Transcript Slide 1

Taking the bite out of carers’
“black dog”
Emma Cother - Projects Coordinator
Population Health Congress, Adelaide, September 2012
Additional authors: Katie McGill, Dr Deanna Pagnini, Tania Ewin, Elena Terol, Celia Rae, Gemma Edgar and Todd Heard
Scope of Presentation
Partners in Depression –
a program designed to take the bite out of carers’ black dog
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What is it?
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How has it been disseminated across
Australia?
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What impact has it had?
What is Partners in Depression?
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Psycho-educational program for those who love, live with or care for a person
experiencing depression
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Based on adult learning principles
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Six-session program run by two facilitators in community settings
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Dual focus - 1st hour looks at issues for the person with depression & 2nd hour
focuses on the carer
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Sessions include structured activities and discussion as well as self-reflective
practice for at home
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Evidence-based
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Culturally sensitive but not culturally specific
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Guided by principles of self care
The Program
1.
What is depression
2.
Treatment options for depression
3.
The caring and support
experience – grief, stigma, carer
life course framework
4.
Introduction to CBT
5.
Suicidally, self-harm &
communication strategies
6.
Help-seeking and self-care
Rationale
Research has shown that people who love, care for or support a person with
depression…
• Are at risk of developing mental health problems themselves
(Jeglic et al., 2005)
• Have higher levels of psychological distress than the general population
(Kim &
Salyers, 2008; Jeglic et al., 2005)
• Value opportunities to connect with others in a similar situation
(Highet et al., 2004)
• Are interested in learning and strengthening coping and self-care strategies
(Muscroft & Bowl, 2000)
Rationale
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Families and carers provide assistance and support to the person with mental
illness, and indeed for mental health services
would otherwise be
overwhelmed (Hayman, 2005)
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Carers/families have a right to:
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Be respected for their role and experiences
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Receive appropriate information and advice
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Have their views and needs taken into account
(Mental Health Act 2009)
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Carers are often the forgotten allies in the battle against depression
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Prior to Partners in Depression, few services existed to specifically address the
needs of carers of people with depression
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Outcomes for people with depression improve when the needs of the family
members for information, clinical guidance and support are met
(Dixon et al. 2001)
Pilot Phase
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2007 – 2008 in Hunter New England region
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Co-funded by beyondblue: the national depression initiative
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Consultation and scoping phase:
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literature review
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focus groups
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reference group
Implementation phase:
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Train the trainer model
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Pre and post program data collected from participants
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Training data collected from facilitators
Pilot Evaluation
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At baseline, participants had higher levels of depression, anxiety and stress (as
measured by the DASS) than the general population = levels reduced by a
statistically significant amount after attending the program
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Participants’ psychological distress scores (as measured by the K10) significantly
reduced from baseline to post program
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Group format considered one of the most important features
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Participant outcomes were equivalent regardless of whether the program was
delivered by HIMH facilitators or externally trained facilitators
National Dissemination
• Grant from nib foundation = August 2009 to April 2012
• 3 phases – stakeholder engagement (reference group, external evaluator, patron, state
based decision makers) training and program support
• Community capacity building model – 400 health and community professionals from
metropolitan, regional and rural areas recruited to become facilitators
• Successful applicants attended free 2-day facilitator training course in various locations
around Australia delivered by project team
• Facilitators committed to delivering the program at least 3 times
in their local community in a 12 month period = accreditation
• Provided with all participant resources and a range of clinical and
administrative support at no charge
• Not paid by project team to deliver the program – required to
have management support to deliver as part of their ‘core
business’
Facilitator Manual
Evaluation
• Quantitative and qualitative data
• Data collection March 2010 – April 2012
• External evaluator
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Facilitator data sources:
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Program fidelity checklists after
each group
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Participant data sources:
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Baseline questionnaire (N=1220)
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Post-program questionnaires (N=959)
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Post-program feedback
questionnaires (N=105)
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Group member 6 month follow-up
questionnaires (N=119)
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Focus groups (2 groups, 11
participants)
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Group member focus groups (3 groups,
18 participants)
Follow-up phone interviews with group
members (N=40)
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Participants
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Over 1200 Australians attended the program during national dissemination
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80% of participants were women
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Average age = 53
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75% born in Australia
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Many rarely disclosed they are caring for someone with depression
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64% of the people with depression also had co-morbid physical or mental
health problems
Baseline K10
Key Areas of Improvement
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Quantitative data show that participants made improvements in important areas:
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Knowledge
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Awareness of impact of depression
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Improved communication skills
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Self-care and coping techniques
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Encouragement for help-seeking behaviours
“It was like a valve being opened on the pressure cooker (us!).
It gave me a frame of reference which was proven and reliable.
It helped me to remain calm more often and to identify
depressive behaviours, and to not blame myself”
“It has given me an understanding of depression,
not to blame but accept that this is how things are
and to try to be positive when dealing with issues”
Echoed in qualitative findings:
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–
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They are not alone in their experiences
The importance of self-care
To ask for help when they need it for themselves
Effective communication skills
To step back/set boundaries
To maintain hope
“It is more relaxing relating to them
because I know I can only support
them, not make them better”
“Meeting others in the same situation as
myself - this has been the best thing for
me from the program”
Key Applications of Learnings
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The majority of group participants were able to apply what they learned:
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At program’s end = 84%
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6 month follow-up = 83%
Applications included:
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Changing the way they communicated/reacted to situations
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Taking time for themselves
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Encouraging discussions about potential changes in treatment
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Disclosing their experience with depression to others
“The Partners in Depression program was
excellent. I didn’t realise I was a carer and I
didn’t realise the impact caring was having
on me until I attended the group”
“Reflective listening. I used this
technique to calm our son instead
of inflaming the situation.”
“I'm more direct and upfront about where my boundaries are”
Key Impacts on Relationship
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The majority of group participants felt the program had an impact on their relationship
with the person with depression:
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At program’s end = 82%
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6 month follow-up = 80%
Kinds of impact:
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More understanding of the other’s perspective
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Appreciation of carer doing the course
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More patience
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More positive encouragement
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In some cases the carer disengaged from the person with depression
“I was really fortunate that my husband was 'really pleased
and impressed' that I was able to attend the program - he
thanked me for trying to learn more to support him”
“I am listening to them again. I feel I
had switched off and that wasn't
doing our relationship any good”
Reduction in Psychological Distress
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Level of
psychological
distress
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Baseline
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Program end
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6 month
follow-up
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Low (10-15)
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30.0%
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43.0%
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48.7%
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Medium (16-29)
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57.6%
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50.9%
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43.4%
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High (30-50)
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12.4%
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6.1%
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8.0%
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N
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1220
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872
•
113
Overall Satisfaction and Recommendation
• 86% were very or extremely satisfied with the program as a whole
• 98% of participants would recommend it to others
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The <1% who were extremely or somewhat unsatisfied felt it was too rushed or too basic
• Nearly 2/3 of participants in the six month follow up have recommended Partners in
Depression to others
• 50% of those at the six month follow-up have had some contact with either other
group members or facilitators (35% other group members; 21% facilitators)
• Would like program to be more widely available, and promoted more extensively
• Some suggested improvements:
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Generally would like the program and session times to be longer with more time for sharing
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Additional suggested topics such as youth specific version, anxiety specific version, how to
handle aggressive behaviour etc..
Other Items of Note
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The material and the group setting can be confronting
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It took a lot of courage on the part of some group members to “cross the threshold”
into the room
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Many group members had never discussed their experiences before and it took a
while to develop trust
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Talking in a group setting was a new experience, particularly for some male group
members
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Some topics could raise painful issues: e.g.. grief and loss, suicide
Key Wins
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Consistent feedback about high quality of training course
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Consistent feedback about high quality of participant resources
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High level range of people being trained as facilitators, from diverse backgrounds
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Innovation of facilitators in delivering the program to vulnerable populations
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Organisations are taking the delivery of the Partners in Depression program as an
opportunity to partner across organisations
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Many participants continue to meet up and provide support to one another once their
group has ‘finished’
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Statistically significant decrease in psychological distress experienced by participants
who attend the program
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beyondblue funding to turn ‘practice into publications’
Where to Next? – Consolidate and Enhance Initiative
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Piloting a ‘Facilitator Peer Training’ model
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Implementing a ‘Carer Participation Strategy’
– PID Peers
– Ambassador Program
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Implementing a ‘Broker’ Strategy’ to enable delivery of program within major
organisations or relevant settings such as EAP
How Can You Get Involved?
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Register your interest in being trained as facilitator = send an email to
[email protected]
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Refer people who love, live with or care for someone with depression to the program
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Register your interest in being kept up to date with progress on the initiative and
associated research
Thank you
www.partnersindepression.com.au
[email protected]
“ Partners in Depression was really useful and even 12 months later, it continues to
help. Last week, my daughter mentioned something and I said to myself “Hang on! I
recognise this! This is her depression talking.” Before Partners in Depression, I
wouldn’t have recognised this, nor would I have had the confidence to deal with it”