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Project ECHO Archive

Choose an ECHO topic below to see presentations and peer recommendations.

August 6: Social Isolation And Aging 

Camille Russell, Office of the State Long Term Care Ombudsman

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

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

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

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 the language used is in simple terms
        • That the individual is appropriately informed of all consequences
        • Practice reflective listening
        • Ensure consent from member, not just the guardian
      • Ensure continued access to BH supports
        • Helping with the anxiety around cancer treatment
        • Supports with regards to having a double mastectomy and the long-term psychological consequences surrounding that experience
  • 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:
        • Habitat for Humanity
        • Builder’s union
      • 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 

November 14 – Physical Health and Impact on Behavioral Health 

November 21 – Culturally Competent Care for the LGBT Community 

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

SEPTEMBER 5 - SOCIAL DETERMINANTS OF HEALTH 

SEPTEMBER 12 - HOUSING SUPPORTS 

SEPTEMBER 19 - EMPLOYMENT 

SEPTEMBER 26 - FOOD INSECURITY

  • 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