Week 7 - Interventions pt2 - Health Psyc and HIPping

Question 1

A HIP is

Answer 1

• An integrated role within primary care.
• The HIP model aims to improve overall health outcomes by improving access to efficient and effective behavioural health supports within primary care settings.
• It uses a population-based approach to the delivery of behavioural health services.
• HIP services fit into and reflect the primary care setting.
• Mental health care becomes a routine part of good health care.

Question 2

Benefits of having a HIP role

Answer 2

• Improves population health (a little for a lot of people).
• Enhances people’s experience in primary healthcare.
• Reduces cost.
• Promotes wellness.
• Supports and addresses medical and psychological challenges.
• Saves GP and nurse consult time and supports them to work at the top of scope. * Gives team members confidence to initiate or have mental health conversations. * Reduces referrals to specialist or secondary services.
• Improves collaboration across services.

Question 3

Distribution of care for those experiencing mental health or substance use challenges in the US in 1989

Answer 3

• 59% receive no care
• 20% rely on specialist mental health support
• 21% receive primary care support

This is the trigger for looking for a new way of working - aka with health psychs and HIPping

Question 4

_____ % of New Zealand adults see a GP in a year

Answer 4

78%

Question 5

1 in ___ live with a mental health or addiction challenge each year
Almost 1 in ___ were Māori, 1 in ___ Pasifika, 2 in __ of people in prison

Answer 5

5
3
4
3

Question 6

_____% experience mental health or addiction challenges over a lifetime

Answer 6

50 – 80%

Question 7

Over ____ of people attending addiction services have a co-existing mental health condition, and ____% of people attending mental health services have a co- existing substance use issue

Answer 7

70%
30 – 50%

Question 8

1 in ____ secondary students report poor emotional wellbeing

Answer 8

4

Question 9

Quadruple aim of HIPping

Answer 9

1. Improves population health.
2. Enhances people’s primary care experience.
3. Reduces cost.
4. Promotes provider wellness.

Question 10

Where HIPs came from

Answer 10

• Dr Patti Robinson is an American clinician who was involved in research that led to development of the HIP model.
• Patti and the team at Mountainview Consulting developed training to prepare and support new HIPs into working in a primary care practice.

Question 11

HIP services in practice

Answer 11

• 50% same day appointments
• 50% initial/booked in appointments
• Around 10% of people are recommended for higher level of care
• Broad range of referrals from GPs and RNs
• HIP services align with the needs of practice demographics

Question 12

Rates of returning patients for HIP

Answer 12

In a typical HIP practice:
* 50% of people are seen one time
* 20% 2-3 times
* 20% 4-5 times
* 10% more than 5 times (continuity people)

Question 13

Michie, S. et al. (2011) Wheel; Intervention function of the behaviour change wheel

Answer 13

1. Education – increase knowledge or understanding
2. Persuasion – use communication to induce positive or negative feelings or stimulate action
3. Incentivisation – create expectation of reward
4. Coercion – create expectation of punishment or cost
5. Training – impart skills
6. Restriction – use rules to reduce the opportunity to engage in target behaviour (or to increase the target behaviour by reducing the opportunity to engage in competing behaviour)
7. Environmental restructuring – change the physical or social context
8. Modelling – provide examples for people to aspire to or imitate
9. Enablement – increase means or reduce barriers to increase capability (beyond education) or opportunity (beyond environmental restructuring).

There’s a picture of the wheel in the slides

Question 14

Role of Trauma

Answer 14

• Trauma is the lasting effects of events, circumstances or intergenerational traumatic experiences on a person or group of people.
• Trauma includes:
  Historical trauma from colonisation for many Māori.
  Trauma due to discrimination eg the rainbow community, refugees people with disabilities, some religious groups.
  A traumatic event like a natural disaster, experiencing or witnessing violence. Trauma due to the cumulative impact of Adverse Childhood Experiences.

Question 15

Role of Adverse Childhood Experiences

Answer 15

▪ An American study looked at the lifetime impact of these ten adverse childhood experiences (ACEs)20.
▪ It is the largest study done in this area and has been replicated around the world.

• considers physical, emotional and sexual abuse
• considers physical and emotional neglect
• Considers household dysfunction; mental illness, domestic violence, separation and divose causing stress to the child, relative in prison, substance abuse in the house

Question 16

ACEs scores

Answer 16

• Each type of ACE gives a score of 1
• A high ACE score means a person is more likely to experience ongoing impact throughout their life. BUT there are protective factors…
• ACEs sometimes don’t negatively impact to this extent if these factors are present:
  oOne safe, supportive adult
  oMastering a skill
  oRelationships with people from other generations

For every 100 people; 33% have no ACEs, 51% have 1-3 ACES and 16% have 4-8 ACEs

Question 17

Role of Flourishing

Answer 17

• Flourishing reduces the risk of common mental health challenges like anxiety and depression.
• It varies among groups and is modifiable with low intensity ACT techniques.

Good diagram for the circular flow starting with;
positive emotions < Engagement in life < Healthy Relationships < A strong sense of meaning < A sense of accomplishment < back to positive emotions

Question 18

Experiential avoidance

Answer 18

• Experiential avoidance is altering behaviour to avoid uncomfortable thoughts and feelings. This can lead to unhealthy behaviours.
• This is a response to social context eg
  “If you feed bad, something is wrong with you”
  “Avoid negative thoughts and feelings – smoke this, drink this, wear this, eat this, buy this …..
• The HIP can help people change their perspective of the problem, increasing their psychological flexibility so they can behave differently and suffer less.
• Psychological flexibility is learning to be aware and accepting of the pain that comes into our lives, while continuing to pursue what we value.

Question 19

Choice Point Diagram ; Adapted from: Robinson, Gould, &Strosahl.

Answer 19

• in lecture notes

Question 20

THE BULL’S EYE model

Answer 20

Diagram in notes
- could have any label in the 4 corners, but tries to help patients/client to get on target