Commonwealth council on aging best practice awards 2006-2016_dars

1. Taking Charge of Our Health and Wellbeing:
Chronic Disease Self-Management Education
(CDSME)
Virginia Governor’s Conference on Aging May 3. 2016

2. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Presenters
April Holmes Savannah Butler
Joyce Nussbaum

3. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Why Self-Management?
People spend 99 percent of their time outside the health
care system — and what they do outside largely
determines their quality of life.
This prepares them for the 99 percent.
Kate Lorig
Stanford University Patient Education Research Center

4. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Chronic Disease Self-Management Education
✶ Evidence-based disease self-management programs
✶ Developed and researched by Stanford University
✶ 6 week workshop, 2.5 hour sessions
✶ Tools and skills to:
⬧ Deal with symptoms
⬧ Manage common problems
⬧ Participate more fully in life

5. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
“Train-the-Trainer” Model
Master Trainers
Lay Leaders
Program Participants Completers: Attend at least 4 of 6 sessions

6. Chronic Disease Self-Management Program

7. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Sample Activity:
Action Planning

8. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Long-Term Research Findings
Improved/Enhanced Reduced
♦ Energy ♦ Fatigue
♦ Physical activity ♦ Limitations on social role
activities
♦ Psychological well-being ♦ Pain symptoms
♦ Partnerships with physicians ♦ Emergency room visits
♦ Health status ♦ Hospital admissions
♦ Self-efficacy ♦ Hospital length of stay

9. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
National Study Findings:
Lower Health Care Use
Baseline 6-Month 12-Month
Percentage with any
emergency room visits in
the past 6 months
18% 13% 13%
Percentage with any
hospitalization in the past
6 months
14% 11% 14 %

10. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
National Study Findings: Lower Health Cost
• $714 per person saving in emergency room visits
and hospital utilization.
• $364 per person net savings after considering
program costs at $350 per participant.
• Potential saving of $6.6 billion by reaching
10% of Americans with one or more chronic
conditions.

11. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
CDSME in Virginia
• 2005: Introduced by Virginia Department of Health.
• March 2010: Two-year grants to states from US
Administration on Aging to disseminate CDSM to older adults.
Virginia receives $1,040,000 – one of the highest awards.
• September 2012: Virginia one of 22 states awarded a 3 year
grant under the Prevention and Public Health Funds, Affordable
Care Act.
• Area Agencies on Aging local lead agencies under the grants.

12. 2
1 3
4
5
6
7 8A
8B
8C9
10
12
13
14
15
16
17/18
19
20
21
22
11
8D
1 Mountain Empire Older Citizens
2 Appalachian Agency for Senior
Citizens
3 District Three Senior Services
4 New River Valley Agency on Aging
5 LOA Area Agency on Aging
6 Valley Program for Aging Services
7 Shenandoah AAA
8A Alexandria Division of Aging and Adult
Services
8B Arlington Agency on Aging
8C Fairfax AAA
8D Loudoun County AAA
8E Prince William AAA
9 Rappahannock-Rapidan
Community Services
10 Jefferson Area Board for Aging
11 Central Virginia AAA
12 Southern AAA
13 Lake Country AAA
14 Piedmont Senior Resources AAA
15 Senior Connections, The Capital AAA
16 Rappahannock AAA
17/18 Bay Aging
19 Crater District AAA
20 Senior Services of Southeastern Virginia
21 Peninsula Agency on Aging
22 Eastern Shore AAA - Community Action Agency
8E
Virginia’s CDSME Programs 5-2-16

13. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Participation in CDSME Workshops
April 1, 2010 through April 7, 2016

14. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Accomplishments
Reached diverse populations:
• Workshops in Spanish, Chinese, Vietnamese, Korean and
sign language
• Persons with disabilities
• Embedded at Wilson Workforce and Rehabilitation
Center
• Centers for Independent Living
• Behavioral health and recovery programs
• Clubhouse programs
• Six state prisons
• Low income and homeless populations
• Formed lasting partnerships-locally and statewide

15. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Senior Connections, The Capital Area
Agency on Aging
• Savannah Butler, Local coordinator for CDSMP at Senior Connections, The
Capital Area Agency on Aging.
• Our Mission: "Empowering seniors to live with dignity and choice.“
• Areas that we serve: counties of Charles City, Chesterfield, Goochland,
Hanover, Henrico, New Kent and Powhatan, and the City of Richmond.
• Been offering this program since 2010.

16. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Jail and prison inmates have a disproportionate burden of many chronic medical
conditions compared to the general population, including hypertension, asthma,
arthritis, cervical cancer and hepatitis.
Chronic Medical Diseases Among Jail and Prison Inmates
By Ingrid A. Bingswanger, MD, MPH , 10/25/2010
Chronic Disease in Prison
Populations

17. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Leading conditions: 34 to 49 year old men and women in US
prisons:
1. Overweight (47%)
2. Hypertension (24.7%)
3. Obesity (24.7%)
4. Arthritis (23.1%)
5. Asthma (13.9%)
6. Hepatitis (12.9%)
Chronic Disease in Prison Populations

18. Taking Charge of Our Health and Wellbeing: CDSME
Chronic Disease
in Virginia’s Prison Populations
♦ About 1/3 have a chronic care condition
♦ (asthma, diabetes, hypertension, HIV)
♦ Some have multiple chronic diseases
♦ Genes account for approximately 30% of wellness
♦ Inmate self-responsibility and discipline
♦ (diet, exercise, rest, and medication) are keys to health
VGCoA 5/3/16

19. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Senior Connections’ Partnership with
Local Prison
• Partnered with Powhatan Correctional Center in December 2012
• Orientation is a 3.5 hour process- go over dress code, prison life, do's and don'ts,
background check, and wait about 90 days to receive volunteer badge
• First workshop at Powhatan started about a month later
• Lessons learned in the first prison system:
• A class full of only male offenders, with two female leaders, was well
received and a success. The men were very respectful
• By the fourth workshop, a male leader was co-facilitating. Coordinator noted
that the men really “emulate him and hung on his every word”.

20. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Senior Connections’ Partnership with
Local Prison, continued…
• Powhatan Correctional Center closed at the end of 2014 and we developed a new
relationship with Deep Meadows.
• Deep Meadows is located in the same county.
• 4 trained leaders that have gone through orientation and able to teach
• Classes best in the afternoon
• Teach every four months
• Local Numbers
• 6 workshops – 80 participants- 68 completers- 85% completer rate at Powhatan
Correctional Center
• 3 workshops- 38 participants- 30 completers- 80% completers rate at Deep
Meadows Correctional Center.

21. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Senior Connections’ Partnership with
local Prison, continued…
• Action planning, problem solving, and decision making are three skills that most of them
lack and are valuable for success in the facility and after release.
• Workshop benefits:
• Offenders learn to trust one another.
• Are able to help each other with their action plans and following through with their
actions during the week.
• Leader describes her experience with action planning saying “ I will never forget one
session in closing where a rather young inmate said he just wanted to go outside, that
it had been years since he had been outside and his confidence level was low on
being able to accomplish this. One other older gentleman-said ‘I will help you- we
will do this together.’ It touched my heart”
• Here are several letters as to why we do this…

22. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
A Regional Approach to
Maximizing Resources
VPAS CDSME plan for program sustainability
• Local organizations provide workshop sites, snack, marketing and
sometimes books and Leaders
• All Leaders are volunteers to VPAS
• Exploring billing Medicare for CDSME Workshops
• VPAS Regional Plan
o Purpose: Establish a mutually beneficial partnership with other
Area Agencies on Aging (AAAs) to increase sustainability and
provide an opportunity for efficient and cost effective expansion
of CDSME programs through regional collaboration.

23. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
A Regional Approach to
Maximizing Resources
•Sustainability
o revenue for existing program
o reduce start up time for new programs
o avoid duplication and loss of certification for Master Trainers
•Support
o start strong
o share best practices
o minimize early mistakes
Why a Regional Approach?

24. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
A Regional Approach to
Maximizing Resources
VPAS provides
• Leader training
• Fidelity
• Data entry
• Program and technical support
• Marketing messages
JABA and SAAA provide
• Local coordinator
• Leader recruitment
• Workshop scheduling
• Local marketing
•Local budget
How it works

25. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
A Regional Approach to
Maximizing Resources
JABA
• Local Coordinator
• Ten CDSMP Leaders
• Five workshops completed
• Second Leader Training Scheduled
• Scheduling additional workshops
SAAA
• Local Coordinator
• 3 CDSMP Leaders, 2 cross trained in
DSMP and CTSP
• 3 CDSMP and 1 DSPM workshop
• Additional leaders registered for upcoming
Leader Training
Progress to Date

26. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Questions?

27. Taking Charge of Our Health and Wellbeing: CDSME VGCoA 5/3/16
Contacts
April Holmes
Department for Aging and Rehabilitative Services
april.holmes@dars.virginia.gov
804-662-7631
Savannah Butler
Senior Connections
sbutler@youraaa.org
(804) 343-3004
Joyce Nussbaum
Valley Program for Aging Services
joyce@vpas.info
(540) 896-8567