeting of the

BI-Cycle Program. Keith will have to consult and gain majority improvement from all
committee members in order to distribute funds, where to use funds, and how the funds will be
used.
3.

Jan Heckemeyer, will be responsible for educational planning and sourcing. She will be

responsible for making sure the Bipolar Education Program curriculum is utilized, up to date,
and results are posted and available. She will also have a hand with directing online classes on
Facebook, making sure to schedule them and keeping source material up-to-date as well.
4.

Mr. R. James Kelly, will share responsibility of running office, handling resources and

marketing material to participating hospitals, clinics, and other healthcare facilities.


5.

Marguerite Grandelious will share responsibility of running office, handling resource and

marketing material. Marguerite also will be responsible for technical operations of the website
which includes maintaining office computers, webcams, and all other equipment to run online
components of BI-Cycle.
6.

Leon Ashford, Ph.D., will primarily be used as a “spokesman” to the BI-Cycle program.

Leon will help host events to lobbyists, educators, and other healthcare professionals. Getting
the word out about the BI-Cycle program will be a large responsibility of Mr. Ashford’s.
7.

Ted Brandt, will have a responsibility of understanding of new policies that affect the

program. He will also be responsible for published results for all aspects of the BI-Cycle
program. This includes: objective results, financial results, evaluation results, and any other
results that are important to the program.
8.

Harry Veo, will be responsible for putting together an exercise program that works for his

gym business and attracting members to these classes. Harry will work alongside the BI-Cycle
program to help evaluate results of attendance and help with editing and implementation.
9.

Charlotte Taff, will be responsible for putting together an exercise program with Harry

Veo. Mr. Veo works for her gym business and will be helpful with attracting members to these
classes. Charlotte will work alongside the BI-Cycle program to help evaluate results of
attendance and help with editing and implementation.
10.

CVS Member Sponsor will be responsible for the medication adherence monitoring

survey using Medication Therapy Management (MTM) program. This sponsor will also educate
those who are on bipolar disorder medications.


11.

Walgreens Member Sponsor will be responsible for medication adherence monitoring

survey using Medication Therapy Management (MTM) program and also educating those who
are on bipolar disorder medications.
12.

Wal-Mart Member Sponsor will be responsible for the medication adherence monitoring

survey using the Medication Therapy Management (MTM) program. The sponsor will also be
responsible for educating those who are on bipolar disorder medications.
13.

Also: 6-10 members from the priority population who are bi-polar sufferers that can help

advocate the program by educating other sufferers and helping implement program objectives in
the community. The other members of the planning committee will help with implementation,
evaluation, education, and all other aspects of the BI-Cycle program.
Phase 4: Putting the Plans into Action:
BI-Cycle will follow a three step process of implementation which includes: pilot testing,
phasing in, and then total program implementation. There are several advantages of following
this three step process of implementation. Pilot testing will allow the BI-Cycle Dream Team to
test the program out on a segment of the priority population, allowing a closer control of the
program. During the testing process, the Dream Team planners can check to see if BI-Cycle’s
intervention strategies were implemented as planned and if the intervention strategies are
working. If so, then there are enough resources available to operate the program and allow the
participants to adequately evaluate BI-Cycle for effectiveness. Participants will be allowed to
critique every aspect of BI-Cycle. Using the results from the pilot test, the BI-Cycle Dream
Team can phase the program accordingly. Phasing in also has its benefits, it allows the Dream
Team to have full control, evaluate as they go, and allow for proper filtration of the BI-Cycle


program. Phasing in will start in Kansas City, downtown in the city market area. This will limit
participants but will allow a good mix of the priority population. The first component of BICycle will be tested in this area, using the STABLE measurement tool for diagnosing newly
identified sufferers. It will be tested in this area for a month. Healthcare providers in this area,
who can diagnosis bipolar disorder, and are participating in the BI-Cycle program will use
STABLE as the only diagnosing tool. Part of using STABLE includes in selecting a “buddy” to
be a social support to the sufferer. After six weeks results will be quantified on the effectiveness
of using STABLE and the “buddy” support. Results will dictate when the next stages of the BICycle Support System can be implemented into the test area and thus the total priority
community. The goal is to test every aspect of BI-Cycle within the test area with a 6-8 weeks
maximum. Beyond 8 weeks, additional time could delay other operational objectives and goals
for the program.
Phase 5: Ending or Sustaining a Program:
The expectation for the BI-Cycle program is to keep it functional until all goals and
objectives have been met and there is no longer a need for the program in the Missouri
community. It would be ideal that BI-Cycle’s purposes are concluded smoothly with little or no
hindrances, but realistically that is not possible. Sustainability of the BI-Cycle program will
prove to be the challenge. Funding, environmental concerns not yet identified and etc., are
external elements are issues that may cause problems with keeping BI-Cycle up and running to
meet its goals and objectives. If need be then the Dream Team members and other planners will
try to institutionalize BI-Cycle and will constantly evaluate internally to allow critical feedback
and evaluation from participants. Also members can advocate for the program through necessary
channels, such as review boards, grant and funding sponsors, and even tapping into political


powers and even partnering with other organizations that believe in BI-Cycle is a possibility as
well.
BI-Cycle program concerns:
BI-Cycle will take great care to keep planners, participants, and other active parties safe,
secure, and try to invoke peace of mind by explaining the nature and purpose of BI-Cycle,
informing all involved about risks and dangers, benefits for participation, other treatments,
interventions or programs as alternatives, and allow complete discontinuance of program
participation. In case of medical emergencies that may prevent further participation or initial
participation, BI-Cycle will not accept anything less than a clearance from a physician. BI-Cycle
cares about its planners and participants and there will be OSHA workplace guidelines as
needed. MSDS sheets will be used, HIPAA guidelines, and other applicable state and federal
workplace requirements will be followed as well. All participants will have to follow program
guidelines to receive benefits from the BI-Cycle program and all planners along with other
personnel will be held to accountable to the utmost ethical codes. A program manual will be
available to all interested parties along with an SOP guideline for planners. Planners will also be
fully trained in the areas of diversity, sensitivity, and legal procedures regarding ethical conduct
and such. Any problems that arise will be handled by Dream Team members and appropriated to
the necessary person or persons that can resolve the issues. All issues will be documented and
filed and kept at the main office for recordkeeping.


XII. Evaluation
There are a few evaluation elements that will be included with evaluating BI-Cycle.
Formative evaluation will insure that important information is constantly checked and available
to stakeholders. This will also allow Dream Team members and other programmers to revise,
revisit, and redirect the BI-Cycle program as needed. This will be essential between
implementation cycles (pilot testing, phasing in, and total implementation). Elements that will
be evaluated will be adequacy of resources, consumer-orientation, support, accountability,
response, interaction, and satisfaction. The process evaluation elements that will be essential for
the BI-Cycle program are fidelity, reach, response and context.
Just like pilot testing is essential to total program implementation so is pretesting.
Pretesting will be done in between each cycle in at least the form of data collection. The data
collected from each stage will give important information on if BI-Cycle’s core elements are
effective and allow for checkpoint analysis of each stage. According to McKenzie, Neiger &
Thackeray, pretesting has been defined as an evaluation that involves systematically collecting
intended-audience reactions to messages and materials before the messages and materials are
produced in final form (McKenzie, Neiger & Thackeray, 2013). From the formative, process
and pretesting evaluation conclusions can be drawn using summative evaluation. The evaluation
design that will be used will be the experimental design. The experimental evaluation design is
one of the most useful and powerful design types. It allows random assignment of groups and
measures both.
Information gathered will be quantitative and qualitative in nature. Before participating
in the BI-Cycle program participants will fill out a quick questionnaire that will help program


directors assess their attitudes, knowledge, medication adherence, and current social support
level they are receiving. This questionnaire will be submitted using the phone app or directly on
line through email. This reporting requirement will be submitted weekly. The BI-Cycle office
personnel will pull these results as they come in and comply the results in an excel spreadsheet
so that graphs, charts, and so forth and be interpreted. This will create great quantitative and
qualitative data. Also during the pilot testing, BI-Cycle will be evaluated and changes can be
made accordingly. The limitations to this evaluation are it relies heavily on self-report and
participation from a home base. The information that is received will have to be analyzed
thoroughly to make sure it is unbiased, accurate, and complete. This will require a significant
amount of detail by the office staff or persons running the main office.


The goal is having a strong internal validity to validate the program. Factors like having another
program offered elsewhere within the same priority population that offers similar benefits may
affect internal validity; this is why that randomization will be used to choose group participants
of the evaluation process. These members will mimic the makeup of the priority population.

XIII. References


(2000). Stable resource toolkit. (4th ed.). Washington D.C.: American Psychiatric Association.
DOI: www.cqaimh.org/pdf/STABLE_toolkit.pdf
Black Dog Institute. (n.d.). Retrieved from
http://www.blackdoginstitute.org.au/public/bipolardisorder/bipolareducationprogram.cfm
Bipolar Disorder. (2008). Retrieved from http://www.nimh.nih.gov/health/publications/bipolardisorder/nimh-bipolar-adults.pdf

CDC. (2011, July 01). Burden of mental illness. Retrieved from
http://www.cdc.gov/mentalhealth/basics/burden.htm
Hirschfeld, R., & Lana, V. (2005). Bipolar disorder "costs and comorbidity". The American
Journal of Managed Care, 11(3), S85-S90. Retrieved from
http://www.ajmc.com/publications/supplement/2005/2005-06-vol11-n3Suppl/Jun052074pS85-S90/
The global burden of disease. (2002). Retrieved from
http://www.who.int/mip/2003/other_documents/en/globalburdenofdisease.pdf
Kesseler, R., & Chiu, W. (2005, June). National institute of mental health. Retrieved from
http://www.nimh.nih.gov/statistics/1BIPOLAR_ADULT.shtml
McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2013). Planning, implementing & evaluating
health promotions programs. Glenview: Library of Congress Cataloging-in-Publication
Data.
The mood disorder questionnaire. (2000). Retrieved from
http://www.dbsalliance.org/pdfs/MDQ.pdf
The National Institute of Mental Health (NIMH). (2009). Retrieved from National Institute of
Health website: http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Rogge, T. (2012). Bipolar disorder. A.D.A.M. Medical Encyclopedia. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
www.wfmh.org. (2006). Retrieved from
http://www.wfmh.org/PDF/KEEPINGCARE/Serious Mental Illness fact sheet.pdf
World health organization. (2012). Retrieved from
http://www.who.int/mental_health/mhgap/evidence/psychosis/en/


Appendix A
Needs Assessment Mood Disorder Questionnaire


The MDQ was developed by a team of psychiatrists, researchers and consumer
advocates to address
a critical need for timely and accurate diagnosis of bipolar disorder, which can be fatal if
left untreated.
The questionnaire takes about five minutes to complete, and can provide important
insights into
diagnosis and treatment. Clinical trials have indicated that the MDQ has a high rate of
accuracy; it is
able to identify seven out of ten people who have bipolar disorder and screen out nine
out of ten
people who do not.1
A recent National DMDA survey revealed that nearly 70% of people with bipolar
disorder had received
at least one misdiagnosis and many had waited more than 10 years from the onset of
their symptoms
before receiving a correct diagnosis. National DMDA hopes that the MDQ will shorten
this delay and
help more people to get the treatment they need, when they need it.
The MDQ screens for Bipolar Spectrum Disorder, (which includes Bipolar I, Bipolar II
and
Bipolar NOS).
If the patient answers:
1. “Yes” to seven or more of the 13 items in question number 1;
AND
2. “Yes” to question number 2;
AND
3. “Moderate” or “Serious” to question number 3;
you have a positive screen. All three of the criteria above should be met. A positive
screen should
be followed by a comprehensive medical evaluation for Bipolar Spectrum Disorder.
ACKNOWLEDGEMENT: This instrument was developed by a committee composed of the following
individuals: Chairman,
Robert M.A. Hirschfeld, MD – University of Texas Medical Branch; Joseph R. Calabrese, MD – Case
Western Reserve School
of Medicine; Laurie Flynn – National Alliance for the Mentally Ill; Paul E. Keck, Jr., MD – University of
Cincinnati College of
Medicine; Lydia Lewis – National Depressive and Manic-Depressive Association; Robert M. Post, MD –
National Institute of
Mental Health; Gary S. Sachs, MD – Harvard University School of Medicine; Robert L. Spitzer, MD –
Columbia University;
Janet Williams, DSW – Columbia University and John M. Zajecka, MD – Rush Presbyterian-St. Luke’s
Medical Center.
1 Hirschfeld,

Robert M.A., M.D., Janet B.W. Williams, D.S.W., Robert L. Spitzer, M.D., Joseph R. Calabrese, M.D., Laurie Flynn,
Paul E. Keck, Jr., M.D.,
Lydia Lewis, Susan L. McElroy, M.D., Robert M. Post, M.D., Daniel J. Rapport, M.D., James M. Russell, M.D., Gary S. Sachs, M.D.,
John Zajecka, M.D.,
“Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire.” American
Journal of Medicine


Appendix B
STABLE TOOLKIT
http://www.cqaimh.org/pdf/STABLE_toolkit.pdf
(file could not be attached electronically, some excerpts included on following pages)


Appendix C
NIMH Bipolar Disorder Pamphlet
http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-read/adult_updated%20(2).pdf
(pamphlet could not be added electronically)


Appendix D
Black Dog Course
http://www.blackdoginstitute.org.au/public/bipolardisorder/bipolareducationprogram.cfm
(On-line course, cannot be added electronically)


Appendix E
Flyers

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