Meet the New Care Manager – Judy Mazel, MSW

During a recent interview with Judy Mazel, she had the following responses to questions posed to her about her previous work and her present duties for CHD Health & Wellness.

1.             What made you interested in working in integrated care?

The main reason for my interest in integrated care is my belief that all people are entitled to and should receive primary care with an appropriate provider for physical and mental health care. Providing good and consistent primary care, coupled with mental health care, reduces the need for emergency care and is a way to increase preventative care.

2.             Can you briefly describe your experiences related to primary care?

I have worked with an Adult Foster Care provider and Hospice/Home Health Care provider.  Both forms of care are a way to support primary care.

3.             What is your thinking about integration and how it will work for CHD and Caring Health Center?

It is logical to me that CHD and Caring Health Center work jointly to provide integrated care.  Both organizations are reaching out to the same local community. A joint effort will provide increased care to a shared population in the community and therefore help to endure both psychiatric and primary care are received and integrated.


4.             What is your view on the state of health care?

I believe that affordable health care coverage is needed and should be provided for all Americans. I also have concern that primary care doctors are pressured by insurance demands and this can reduce the time providers have for client visits.

5.             What is one thing you would like your readers to know about you?
I believe in a holistic model of health care that incorporates care for a persons mind, body and spirit.


6.             What do you do when you are not working?

When not at work I enjoy spending time with family and friends. I enjoy taking walks in nature and listening to Bluegrass or Reggae music.

Yoga on Fridays

Gardening with Clients

Yesterday in the garden, clients enjoyed the warm and sunny weather as well as tilling the earth. We all weeded for nearly an hour, casting aside unwanted plantings and pesky weeds. We are readying the ground for next week's planting of seeds to grow a number of different herbs, flowers and a few vegetables.

Several clients took turns removing two large root-bound daylilies (which found new homes with staff members). They appeared to enjoy the labor involved in removing the plants, which they had deemed inconvenient to the layout they crafted for the garden.

All clients reported that they will return next week. This, despite the hard labor of weeding during the first class. At next week's class each client will choose a packet of seeds to plant and nurture throughout the summer.

Job Opening at CHD

SAMHSA Project Coordinator Job Description

CHD is actively seeking a qualified clinical professional to coordinate its initiative funded by SAMHSA.

Program description: Continued integration of primary and behavioral health care within programs serving adults diagnosed with mental illnesses in Holyoke and Springfield. The program facilitates coordination of medical, mental health, and social support services including wellness, health promotion, and disease prevention and treatment initiatives.

Position responsibilities: Development and implementation of program policies, procedures and workflows in collaboration with Project Director and Chief Program Officer; supervision of program staff, subcontractors and student interns; overall responsibility for day-to-day operation of the Integration Program; supervision of two Care Managers; oversight of quality assurance and quality improvement processes; coordination of data collection and analysis with the program Data Evaluator; management of client recruitment, marketing and development; participation in ongoing professional advancement opportunities and networking with funding agency; facilitation of the integration of primary care services with psychiatric, therapy, and program social support services.

Qualifications: Masters Degree in related field; clinical or nursing license preferred; minimum two years supervisory and leadership experience; excellent organizational skills; high energy, creative and inspirational leader; experience utilizing Motivational Interviewing to promote change; experience utilizing data to improve service quality; bi-lingual, bi-cultural candidates are strongly encouraged to apply. 

Applicants may apply online at www.chd.org using requisition number 14-0077.

Garden Clinic Beginning in May

One Client's Past-Year Treadmill Use

One male client aged 66 has been the most devoted in his use of the treadmill. Since the treadmill was installed in September 2013, this client has spent an average of 236 minutes on it per month. His total number of minutes on the treadmill, which began at just 1, is now a full 12. Below are graphs of his vital statistics collected during the past year as he used the treadmill. What is interesting is that although his weight has not decreased appreciably, it has remained constant and has not increased. Similarly, although the client's blood pressure was higher than first assessed between start and end treadmill use over the past year, there is visual evidence of improved health as the client's waist circumference has reduced.  

5K Walk, Run, Roll - September 14, 2014

 

 

Writing Class in Springfield, MA

Annual Program Data Summary (N=164)

The Center for Addiction Recovery (CAR) conducts the process and outcome evaluation of CHD’s Health and Wellness Program. There were 164 individuals served by Health and Wellness from February 1, 2013 to March 31, 2014. Of those 164 clients, 63 were matched at baseline and 6 month data collection points. What follows is the demographic composition of the population served and the analysis and comparison of the baseline and 6 month NOMs data collection.

There were 164 clients served by CHD’s Health and Wellness program as of March 31, 2014, the majority female (97, 59%). Just under 70% (69%, 113) of clients ranged in age from 25 to 54. Seventy-six percent (124) reported being heterosexual. The majority of Health and Wellness clients identified as Caucasian (107, 65%), followed by Puerto Rican (47, 29%) and American Indian (50, 30%). One client reports being a refugee. Five (3%) report having served in one branch of the military and 76 (46%) have at least one loved one currently serving. Twenty-one percent (30) of clients have no history of trauma. There are 10 cases (7%) of active physical violence in those served by Health & Wellness in the 30 days prior to intake.

Forty-four percent (64) of clients report their overall health to be excellent, very good or just good. Only 32% (46) of clients report not having symptoms that bother them; 59% (86) report no trouble handling daily life, feeling in control over their life (86), or having no trouble handling crises (87). Sixty-six percent get along with their family (97) and 92 report good social situations (63%). At intake, 63% (92) of clients report being satisfied with their housing situation.

Mental illness symptoms afflict many clients. Only 28% (43) report little or no problem with nervousness or restlessness in the past 30 days. Rates are slightly higher for those reporting that things are not an effort (49, 32%). About half of Health & Wellness participants report little to no feelings of hopelessness (76, 50%), depression (83, 55%) or worthlessness (82, 54%).

Four clients (3%) report being homeless in the past 30 days. Ninety-four percent (139) had not been admitted to a psychiatric hospital. In the past 30 days, 95% (141) had not been admitted to a detoxification unit, none had been to jail, and 93% (138) had not been admitted to the emergency room.

Only 9% (13) of clients are enrolled in school or job training and 10% (15) are employed. One-third of clients did not finish high school (47, 33%) and slightly more (52, 36%) have some college experience.

Two-thirds of program participants (95, 66%) report being satisfied with their friendships; 78% (112) have people with whom they do enjoyable things. Fewer feel a sense of belonging (83, 58%) and 72% (103) report enjoying the support of family when needed.

Biometric data collected on program participants at intake reveal many at risk of ill health, notably 52% (76) at high levels of CO Breath scores; 83% of participants have at risk BMI scores; 68% of men and 79% of women have high waist circumference measures. Blood draw sample size is small but outcomes for certain measures warrant further serious attention: notably blood sugar (35% at risk); hemoglobin A1C (63% at risk); total cholesterol (22% at risk); and, triglycerides level (40% at risk).

In this next section, outcomes are examined at six months for the 63 clients for whom there are matched intake and six-month data. There were increases in participants reporting good or better on all functioning domains, including overall health by 31%.

The exceptions were satisfaction with school or work (-21%) and whether symptoms were bothersome (-7%).

There were improvements in mental health symptoms for participants on every domain except hopelessness (-15%).

Clients reporting less than weekly use of tobacco didn’t change at the six-month data point. There was a small drop in the number of clients using cannabis less than weekly, and no change on any other illicit drug use, with no clients partaking (answering "never").

There was a significant increase by 20% in the number of clients fully housed at six months.

The number of clients reporting feeling happy with their friendships rose by 2% while those reporting having someone with whom to do something enjoyable dropped by 8%. Those feeling a sense of community rose by 9% and there was no change in attitude towards the support of family when in need.

 CO breath scores at caution dropped by 66% but scores at risk rose by 3%. More clients had BMI results that signaled caution (+66%). The results for waist circumference were mixed, men with caution level measures dropped by 50%, but 16% more had at risk waist measures. Women’s waist circumference dropped both in terms of those at caution (-300%) and at risk (-7%). More clients had a systolic BP outcome at caution (+10%) and risk (+62%). There was no change in the number at caution for diastolic blood pressure readings and an increase for those at risk by 25%.

Positive responses to program satisfaction questions ranged from 51% to 98%; with the lowest having to do with being informed of medication side effects (51%) and the highest about liking services (98%).

(Source: The Center for Addiction Recovery Report, March 31, 2014) 



 

Music, Fun & Dance

The present 6-week cycle of dance class, led by Evelyn Bloom, focuses on having fun moving to music. Clients attend the weekly classes and enjoy learning about different styles of dance, rhythms, and ways to move to music. The classes do not include complicated choreography, but just enough phsyical activity to gets clients' cardiovascular systems pumping through a fun activity. Below please find our advertisement for the class.

Healthy Cooking Class

"Cooking with Kedian" happens every Monday morning at CHD. Clients work alongside leader Kedian to prepare a nutritious lunch for the whole day treatment program. Kedian provides guidance on meal preparation, healthy options and portion sizes, and safe food service. She is gifted at providing authoritative guidance without doing the tasks for clients. Kedian is a natural in the kitchen and clients flock to her class.

 

 

 

Art Therapy | Collaborative Puzzle

During a recent art therapy workshop, clients were presented with a large blank puzzle and asked to work collaboratively to produce the puzzle as a group. Each client was given 2-3 pieces to create and contribute to the whole puzzle. Clients were asked to think about what things they bring to the group when decorating their puzzle pieces. When the clients finished decorating the puzzle, the group assembled it together, each client helping to find the pieces that fit. This promoted a positive discussion about working together and what each client brings to the group environment. See photos of the finished puzzles here:

Chair Massage | Words from the Massage Therapist

Recently I spoke with Jen Eckard, CHD Health & Wellness's chair massage therapist, and she had this to say about her experience working with our clients:

 

"It has been really wonderful to give seated massage at CHD. I've been really touched by the happy and grateful response of the clients, and I grin when I hear them walking around announcing that they've just gotten a massage. It brings massage back into the context of being a simple human thing, a way to connect and care for each other, rather than a luxury for a privileged few. Sometimes I feel that I'm giving safe, caring touch to someone who has rarely experienced it in their lives, and that is truly good for the soul. I also really enjoy being in the CHD environment; the staff are clearly putting so much thought and care into the programs, and I'm sure it makes a huge difference in the lives of the clients."

 

 

Mindfulness Training Exercises

Exercise 3: "Describing a Photo"

Sweet, compact, grape hyacinths sway

Fragrant, firm and lasting

Bloooming at the tail of May

For a miniature bouquet's crafting

Sweet, compact, grape hyacinths sway

Concord-like an aroma strong

Blosoming at the break of day

For a miniature bouquet that's long

Exercise 4: "Describing a Piece of Lemon"

Initial taste is pucker-producing

Sunny yellow and never sweet

Saliva condenses and is conducing

But savory is tout suite!

Art Therapy | Spring Growth Drawing

In a  recent art therapy class, each client was given the directive to create either a flower or a tree. Then the clients were asked to write on the bloom/petals things that they want to grow/develop in their lives. On the stem, clients were asked to write what they will do to make these things happen; and at the roots, they were asked to write what will feed/support their growth. Here are some of the drawings the clients produced during this class.

 

 

 

Laughter Therapy

Today we had a laughter therapy group led by a certified laughter leader. Eleven clients participated (4 females; 7 males) of mixed ages and psychiatric diagnoses. The leader informed clients at the beginning that research shows fake laughter can turn into real laughter via exercises. As the hour unfolded, this was precisely the case.

The leader asked clients to think about why laughter could be good for them. Several clients stated that they thought it would help with “endorphins, increased eye contact, improves your insides, and reduces stress.”

A series of exercises progressed from small moments of joy to raucous and boisterous full-bellied laughter. The first exercise involved a “ho-ho, ha-ha” warm-up exercise, which clients slowly warmed to and which became the refrain throughout the whole class. The warm-up involved repeating the phrase ho-ho, ha-ha and following this up with a round of clapping.

The second exercise involved hand shakes and laughter. Clients were asked to move about the room, introducing themselves to one another and laughing while they shook hands. It was great to see some clients who are really plagued by anger and negative symptoms participate in the exercise. After this exercise the leader asked why clients believed children laugh much more than adults throughout the day. One astute client replied, “Because it’s not appropriate to laugh during the business work setting.”

The third exercise involved laughing while patting one’s legs and then raising one’s arms in the air. During this exercise, clients were asked how they felt so far. Three clients said that they felt “stronger; a lot better; and happy.”

The fourth and final exercise involved passing around balls of small, medium and large sizes. Clients were asked to laugh in a small, medium and hearty way depending on the size of the ball that was tossed to them. This exercise quickly turned into infectious laughter amongst group members. When an imaginary ball was tossed to a particular client who had previously been reticent to participate, she appeared to become more engaged. For some reason this exercise was more enticing to this participant. Perhaps it was somewhat less threatening to her. Another possible explanation is that she warmed up to the exercises over time.

The leader gave clients a laughter practice handout which offered suggestions for ways of integrating laughter into their daily lives and practices. One client began to immediately highlight sections of the practice handout that called to him.

All clients appeared to have a great time during the laughter therapy session. What is clear is that there was a natural progression from reserved and small laughs to a larger, communal and boisterous laughter for all.   

Art Therapy | Tissue Paper Painting

In a recent art therapy workshop, clients were asked to think about what their stress looked like and to create an abstract depiction of it using tissue paper and a mixture of glue and water paste.  Various colors of tissue on watercolor paper were used to create their tissue paper paintings. Below please find some of the paintings created by clients.

 

 

Writing Retreat | A Client's Poem

The warm summer sun feels good on your face, and the warm winds blow through your hair, and the wet sand through your toes, when you walk on the beach, on a warm summer day.

Developing the Workforce

A central player in the integrated care team is the peer recovery support member. This position is especially valuable for peers seeking to gain professional experience in the health care field and will aid in the increasing professionalization of the allied health worker. Here is how I envision the Peer Recovery Support staff member(s) working within and adding to our integrated health care team.

 
The peer recovery support position (PRS) partners with the Health & Wellness Program to provide the following types of service.

• Wellness coaching. PRS partners will be able to provide wellness coaching—that is, providing one-on-one or group counseling to help patients obtain their personal health objectives. This service will complement the rich array of wellness activities planned for the Health & Wellness program, including Yoga, music and art therapy, health cooking classes and cardiovascular exercise programs.  

 

• Recovery education and support. PRS partners will lead or co-lead self-help recovery services, perhaps even based on the 12-Step model.

• Chronic Disease Self-Management Program Leadership. PRS partners will be trained to lead or co-lead 6-week-long CDSMP workshops which instruct participants on ways in which to better manage their chronic illnesses, whether they are physical or emotional in nature. The Stanford University CDSMP model will be used for this instruction.

• Marketing. PRS partners will be able to assist with development of marketing and recruitment materials, including social and print media. CHD Health & Wellness has a Facebook and main webpage that require regular updating. PRS partners with interest in this work will be invited to update the pages, provide content and assist in designing other marketing materials.  

• Medical assistance. For PRS partners with a strong interest in health care, opportunities will be made available for assisting with obtaining patients’ vital signs, scheduling patient visits, collecting personal health information and arranging for medical taxi transport to and from visits.

Integration Case Report

Introduction

This case report describes the psychiatric behavior and primary care activities of a married 46 year old female diagnosed with major depressive disorder, severe in type, without psychotic features. What is perhaps most important to glean from this case is the benefit that the integration program, including primary care and behavioral health care, has had in the recovery experience evidenced by the patient.

Case Description & Discussion

The patient began experiencing depressive symptoms and was diagnosed with MDD in 2011, shortly after experiencing a spontaneous abortion of her first and only pregnancy. The patient was hospitalized and began a course of antidepressant therapy treatment— fluoxetine hydrochloride, 20 mg/day for 38 weeks. Meantime, the patient began participating in a weekly DBT group as well as attending individual psychotherapy of the psychodynamic type.

In 2012, the patient enrolled in the integrated services program through which she now obtains her medical care. The patient weighs 165 lbs and is 5’1 inches tall. Although she is not morbidly obese, the patient has been encouraged by the PCP to eat more nutritiously, exercise more regularly and lose approximately 20 lbs. The patient has gone to check out the gym and has been thinking more about how she wants to proceed long-term. She is feeling more stable and positive, but is worried about SI returning at some point. She agrees to get rid of anything she has held on to with which to hurt herself. According to the PCP, “she seems more hopeful overall.”

Through the integrated services program, the patient began, in 2013 ,to participate in an ongoing therapeutic writing workshop. In the workshops, the patient provides supportive dialogue and orients new members to the group. Her writing is strong and descriptive. She writes mostly about hopeful things, but she did, however, present one poem about the loss of someone close to her, which could well have been veiled reference to her miscarriage.

The patient will continue with weekly psychotherapy and DBT, as well as art therapy and writing therapy. While it is impossible to say for sure what trajectory her recovery would have taken without the integrative services program, it is clear that the patient has benefitted from the therapeutic and physical health care offerings she has received in one setting.

Healing Hearts Made by Clients

Writing Retreat Poem

 

The Writer

by Phyllis St. George

 

All these years

You've resisted

Growing up.

 

Waiting for your parents

To change?

Wanting to redo

Your childhood?

 

There are no Redo's and

No Back-to-the-Future's.

 

What's done is done.

Move on.

Be a big girl.

Take some responsibility

For your life.

 

How long are you

Going to hold out?

You are missing

So much.

 

Being a grown-up

Can't be all

That hard.

By now you know

It's more than

Paying bills

On time;

Owning a house,

A car, a cat;

Going on

Vacations.

 

Just write.

Just write and eventually,

One day

You will be there, and

You won't have noticed.

Thoughts about integration as CHD Health & Wellness turns 1 year old

It was gratifying to know that we have made it through the first year with healthy financial outcomes. Of course there is much more to be achieved financially, but our outcomes are very solid for the program being only one-year old.

But financials provide only one reason to be gratified. Some of the best reasons for feeling gratified, however, are directly related to client outcomes. As mentioned before, clients report feeling very satisfied with the integrated services program, that they have safe housing, that they are satisfied with their social connectedness and that they are generally satisfied with their lives.

The real mark of the success of our program, even only at the one-year goal, is the physical health outcomes. Health indicator data are presently being analyzed and will be available for mention here soon. But for now, what can be said is that clients are actively moving about, engaging in exercise and other wellness programs and attending their primary care visits and follow-up appointments. One client recently said of the primary care provider, “I really like [her]. She is very different from all other doctors I’ve had because she listens to me. She spends time listening to me, she shows compassion and is very helpful and gives me good advice.”

So, as the program turns one-year old, permit me to thank all who have been involved with our program, namely the staff at CHD who have helped with our success. The CHD Health & Wellness team continues to be grateful for collegial support and looks forward to many more years of program success and enhanced client wellness.

Relationship Between Integration and Employment Behavior

A closer examination of the rates of employment and job training participation by clients enrolled in CHD Health & Wellness integrated services program is warranted. What is known is that at baseline, only 6% (5) of clients were enrolled in school or job training and 13% (10) were employed.  One-third of clients did not finish high school (28, 36%) and an equal proportion (26, 34%) has some college experience.

 

By the six-month data point, however, the number of clients receiving school or job training increased by 300%. Yet there was a drop of 40% in those employed at six months.

 

Six the data are for a mere six-month in time, the findings are merely trends. But it is interesting to speculate about what these trends may mean for participants in CHD Health & Wellness.

It is possible that clients become so engrossed in the wellness offerings provided by the integrated services program that their time is consumed by participation in the programs. Similarly, as a result of enhanced integrated clinical care, clients are feeling better and, as a result, encouraged to make a career change or return to school for further training. This last possibility is supported by the data which indicate that clients report feeling happier, more well-adjusted, and socially connected.

This is a trend that we will keep a close eye on as the 12-month data become available for analysis.

Mandalas | Self Symbols

Mandala is Sanskrit for “sacred circle”. It is way of creating order and balance by using the circle as a container for emotions, colors and patterns. In this exercise, clients were given a history of how the mandala is used in various cultures, including the meditative sand mandalas of Tibetan monks and the “medicine wheel” based on the four directions of Native American teachings. Clients could use mediums of their choosing and were given a template to fill in or an already designed mandala to color. Each client was asked to title their mandala.

The art therapy intern a new bulletin board that showcases the mandalas that were created in the two workshops. See photos below.

Double Self-Portraits

For this art therapy activitiy, clients were instructed to create a self-portrait using the medium of their choice to depict two self-portraits. The first portrait was to illustrate how they feel people see them. The second portrait was to illustrate how they wanted to be seen by others. Several client self-portraits are provided below.