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 http://sharpbrains.com/summit-2015/agenda
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. Douglas Ziedonis, M.D., M.P.H.
Professor and Chairman
Department of Psychiatry
UMass Memorial Medical Center/
University of Massachusetts Medical School
Douglas.Ziedonis@umassmemorial.org
Douglas Ziedonis, M.D., M.P.H.
Professor and Chairman
Department of Psychiatry
UMass Memorial Medical Center/
University of Massachusetts Medical School
Douglas.Ziedonis@umassmemorial.org
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
6. The program has five (5) main components:
myStatus
myPlan
myLifestyle
myFitness
myNutrition
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. 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. 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. 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. 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
www.umassmed.edu/cfm/
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. 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. 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
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. 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: http://umassmed.edu/psychiatry/resources/Tobacco/attoc/
19. THE NATIONAL INTREPID CENTER OF EXCELLENCE
BRAIN FITNESS CENTER
WALTER REED NATIONAL MILITARY MEDICAL CENTER
BEST PRACTICES TO NAVIGATE AND
IMPLEMENT THE EMERGING BRAIN HEALTH TOOLKIT
Kate Sullivan M.S., CCC-SLP
Director, Brain Fitness Center
Katherine.sullivan.ctr@mail.mil
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
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
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
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
Photos Courtesy of WRNMMC/NICoE
Selection is based on rehabilitation goals,
challenge level and patient decision.
Program Choice
25. 25
Photos Courtesy of WRNMMC/NICoE
Education tools and progress reports
vary among programs.
Clinician Tools
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
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
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
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
Katherine.sullivan.ctr@mail.mil
Best practices/lessons learned to navigate
and implement the emerging brain health toolkit