Project ECHO Archive

June 8 – Antipsychotic Medications 

June 8 – Antipsychotic Medications (PDF) – Dr. Michael G Skoch, Sunflower Chief Medical Officer, Kelley Hotaling, Sunflower Pharmacist and Dr. Ulisa D. Buckingham, Sunflower Medical Director

Case Study (PDF)

Case Recommendations:

• Explore PERS (persona emergency response system) options WITH him before discharge. If possible, try out devices so he can see which one he would prefer to increase likelihood of him actually using the device
  • Another option would be to add Life360, or a similar app to his phone
• If possible, find a setting where he could have access to 1:1 care so that he can continue doing his preferred activities safely
• Set up intake with Behavioral Health services prior to discharge
  • He could benefit from accessing Peer Supports
• Find opportunities to bring his preferred activities to him- bring the dance party to him!
  • Look into Senior Resource Center to see if they offer dance classes/activities
  • The local YMCA maty also have dance activities available
• Assist with setting up scheduled walks with a buddy, visit with sister
  • Maybe set up consistent outing schedule so he knows when to expect his preferred activities
• Consider a Homes Plus versus an Assisted Living Facility as he might have access to more care in that type of setting

June 15 – Aging And Socialization 

June 15 – Aging and Socialization (PDF) – Leslie Anderson, Executive Director, Kansas Association of Area Agencies on Aging & Disabilities

Case Study (PDF)

Case Recommendations:

• Consider a consultation with neurology to confirm dementia diagnosis
• Follow up with medication prescriber regarding elevated thyroid levels, may need to make adjustments to his medications
  • Elevated thyroid levels could impact depression
• Document what works for the individual
  • Consider using person-centered tools, such as a 1-pager from the Person-Centered Thinking Tools
• Consider utilizing self-management tools
  • Use cue cards
  • Create visual in her handwriting for what her meds are and when to take them
• Medicare also has an “MTM” Medication Therapy Management program where pharmacists can review the medication regimen and print out the information as a resource
• Assist her in having access to video calls with family
• Scheduled time with peers
• Continue to offer a variety of hydration drinks- explore different options
  • Clear/fruit-flavored Ensure
  • Coffee flavored protein shakes/drinks
  • Jelly Drops
• As Hydrocodone can affect cognitive abilities, consider looking at alternative options for pain management
  • What treatment options have been explored for her Arthritis
• Increase opportunities for cognitive activities and reading exercises for mental stimulation

June 22 – Palliative Care 

June 22 – Palliative Care (PDF) – Dr. Kerry W. Pantelis, Centene Corporation Medicare Medical Director

Case Study (PDF)

Case Recommendations:

• Provide education regarding the following, as these could be inhibiting the control of the infection
  • Consider a consultation with a Rheumatologist - if arthritis is untreated, this could be contributing to pain
  • Smoking - providing resources for smoking cessation
  • Untreated Hepatitis C - re explore treatment options with him, and educate that this can be short-term
• Consider a cognitive assessment to determine any supports with decision-making
• Discuss with him about what worked for him in the past when he lived in the community
• Connect with mentoring opportunities- i.e. peer supports through the CMHC- this may be more acceptable to him versus therapy
• Keep exploring his strengths- and draw from these
• Look into Community Ran Organizations (CROs) or Clubhouses as these could also provide some opportunities for mentoring and peer supports
• Revisit the medical order for 1 beer/day
  • This may not be a conducive option for someone trying to achieve sobriety

June 29 – Plan … To Age In YOUR Place! 

June 29 – Plan … to Age in YOUR Place! (PDF) – Camille Russell, State of Kansas Long-Term Care Ombudsman

Case Study (PDF)

Case Recommendations:

• Consider using LifeCourse tools to help map out strengths, supports and needs - to help identify ways to reach quality of life goals.
• Look for opportunities to connect with others based on common interests (golf, audiobooks, technology, etc.)
  • MeetUp
  • Toastmasters or other senior meet and greet groups
  • Spending time at the golf course’s clubhouse to see if he can meet with peers there
• Other opportunities for peer supports:
  • Consumer Ran Organizations (CROs) in the state - check availability
• Medication considerations:
  • Consider a pharmacy review to look at medication interactions - med list shows three benzodiazepines plus a pain medication - this combination could affect cognition
  • Benzodiazepines can also affect sleep - consider a sleep consult (if snoring, drooling, kicking) since he has been a smoker before
  • Bipolar and hypomanic cycles can impact sleep as well. See if any tools/applications to remind him to take his mood stabilizer
  • Anxiety can be impacted by other health issues as well - consider to have labs checked such as TSH thyroid and liver function due to Serzone, and review for other comorbid risk factors
• Would he enjoy being a mentor to others:
  • Volunteer at the library to work or lead reading groups, or reading books to children
  • Foster grandparent programs - connecting with schools for mentoring students
• Long-term care ombudsman

• March 30 – Care Coordination For Individuals In Foster Care 
• March 30 – Care Coordination for Individuals in Foster Care (PDF)
• Case Study (PDF)
• Case Recommendations
  • Consider looking for a BH provider familiar with Trauma-Focused Therapy to address sexual trauma
  • Consider an updated psych evaluation for diagnostic clarity 
  • Consider visiting with a neurologist to look into the possibility of a Tuberous Sclerosis diagnosis
  • Look in to a motivation system or other positive behavior support strategies to help with medication adherence and school engagement
  • Explore her strengths and interests and build connections around these
  • Consider a medication review
    • Geodon has to be taken with food, otherwise it may cause stomach discomfort
    • Focalin would need to have a good balance as it could also cause hyperfocus
    • Look at possible side effects of medication and see how these could possibly be presenting as challenging behaviors
  • Since school is currently her most consistent support, consider partnering with them for implementation of interventions
• April 6 – Crisis Lines 
• April 6 – Crisis Lines
• DCF Family Crisis Response Helpline Background and Functionality - Carelon (PDF)
• 988 Presentation (PDF)
• Overview of 988 for Helping Professionals (PDF)
• Case Study (PDF)
• Case Recommendations
  • Coordinate behavioral health services with school so there is a collaborative approach in helping him reach his goal to graduate school
  • Consider using MTS (Multisystemic Therapy)
  • Offer parent support through the CDF Contractor while in custody and ensure continued supports after release
  • Consider genetic testing to rule out other underlying genetic conditions possibly contributing to behavior challenges
  • Consider a new psychological evaluation for diagnostic clarity, then revisit medication efficacy based on new evaluation
  • Provide crisis supports information to the youth, his family and support system
    • DCF Crisis Line for youth 20 years old or younger 1-833-441-2240
    • 988
• April 13 – MyStrength 
• April 13 – MyStrength (PDF)
• Case Study (PDF)
• Case Recommendations
  • Refer for a Functional Behavior Assessment to help team with identifying functions of behavior, and recommendations for function-based interventions
    • Parsons State Hospital Dual Diagnosis Outreach
    • Since she has an autism diagnosis, could also access a BCBA (Board Certified Behavior Analyst)
    • Incorporate FBA recommendations within a crisis/safety plan that can be developed along with her providers at the CMHC
    • Provide crisis resources
      • 988
      • DCF Crisis Line for youth 20 years old or younger - 1-833-441-2240
    • Look in to using myStrength app - provider can also help her access this
    • Explore vocational goals
      • Pre-ETS (Pre-Employment Transition Services) could be accessed through school
      • Use person-centered planning tools to help her make a trajectory map for future planning
        • LifeCourse Tools
        • Person-Centered Thinking
    • Look in to an updated psychological evaluation for diagnostic clarity- particularly looking in to processing speed as this could impact her frustration with communicating with others
    • With regards to medication, watch for long-term side effects of Depakote, be working with the med provider on this
• April 20 – CMHC Foster Care Services & SED 
• April 20 – CMHC Foster Care Services & SED (PDF)
• School District-CMHC List (XLSX)
• Case Study (PDF)
• Case Recommendations:
  • Involve case team and individual/family therapy provider in conversations regarding permanency plans
    • Help youth with preparation and understanding for if reintegration with biological family is the plan
  • Assist youth and foster family with follow up with dental work
    • Pain could increase behavioral health symptoms and likelihood of aggression
  • Consider accessing an Occupational Therapist to evaluate sensorimotor needs
  • Provide tools for foster parents
    • TBRI: Trust-Based Relational Intervention
    • PCIT: Parent-Child Interaction Therapy
    • CPI: Crisis Prevention
  • Depending on results of psychological evaluation, connect with the local CDDO (Community Developmental Disabilities Organization) if an Intellectual or Developmental Disability diagnosis is identified

October 7 – Case Management Overview 

• Session Topic: Case Management Overview (PDF)
• Case Study (PDF)
• Speaker: Deb Rear, RN, BSN, MBA, Senior Manager of Case Management for Sunflower Health Plan
• Case Study Recommendations:
  • Look into the OneCare Kansas program to see if he would be eligible for services.
  • Although not the least restrictive option, an Assisted Living Facility of Homes Plus in his desired county may offer a more supported and structured living environment to meet his physical health needs, while he waits for a more independent housing option with the low-income apartments,
  • Another option would be to look into group homes or supported housing options through the mental health center.
  • It was identified that smoking while on oxygen poses a huge barrier when it comes to finding any type of housing (apartment, ALF, Homes Plus) that would accept him, given the huge risk that poses.
    • Reintroduce smoking cessation programs as part of his goal for permanent housing.

October 14 – OneCare Kansas 

• Session Topic: OneCare Kansas (PDF)
• Case Study (PDF)
• Speaker: Michelle Styrpejko, Kansas Department of Health and Environment (KDHE)
• Case Study Recommendations:
  • Council member on having Naloxone/Narcan on hand in case of an overdose. Help member obtain and fill a prescription
  • Connect member with community housing supports, particularly ones who follow the Housing First model
  • Member may be eligible for the OneCare Kansas program. Check availability in her county of residence
  • Consider a psych evaluation while inpatient at the hospital for diagnostic clarity, including assessment for cognitive delays
  • While inpatient, consider an SUD/RADAC assessment to establish inpatient substance abuse treatment, should member choose to move forward with this
    • From here, work with member on a step-down to community-based SUD and mental-health treatment
  • Consider accessing services via telehealth, to see if member would be more agreeable to this than going in person

October 21 – Care Coordination During Pregnancy 

• Session Topic: Care Coordination During Pregnancy (PDF)
• Case Study (PDF)
• Speaker: Molly McHenry, RN, Care Manager, Sunflower Health Plan
• Case Study Recommendations
  • Assess for the Brain Injury Waiver to see if she might qualify for additional supports
  • Connect with Parents as Teachers and Infant Toddler Services for early intervention services for the baby
  • Connect with local financial resources
    • Utilize 211/United Way as a resource for looking up
  • Look in to requesting home visits from the health department, or even a Visiting Nurses organization, if available in her county
  • Look into Home Health to see if she would be eligible for that support
  • Encourage her to identify someone as an emergency contact
  • Provide her with domestic violence resources, local support groups may be available for her
  • If she is looking in to future pregnancies, look in to genetic testing or consultation with the OB-Gyn to explore possible cause for past spontaneous abortions/miscarriages

October 28 – Behavioral Health 

• Session Topic: Behavioral Health Case Management (PDF)
• Case Study (PDF)
• Speaker: Diana Erickson, LCPC, NCC Senior Director Behavioral Health, Sunflower Health Plan
• Case Study Recommendations
  • Provide some of the resources from LifeCourse and Person Centered Thinking to assist the member in identifying his goals. 
  • Potentially look at genesight testing if not already completed to ensure medications are appropriate.
  • Potentially look at CMH Clinical Trials to see if there is an applicable clinical trial for the member to participate in.
  • If the member has a goal to finish his education, connect with our employment specialist to access GED voucher and support. 

November 4 – HCBS And Care Coordination 

• Session Topic: HCBS and Care Coordination (PDF)
• Case Study (PDF)
• Speaker: Michele Heydon, BA, HCBS Director, Kansas Department for Aging and Disability Services (KDADS)
• Case Study Recommendations
  • Explore the availability of peer supports at the local community mental health center.
  • Explore Diabetes education available in his area
    • Look in to telephonic or virtual diabetes management programs, such as the one Sunflower offers.
  • Explore additional supports through the local center for independent living as there might be groups available there, or opportunities for other independent living services.
  • Look in to virtual support groups OR
  • Look into interest groups that meet virtually
  • Connect with vocational rehabilitation
    • See if the local CMHC is a local vendor for VR, or
    • See if the CMHC provides employment supports
  • Use person-centered tools, such as LifeCourse or Person-Centered Thinking, for planning to assess his preference and priorities
  • See if member is eligible for the STEPS (Supports and Training for Employing People Successfully).
  • Look in to using a calendar to help manage to-dos and organize schedule

November 11 – Transitions To Employment 

• Session Topic: Transitions to Employment (PDF)
• Case Study (PDF)
• Speaker: Cheryl Laaker, ACRE, Project SEARCH Statewide Coordinator, WORK Program Lead, Sunflower Health Plan
• Case Study Recommendations
  • Connect individual with early intervention services for the child, such as the local
    • Parents as Teachers
    • Infant-toddler services
    • WIC
  • Explore with the job coach other, or additional, job opportunities to go further with his preferred employment
  • With DCF involvement, look in to parent training programs or other types of family supports
  • Depending on location, there may be parent-empowerment programs through the local Community Mental Health Center or Community Action groups

June 3: Navigating Barriers to Preventive Care, Sunflower Approach – Amy Salazar, Supervisor, Community Health Services at Sunflower Health Plan

• Navigating Barriers to Preventive Care, Sunflower Approach (PDF) – Amy Salazar, Supervisor, Community Health Services at Sunflower Health Plan
• June 3 Case Study (PDF)
• Case Study Recommendations:
  • Transportation Services through Sunflower can be used to go to WIC. There are other programs that the parent can benefit from with WIC, such as support services and educational opportunities.
  • Language Services are also available through Sunflower Health Plan at no cost to members. They can call in to request an interpreter during visits to the doctors. In-person language services can also be requested and scheduled (subject to Covid restrictions).
  • It may be helpful to connect parent with resources for cultural needs.

June 10: COVID-19 Vaccine Equity, Dr. Ximena Garcia, MD State Senior Advisor for COVID-19 Vaccine Equity

• COVID-19 Vaccine Equity (PDF), Dr. Ximena Garcia, MD State Senior Advisor for COVID-19 Vaccine Equity
• June 10 Case Study (PDF)
• Case Study Recommendations:
  • Hospice services can potentially assist with survivorship and guardianship process
  • Ensure coordination with DCF to verify plans for his children
  • If possible, clarify vaccination status of the children. Could provide some information on whether individual has some protection if other members of his household has been vaccinated
  • Leverage his natural supports as potential trusted messengers when it comes to education about the vaccine
  • Continue using Motivational Interviewing, such as patience and active listening, when communicating with the individual
  • Utilize available resources through the local health department, CDC to continue providing education to the member- i.e. risk of Covid vaccination vs actual Covid

June 17: Nutrition, Sarah Schaefer, American Heart Association

• Nutrition (PDF), Sarah Schaefer, American Heart Association
• Case Study (PDF)
• Case Study Recommendations:
  • Offer to connect the youth to available prenatal and parenting classes through organizations such as Healthy Babies
  • Kids Network is a great resource for baby items, etc.
  • Ensure that youth is already connected with WIC
  • Regarding transportation barrier:
    • Provide information about ModivCare (transportation benefit through Medicaid)- can provide transportation to medical appointments, or provide mileage reimbursement
    • Since member is a minor, will need to work with foster parents or guardian to set up appointments
    • Also have internal transportation Subject Matter Experts who can help the team with navigation
  • Vouchers for GED Prep classes are available as a benefit through Sunflower Health Plan- connect with Employment Specialist
  • Work with foster care agency on various resources to connect member to with regards to her being transition age, as well as with her potential release from custody
  • Although the youth is in custody, her baby will not automatically be. Ensure that youth has the supports she needs so she can apply for various benefits available for her child, including Medicaid, Childcare Assistance through DCF, SNAP, etc.
  • Sunflower’s Behavioral Health/Foster Care team can assist with navigating supports and resources with relation to her behavioral health and foster care needs.

June 24: Dental Care, Kathy Hunt, RDH ECPII, Oral Health Kansas Dental Program Director

• Dental Care (PDF), Kathy Hunt, RDH ECPII, Oral Health Kansas Dental Program Director
• Case Study (PDF)

March 10 – Medication Assisted Treatment – Andrew Brown, KDADS 

• KDADS State Opioid Response & KanCare (PDF)
• Case Study (PDF)

Recommendations:

• It may be helpful to seek a secondary opinion on the Rheumatoid Arthritis, especially with looking in to alternative treatments for pain management
  • No mention of a PCP, so getting established with one and having a good rapport can help with identifying proper treatment to manage the RA
  • Would she be eligible for a pain pump?
• Medication consultation on the usage of suboxone for pain management, as she this is the medication that will be used for her MAT protocol
• Further education or supports on managing Rheumatoid Arthritis could help with identifying alternatives to pain management- possibly connect with RA Foundation
• Explore history of trauma and root cause of issues with family dynamics- this may have an impact on ongoing SUD and MH treatment
• Peer Supports- find out if this is available at the current inpatient facility, which could then follow her once she transitions to outpatient services
  • This could also assist with counseling and education around following program to recovery
• Narcotics Anonymous could provide member with additional supports and a sponsor to talk to as she’s working on recovery
• Consider a stepdown to a Level 3.1 program after discharge from the inpatient facility
• Develop a goal around identifying supports for employment- explore options available to her through Vocational Rehabilitation

March 17 – Peer Mentoring And Addiction – Shane Hudson, CKF 

• Peer Mentoring and Addiction (PDF) – Shane Hudson, CKF
• Case Study (PDF)

Recommendations:

• Ask this question to help drive conversations regarding treatment and recovery: What outcomes matter the most?
• Consider a Dual Diagnosis Center with Medication-Assisted Therapy
• Consider Medication-assisted therapy, potentially with suboxone
  • If an IV user, consider a monthly injectable
• If the CMHC has a SOAR-trained worker, they can help member navigate benefits, including social security and Medicaid
• Consider a conservator or payee
• Ensure wraparound services through the CMHC, with the addition if substance-use treatment, as well as peer-supports
• Look in to connecting to a community activity center as an opportunity to engage with different peers and develop new hobbies/interests
• Consider drug court- this could potentially provide a court officer who could help with following through on requirements of a treatment program
• Consider connecting with a support group like NA or finding a sponsor

March 24 – Methadone Clinic – Jan Campbell/Roopa Sethi, University Of Kansas Health Systems 

• Methadone Clinic MAT (PDF) – Jan Campbell/Roopa Sethi, University of Kansas Health Systems
• Case Study (PDF)

Recommendations:

• Connect with KC Care Clinic’s needle exchange program, member can utilize this program anonymously
  • Also the potential of additional services through there
• Encourage member to have Narcan available at his residence
  • Can get this through KC Care Clinic
  • Can be picked up from a pharmacy at a low to no cost, depending on insurance coverage
• Consider the addition of peer supports
• Have a conversation with member about his own goals regarding employment, then connect with possible resources, such as Vocational Rehabilitation

March 31 – Therapeutic Supports – Deb Stidham, Johnson County Mental Health 

• Therapeutic Supports (PDF) – Deb Stidham, Johnson County Mental Health
• Case Study (PDF)

October 15: EPSDT Overview, Samantha Ferencik, KDHE

• Kan-Be-Healthy, EPSDT in Kansas and Beyond (PDF)
• Case Study (PDF)
• Recommendations:
  • It would be helpful to understand the root cause of the Cerebral Palsy, whether it be a genetic or physical component.
  • Consider bubble packs or other strategies to help family be more independent with medication administration.
  • Ensure engagement with the PCP, as there are multiple specialists involved in the child’s care. Consider some sort of digital or physical record organization to keep information together.
  • Explore programs/apps that helps with written translation of documents.

October 22: KAN Be Healthy, Jessica Willard, KDHE

• Lead Poisoning in Children Project ECHO Presentation (PDF)
• Case Study (PDF)
• Recommendations: 
  • Explore local community resources for grant opportunities, such as through the Autism Society of the Heartland
  • ASH also has resources for elopement
  • Explore telehealth options for ABA therapy
  • Through ABA, or potentially through the Parsons Outreach team, look in to getting a Functional Behavior Assessment completed to understand functions of behavior
  • Look in to other device options that may be covered benefits- Home Buddy, QMedic or a watch through SafeLink
  • Explore historical services through Infant/Toddler to get a comprehensive pictures of therapies/treatments that child has received

October 29: Childhood Immunizations, Maria Dycoco, MD, Children's Mercy Kansas City

• Childhood Immunizations (PDF)
• Case Study (PDF)
• Recommendations:
  • Look in to HCBS Waiver options for both siblings, the child may qualify for services through the Brain Injury Waiver. The sibling may qualify for services through the SED Waiver.
  • Due to the drug and substance exposure, seek diagnostic clarification to see if child has Fetal Alcohol Syndrome
  • Also screen for behavioral health needs, such as ADHD. Evaluation through a Developmental and Behavioral Health team, such as with Children’s Mercy, may be a good option to get this completed.
  • Provide grandparents with education on what child is working on in Speech Therapy
  • Perhaps recommend that they attend therapy with the child
  • Explore the possibility of the outpatient therapists assisting with administration of the flu shot
  • Provide grandparents with resources for parent training
  • Coordinating through DCF
  • Through the local CMHC- look at options for Trust Based Relational Intervention (TBRI)
  • Kids TLC online parent training
  • Connect grandparents with Families Together to help with navigating systems

November 5: Treatment and Therapies, Teresa Bonham, Sunflower Health Plan

• Therapy Services and EPSDT (PDF)
• Case Study (PDF)
• Recommendations:
  • Explore Telehealth options for services and supports, given the transportation barrier
    • Clarify availability/accessibility of technology and reliable internet
  • Ensure collaboration between the community prescriber and the PRTF prescriber to ensure continuity with medication management
  • Educate parent on importance of engagement and participation with care planning
  • Connect parent with Parent Training resources, potentially through the Family Preservation agency they are already connected with
  • Align case management for siblings (if also on the same health plan) to help mom with coordination

August 6: Social Isolation And Aging 

Camille Russell, Office of the State Long Term Care Ombudsman

• Didactic Presentation: Isolation and Aging (PDF)
• Case Study (PDF)

Recommendations: 

• Contact the member’s tribe for assistance with a welfare check.
• Contact the district court to obtain copies of the guardianship paperwork.
• Consider cultural reasons for lack of communication - i.e., member may be more apt to keep information to herself, or let others in positions of authority to speak for her.
• Communicate with the PCP and/or pharmacy to find out more about member’s care
• Consider bubble packing for medications.
• Check claims if waiver services are being utilized.
• Discuss the option of home health visits with the PCP to ensure the medical needs are being met at home.
• Consider connecting with behavioral health services.
• If still unable to find out more about member’s care, consider making a report to APS for a welfare check.

August 13: Aging In COVID 

Mitzi McFatrich, Kansas Advocates for Better Care

• Didactic Presentation: Elder Abuse, Neglect and Exploitation (PDF)
• Case Study (PDF)

Recommendations:

• Check with a GI specialist. The reflux may be caused by food being swallowed without properly chewing due to individual not having teeth.
• Have a dentist assess oral hygiene, would he be a good candidate for dentures?
• Consider connecting with behavioral health services for psychiatric needs, as well as to address trauma history
• Connect member directly with an ombudsman to help advocate for member
• KS Advocates for Better Care is another resource that member can access for advocacy
• Member can appeal the 30 day notice - connect with Disability Rights Center or KS Legal Service, if needed
• Consider a medication review to assess efficacy - consider PRN meds

August 20: Nursing Home Planning In COVID 

Annette Graham, Central Plains Area Agency on Aging

• Didactic Presentation: Social Isolation of Older Adults: Impact and Response (PDF)
• Case Study (PDF)

Recommendations: 

• Follow up with PCP on “Sundowners” and possible early stages of dementia
• Connect with a Behavioral Health provider for an evaluation of psychiatric needs, including clarification of dementia, and other diagnoses
• Discuss medication regimen, may not have an optimized regimen at this time
  • Pharmacy can complete this review
• Find someone to work with member on learning technology to “open up their world”
• Find ways to honor where member came from
  • Is there a way for her to be involved in staff education, maybe on things facility can do to make things better for the residents
  • Other opportunities for individual to have a purpose, contribute to community
• Look in to Senior Companion Program- these can be done virtually or by phone

August 27: Atypical Antipsychotics In The Elderly & Nursing Home Population 

Rachna Kalia, University of Kansas School of Medicine – Wichita

• Didactic Presentation: Using Antipsychotics in Geriatric Population (PDF)
• Case Study (PDF)

Recommendations:

• Look at medical history to get a better understanding of member’s health
  • Look at past services, including assessments for home and community-based services
• Understand the root cause of homelessness, if possible, in order to develop interventions to prevent re-occurrence
• Connect with the local ADRC to assess for potential waiver supports
• Follow up with facility on how independently he is able to manage the diabetes
  • Is it well-controlled at this time?
• Look in to a psychological evaluation for diagnostic clarity, particularly with the question around cognitive delays
• Consider connecting with BH services, particularly therapy
• Consider looking at supported decision making as a means to assist member with decisions about his life
• Consider a step-down, such as an assisted living facility, so he can continue towards the path of independence while waiting for affordable housing
• Refer to the health plan’s housing specialist to explore housing options
• Refer member to outreach to ombudsman to discuss usage of stimulus check to pay for NF back payment
• If member is interested, consider a smoking cessation program
• Look for hands-on activities to keep member engaged in activities he was successful with in the past

May 7: Parent Management Training – Oregon (PMTO) Model 

• Didactic Presentation: Parent Management Training – Oregon (PMTO) Model (PDF) - Kelly Young LMSW, KVC Kansas
• Case Study (PDF)
• Recommendations:
  • Consider having current placement, who are relatives of the youth, participate in the PMTO sessions.
  • Consider specific Trauma-Informed trainings/therapies for the current placement.
  • The youth (as well as his siblings) could benefit from their own individual therapy. With regards to the youth, some work on recognizing his needs as an adolescent, learning to “be a kid” and allowing his father to parent.
    • Take in to consideration the youth’s age and cultural background too
  • Connect the youth with mentorship programs, or community resources to help him succeed with post-secondary education and/or vocational trauining.

May 14: Anxiety 

• Didactic Presentation: Anxiety (PDF)  – Abby Callis, PsyD, Family Service and Guidance Center
• Case Study (PDF)
• Recommendations
  • Work with individual’s insurance company to explore inpatient hospitalization options
    • If not already working with a case manager, may be beneficial to request one
  • Ensuring a trauma-focused approach in implementation of evidence-based practices
  • Consider doing some research around the cultural and religious practices to better understand what is “typical” behavior when it comes to prayers and rituals
  • Consider using peer-based approaches, such as in group therapy
  • Seek out a clinician trained in Evidence-Based Practices, such as Exposure Response Preventions (ERP) Therapy

May 21: Peer Support 

• Didactic Presentation: Peer Support (PDF) – Andrea Myers, BS, Crosswinds Counseling and Wellness
• Case Study (PDF)
• Recommendations
  
  • Get information on member’s last hemoglobin A1C. It may be helpful to track blood sugars to see if there is an effect on mood (i.e. keeping a log)
  • Confirm when member was last seen by his primary care physician
    • It may be helpful to have collaboration between the PCP and the BH provider
  • If a Sunflower member, look in to the Windsor Telehealth program for additional supports
  • Connect member with psychosocial rehabilitation groups - there may be some telehealth options at this time
  • Connect member with an LTSS Member Advocate for additional peer supports

May 28: Hope And Healing: Trauma-Focused Cognitive Behavioral Health 

• Didactic Presentation: Hope and Healing: Trauma-Focused Cognitive Behavioral Health (PDF) – Roy Van Tassell, MS, LPC, Centene Corporation
• Case Study (PDF)
• Recommendations:
  • It may be helpful to have information of the child’s developmental history, including pre-natal history.
  • Genetic testing may help to rule out any underlying reasons for behavior issues
  • Incorporate grief treatment in to the therapy that this child is receiving
  • Consider a referral to a community organization who specializes in working with children who have experienced sexual abuse
  • Explore how to safely re-instate some of the positive relationships in the child’s life
  • Look in to community-based supports, such as wraparound facilitation within the SED Waiver
  • Look in to resources for co-parenting for the parents

March 19 - How to Help Childhood Cancer Survivors Thrive

• How Primary Care Providers Can Help Pediatric/AYA Cancer Survivors Thrive (PDF) - Joy M. Fulbright, MD
• Case Study for March 19 (PDF)
• Case Study Recommendations:
  • Help the member and family/caregivers understand the prognosis of the disease process
  • Consider palliative care options focusing on symptom relief and quality of life
  • Take into account what is important TO member when creating care plans
  • Consider an appetite stimulant to aid with loss of appetite
  • Also consult with a nutritionist to explore other ways for food to be more appealing
  • Capecitabine may be contributing to the appetite issues
  • Consider an anti-nausea medication
  • Consider therapeutic support for member and caregivers through behavioral health

March 26 - Cancer Prevention and Immunization

• Risk-Stratified Screening (PDF)
• Case Study (PDF)
• Disclosure Statement (PDF)
• Case Study Recommendations:
  • Regarding the Genetic Testing that was completed:
  • Note that some genetic markers for breast cancer is associated with cognitive/intellectual disabilities
  • Genetic markers for the lumps and bumps is also associated with anxiety
  • Be aware of the genetic markers to understand future risks of other cancers
  • Ensure that the individual has received proper Genetic Counseling and Education
  • Ensure consent from member, not just the guardian
  • Practice reflective listening
  • That the individual is appropriately informed of all consequences
  • Ensure the language used is in simple terms
  • Ensure continued access to BH supports
  • Supports with regards to having a double mastectomy and the long-term psychological consequences surrounding that experience
  • Helping with the anxiety around cancer treatment

April 2 - Supports, Prevention and Barriers to Care for Members with Intellectual and Developmental Disabilities

• Cervical Cancer Screening Presentation (PDF)
• Case Study (PDF)
• April 2 Disclosure Statements (PDF)
• Case Study Recommendations:
  • Focus on Person-Centered processes with regards to planning
  • Really listen for what the individual wants
  • Ensure that the individual has a post-treatment plan
  • This can help service providers with knowing and understanding his medical and treatment history
  • Consider the recommendations for ongoing screenings/physicals
  • Having Stage 3 cancer puts him at higher risk for developing other cancers down the road
  • Optimize nutrition - consider asking the oncologist for a referral to a nutritionist to take advantage of the benefits of proper nutrition with regards to after care

April 9 - Nutrition and Cancer

• Nutrition and Cancer Project ECHO Presentation (PDF)
• Case Study (PDF)
• Case Study Recommendations:
  • Based on the family history of cancer, it may be beneficial for the family to investigate the Genetic Predisposition for their family
  • Double check the numbers (weight and lab) on the medical record, as the fluctuation in numbers can point to an issue
  • Consider looping in Sunflower’s Community Health Services and/or LifeShare team to explore community resources regarding upkeep of the home. Possible resources include:
  • Builder’s union
  • Habitat for Humanity
  • Obtain a referral for a dietitian to explore how to optimize nutrition, assess for malnutrition and develop a nutrition plan individualized to the member
  • Work with current medical providers to look at the trends in lab results, or develop a plan to complete lab work on a regular basis to see the trends in her levels.

November 7 – Trauma Informed Interventions 

• Trauma Informed Interventions Presentation (PDF)
• Case Study (PDF)

November 14 – Physical Health and Impact on Behavioral Health 

• Physical Health 101 (PDF)
• Case Study

November 21 – Culturally Competent Care for the LGBT Community 

• Providing Services to LGBTQ Youth in Care (PDF)
• Case Study

December 5 – Psychotropic Medication use in the Foster Care Population in Kansas

• Psychotropic Medications (PDF)
• Case Study

SEPTEMBER 5 - SOCIAL DETERMINANTS OF HEALTH 

• Social Determinants of Health (PDF), Gloria Wilder, Centene
• Case Study, September 5, 2019 (PDF)

SEPTEMBER 12 - HOUSING SUPPORTS 

• September 12 - Housing (PDF), Doug Wallace, Sunflower
• Case Study, September 12, 2019 (PDF)

SEPTEMBER 19 - EMPLOYMENT 

• September 19 - Employment (PDF), Cheryl Laaker, Sunflower
• Case Study, September 19, 2019 (PDF)

SEPTEMBER 26 - FOOD INSECURITY

• September 26 - Eating for Health (PDF), Lana McKinney, American Heart Association

• The Quality of Life Assessment: An Integrated Approach to Identifying Solutions (PDF) - Presented by Nanette Perrin and Kristine Meier
  • Case Study Recommendations
    • Considering the complex medical conditions described with the individual, consider having genetic testing (please specify) to see if conditions describe match a specific syndrome. This information could provide caregivers with a better understanding of how to work with the individual.
    • Consider completing a comprehensive psychological evaluation, including a full scale IQ, to better understand how to address behavioral health needs.
    • Work with guardian, walk alongside individual’s grandmother/guardian and frame conversation around his quality of life. Include her as much as possible in any planning for strategies, including the upcoming consultation with Parsons Outreach Team.
    • Loop in an outside organization, such as the KS Guardianship Program, CDDO or Disability Rights Center, to help educate on a guardian’s duties and responsibilities, and the limitations of those roles and responsibilities.
    • Work with his behavioral health provider (therapist) on incorporating recommendations to broaden world within treatment planning.
    • Have other SSRIs been considered to treat the depression?
• Dementia and I/DD (PDF), Megan Kaunley, RN, BSN
  • Case Study Recommendations
    • When engaging in activities, keep them short and achievable enough so that she experiences success with it.
    • Continue presenting activities based on her interest.
    • Consider making a referral for physical therapy to maintain whatever strength and muscle mass she may have.
    • Consider adding to the memory book, as she has new experiences and visits places, take photos and add to her memory book.
    • Additional recommendations that came after the ECHO session ended:
      • When offering choices for activities, consider using picture or even object representation of those activities.
      • Review end of life preparation - with the rapid decline, it’s possible that this may come sooner rather than later. Prepare her support team for this as it seems like they are her closest supports at this time.
• Crisis Planning for Dual Diagnosis (PDF), Katrin Sweeney, MA, LPC, NADD-DDS
  • Case Study Recommendations
    • Revisit the possibility of getting psychotropic medication by injection to address noncompliance.
    • Considering that a side effect of Yasmin is mood swings, would a different birth control be more appropriate? Consider Depo-Provera.
    • Consider specific trauma therapy, such as EMDR. There is literature that suggests that this treatment has been shown to be effective with individuals with IDD who have experienced trauma.
    • Other mental health treatment modalities to consider: modified DBT (Dialectical Behavior Therapy) or attachment therapy.
    • Work with local agencies, i.e. local school district, to get access to a baby simulator. This could allow her to feel the experience of caring for a baby.
• Creating a Path to Employment (PDF), Cheryl Laaker
  • Case Study Recommendations
    • Consider occupational therapy evaluation to look at sensory needs to support self-regulation.
    • Consider supports from a therapist to develop self-regulation/coping strategies
    • Consider supports from a therapist or job coach on identifying work-appropriate social interactions (i.e. some social interactions are appropriate with a group of friends, but not necessarily in a work setting)
    • Consider the timing and potential of interaction between medications, particularly the stimulant in the evening:
      • How is his sleep affected
      • Look at side effects of Concerta
      • Review medications with psychiatrist
    • Identify strategies to engage appropriately between tasks, i.e. finding work or having a list of maintenance tasks to work through the end of the shift
    • Look for a work setting that may have similar-aged co-worker

• Introduction and Overview of the Fundamentals of Addiction Treatment (PDF) - Dr. Sosunmolu Shoyinka
• Pain Management and Addiction Interaction (PDF) - Dr. Karl Haake (Centene Medical Director and Pain Management Specialist)
• Opioid Dependence Addiction and Naloxone Education (PDF) - Dr. Karen Moeller (University of Kansas School of Pharmacy Clinical Professor and Vice Chair for Education)
• Medication Assisted Treatment Kansas State Policy (PDF) - Dr. Daniel Warren (University of Kansas School of Medicine Assistant Professor - Drug and Alcohol Use Disorder)