Nurse Care Management, HMSR and Integrated Care for SMI

Presenter – Wendy Silver RN BHCare 435 East Main St. Ansonia, CT 06401 tel. 203.736.2601 ext. 1224

Problem Overview – 25 years earlier mortality, suicide, accidents, complications secondary to lack of insurance, difficult access to medical care, obesity, diabetes, COPD, HTN, hyperlipidemia, elevated cholesterol and metabolic syndrome. SAMHSA Grant – 13 original colonies (now 54) given Federal funding to bring medical care to behavioral health care clinics. “Wellness” – (as defined by the American Heritage Dictionary): “The condition of good physical and mental health especially when maintained by proper diet, exercise and habits.” Engagement – goals and ownership for improved health (or documentation for disability status?) self direction individual and person centered empowerment holistic non-linear strength-based respect responsibility peer supported hope

Medical Program – medical care on site once weekly, scheduled appts. and slots for walk-ins, referrals to specialists (dental, ortho., derm. GYN etc.) and for testing (X-rays, MRIs, labwork). Labs also drawn on site. Access to RN 4 days/wk. for engagement, consultation, triage, direction and support. CDT and TRAC interviews and updates. Flu clinic.

Wellness Classes – 10 sessions (see summary of topics) 4 times per yearHelpful information, connection, a meeting place for dialogue about health and well being with peer support 1:1 as desired. A place to bring questions and concerns about various topics related to health.

Benefits – access to medical care on site, referrals, testing and lab work Case managers can facilitate transportation if and when needed for medical care and/or further diagnostic testing or treatment. Related Topics and barriers – difficulty with engagement/retention (clients and providers!), difficulty with phones, late cancellations, no shows, fluctuating interest/follow through in personal health and well-being dependent upon other factors including, mood, finances, family dynamics/chaos, work schedule, child care, child illness etc. Miscellaneous – availability, responsiveness, sharing information, engagement opportunities, openess to introducing wellness concepts wherever and whenever possible. Meet the inquirer at their level of interest. Help facilitate access and connection to care.

Health Management Strategies for Recovery
10 – 75 minute classes for our clients. Take one class or all 10. Client must be part of HMSR program to be eligible. Dates and times TBA. Clients will be followed by HMSR RN. Initial interview is approx. 45 min.

1.) Understanding Your Illness from Head to Toe: Participants will identify psychiatric and medical illnesses they are living with along with the challenges that impact on family, social, and occupational functioning. Participants will learn about health risks that are unique to persons with mental illness and how HMSR can be helpful. 2.) Defining Health and Healthy Living: Participants will understand the concepts that define overall health…including a more holistic definition including intellectual, spiritual and environmental dimensions. Social health and healthy relationships will be discussed and explored as well as recognizing signs of physically compromised health and well-being. 3.) Preventing and Managing Health Problems: Participants will identify specific strategies for managing symptoms and will understand their role in determining the outcome of their illness/s.Individual plans will be developed to prevent relapse and crises. 4.) Choosing Support Systems to Promote Recovery: Participants will learn about and understand the importance of social support and its relationship to health and wellness. Clients will identify strategies to increase social support and identify key people, groups or systems that will be instrumental in their recovery and continued success. 5.) Understanding and Using Medication Effectively: Participants will learn what/how to ask their prescribers important questions and to make informed decisions about the medications they take. Clients will develop a plan that enables them to better manage their medications and side effects. 6.) Being Well and a Well-Being Toolkit: Participants will understand the impact of stress on their health. They will understand the mind/body connection and acquire new skills in stress management. Clients will learn how to identify stressful situations and better manage stress in their daily lives. 7.) Developing Your Wellness Plan: Participants will identify one or more wellness goals to add to their agency treatment plan and will develop an over-all Wellness Plan (me now/ me as I want to be). 8.) Nutrition and Diet for the Mind and Body: This class and the following will be taught by a registered dietician. It will cover daily food group needs and how to improve eating patterns. A work sheet will be distributed and recommendations will be made for each participant. 9.) Nutrition, Diet and…What About Exercise? Participants will understand the health benefits of exercise and will understand the relationship between choice of food, caloric intake, and portion size. 10.) Celebrating Your Commitment to Health and Recovery: Consumers will formally share their Wellness Goals/Plan with the group and “support” person/friend they have brought to join them. This supportive friend will understand their own role in supporting the client’s health, and recovery. There will be a small party with fruit/veggies to celebrate completion of the wellness curriculum.


 Eat close to the source. WHOLE grains, raw fruits and veggies  Start your day with breakfast  Nuts are brain food & heart healthy (omega 3s). Small amounts of nuts with oatmeal, yogurt and/or fruit will satisfy your hunger longer than without them. Try it – find out for yourself!  Drink water throughout the day. NO SODA! Limit fruit drinks!  Chew your food thoroughly  Allow 20 minutes to eat your food – this is the time required to actually FEEL full. PACE your ingestion of your meal  Make meals attractive – decorative plates, placemats, flowers – visual appeal adds so much to the pleasure of the dining experience – even a single flower enhances the visual feast.  SMALLER PORTIONS and also wait 20 minutes prior to adding more to your plate. Drink water to add to the feeling of “fullness”  Make exercise a part of your DAILY routine – SWEAT is GOOD!  Endorphins make for a happier you – find them through exercise, music, connection with friends and making plans with others.  Make GOALS – have a VISION for yourself. Break down larger goals into small attainable goals…one brick at a time adds up.  Do not food shop when hungry  Shop the PERIMETER of the store – avoid the isles  Stick with your shopping list – avoid impulsive purchases  Smaller, frequent meals are preferable to larger meals  Avoid eating after 8 PM – if you must, have a piece of fruit.  Substitute healthy/low calorie foods for ice cream, cake and cookies – you CAN alter your pallet and be SATISFIED!


 Substitute lower fat milk, yogurt and cheeses for higher fat dairy.  Eat WHOLE or MIXED grain pasta and breads.  Cut back on use of butter – instead use olive oil, canola oil or butter substitutes (ie: Olivio made from olive oil as one example).  Eliminate soda and high fructose corn syrup drinks from your diet.  Reduce added sugar to your foods and beverages.  Chose cereals with no sugar and with whole grains and high fiber  Add sugars from fruits and add them to cereals: strawberries, bananas, raisins etc.  READ LABELS – many foods are marketed as “healthy” and are not. The longer the list of ingredients – often those products or foods should be avoided or at best, consumed minimally.  Eat smaller more frequent meals vs. larger heavy, high caloric meals.  Savor the flavor – slow down and really enjoy the tastes – freeze grapes in small bags before the go bad. Eat them one at a time for a snack.  Make conscious efforts to ALTER your current food choices and habits EXAMPLE: substitute low calorie (popcorn – no butter) for ice cream.  Be careful about “emotional eating” – much damage can be done – better to take a walk or go to the gym than to eat a pint of ice cream.  Find a buddy/support person to call when upset or in need so food is not the first action for self soothing.


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GRAPES – put them in the freezer – eat frozen and slowly SALAD - for dinner - make extra – for lunch tomorrow CHICKEN – avoid the skin when possible - avoid fried! VEGGIES – cut up extra to keep on hand for a quick snack POPCORN (no butter) – low calorie & satisfies the need to munch 0% FAT YOGURT – a great substitute for ice cream – add fruit! GRANOLA BARS – make your own – easy and better for you FLAVORED WATER – add slices of lemon, kiwi, strawberries, lime PEANUT BUTTER – add shredded carrots (can hardly taste it!) TUNA – mix with avocado and skip the mayonnaise! (or 50/50) TUNA – mix with lemon and olive oil – add veggies (broccoli etc.) OATMEAL/OATS – eating regularly - lowers cholesterol OATMEAL – add raisins, walnuts and/or almonds for variety (the nuts will keep you satisfied and less hungry for longer) WHOLE GRAINS – in breads, pasta and cereals – read labels! NATURAL and unprocessed is the goal ORGANIC is the goal – try Quinoa and wild rice if you haven’t! PESTICIDE FREE is the goal – be sure to wash all fruit thoroughly! 1% or fat free milk is ideal – organic is even better CHIPS – many are baked products – avoid fried chips/French fries DIPS – use yogurt vs. sour cream FROZEN YOGURT vs. ice cream SWEETS - in moderation ALTER YOUR PALLET – over time: fewer sweets and fats SMALLER PORTIONS! Enjoy weighing less and feeling better!

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