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| IMPLEMENTATION STORIES
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More Colorado Access
Care Management Training
Care management staff (registered nurses and paraprofessional staff) were trained in a modified version of the RESPECT-Depression care management model using training manuals from the original trial and website that were tailored to complement existing care coordination training to serve patients with medical illnesses. The standardized training employed RESPECT-Depression tools, including the depression care management intervention and protocols, clinician resource presentations (e.g., Depression as a Chronic Disease, Mood Disorders: Identification and Management), and patient education and self-management materials. The depression care management training also included evidence-based depression diagnosis, assessment, and treatment guidelines provided by the Colorado Clinical Guidelines Collaborative and local mental health and community resources. Additionally, care management staff received training on motivational interviewing for persons with chronic medical illnesses and depression, developing care plans, and prioritizing treatment goals.
Depression Screening and Intervention
A cohort of high-cost, high-risk Colorado Access health plan members were screened over the phone by care managers using health-screening questionnaires, including the Patient Health Questionnaire-9 (PHQ-9). Members with PHQ-9 scores of 10 or above were enrolled into the integrated depression care management program. Additional screens for other psychiatric conditions (dysthymia, anxiety, psychosis, bipolar disorder, and substance abuse), physical health conditions, and psychosocial needs were also conducted during enrollment. Nurse care managers utilized this screening information together with existing administrative, medical utilization, and prior health risk assessment data to develop a prioritized care management plan. The nurse care manager determined objective and measurable treatment goals and interventions and tracked progress made towards these goals.
Structured assessments, care plans, nurse follow up, and supervision notes were tracked in an electronic health plan registry to aid clinical processes (e.g., timing of follow-up contacts consistent with the RESPECT-Depression protocol and outcomes tracking). The electronic registry software was internally developed by the Colorado Access health plan and included standard care manager screens (e.g., PHQ-9 screens over time) and assessments, individualized care plans, provider reports, and supervisor reports.
Self-management Strategies
Colorado Access tailored illness management strategies for enrolled program members based on assessments of barriers to accessing care, understanding of specific illnesses (e.g., depression, diabetes), readiness for behavioral change (motivational interviewing/stage of change), and educational materials. Depression self-management and educational materials (e.g., Managing Your Depression: Things you can do to help yourself; Depression Self-Care Action Plan; What is Depression?; Antidepressant Medications; Psychological Counseling; and Key Antidepressant Instructions for Patients) were slightly modified from the RESPECT-Depression Project and were available in English and Spanish Colorado Access also developed a community resource book with resources for depression treatment, as well as for transportation, additional services, and support groups that care managers used to assist enrolled program members.
Supervision
Care manager supervision was provided on a weekly basis, using a case conference format, by the plan’s medical director, a psychiatrist, and a psychologist. The supervision team was trained in the RESPECT-Depression protocol and reviewed depression treatment response and enrolled health plan members’ progress with the care manager. Since the cohort of enrolled health plan members had both depression treatment and medical illness management needs, the supervision team reviewed both depression and medical treatment interventions, assisted with prioritizing each medical and psychosocial needs, and developed or refined action plans with evidence-based interventions and measurable, objective goals. The supervision team also assisted the care manager in designing individually tailored health education and self-management goals for health plan members with depression and co-occurring medical illnesses.
Marshall R. Thomas, MD
President and CEO, Colorado Access
Executive Director, University of Colorado Denver
Department of Psychiatry Depression Center
Jeanette A. Waxmonsky, PhD
Assistant Professor
University of Colorado Denver
Department of Psychiatry Depression Center
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