DEVELOPING THE CAPACITY TO DELIVER CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS (CDSMP) WORKSHOPS REQUEST FOR APPLICATIONS

Transcription

1 DEVELOPING THE CAPACITY TO DELIVER CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS (CDSMP) WORKSHOPS REQUEST FOR APPLICATIONS PURPOSE The National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Division of Population Health/Arthritis Program, is pleased to offer this opportunity for local health departments (LHDs) to develop the capacity to deliver effective Stanford model of Chronic Disease Self-Management Program or Arthritis Self- Management Program, English or Spanish (Tomando Control de su Salud) version, from here on referred to as CDSMP collectively. In expanding the availability of the CDSMP to additional local jurisdictions we seek to expand the use of evidenced-based programs while enhancing the well-being and self-efficacy of persons with a chronic illness. BACKGROUND The CDSMP is a six-week educational workshop for people with chronic conditions (e.g. arthritis, diabetes, lung and heart disease). Evidenced-based, self-management education programs have been proven to significantly help people with chronic diseases. Coupled with clinical care, this program teaches participants how to exercise and eat properly, use medications appropriately, solve everyday problems relative to their medical conditions, and to communicate effectively with family, friends and health care providers. The CDSMP workshops are provided in community settings such as senior centers, churches, libraries, and hospitals. Each workshop is led by a pair of trained leaders; it is recommended that at least one of the leaders is a person with chronic disease. To learn more about CDSMP, please visit To learn more about the evidence on the effectiveness of CDSMP, please visit To learn more about the challenges and successes of CDSMP implementation, please visit The CDSMP Master Trainer (trainer of leaders) must be currently licensed by Stanford University. Information on leader training and Master Trainer is available at the Stanford Patient Education Research Center. Please visit

2 P a g e 2 NACCHO S CDSMP OBJECTIVES Serving as a national support network of LHD-CDSMP, NACCHO s goals for the project are the following: (1) Ensure LHDs are appropriately trained and show increased implementation of best practices and evidence-based practices specific to CDSMP delivery within local health departments; (2) Establish partnerships with national organizations and other interested agencies to coordinate CDSMP related activities, set guidance, and establish priorities for delivery within local communities; and (3) Provide timely and targeted technical support to LHDs as they build their capacity to deliver CDSMP. In order to accomplish these goals, NACCHO will operate as a national resource and technical assistance center for local health departments CDSMP. This centralized delivery of targeted resources and technical assistance will allow LHDs to access assets that will assist them in implementing CDSMPs. NACCHO will also coordinate a CDSMP community of practice (CoP) model for LHD members who operate CDSMP within their jurisdictions. The CDSMP CoP will convene LHD staff, national partners, and subject matter experts through a variety of mechanisms, i.e., conference calls, webinars, newsletters, blasts, social media, and the web. NACCHO will maintain an on-line repository of tools and resources for local CDSMP initiatives. National, state, and local subject matter experts will be invited to present best practices through conference calls, podcasts, blasts or webinars. National partners will also be invited to present the latest chronic disease prevention and control strategies, data and trends, and opportunities for collaboration. Within the CDSMP CoP, LHD members will be convened, virtually, by NACCHO to further discuss their role in a national dissemination of CDSMP, chronic disease prevention/management policies and practices, and to share evidence-based practices and lessons learned. CDSMP CoP members will have an opportunity to network with their peers in this forum to share best practices, lessons learned, and challenges. NACCHO will engage in a variety of evaluation activities to assess our capacity to be a national support and resource network for LHD-CDSMP, and assess the capacity of LHDs to effectively deliver CDSMP. An annual LHD-CDSMP survey will be developed and distributed that will assess (1) involvement and satisfaction with the CDSMP CoP; (2) new strategies, policies, and activities that LHDs are using in their CDSMP work; (3) new partnerships that have formed as a result of participation in the CDSMP CoP; (4) support, training, and technical assistance needs of CDSMP COP members; and (5) strategies used for sustaining CDSMP in LHDs. NACCHO-LHD CDSMP This opportunity will provide funding support to LHDs to develop their capacity to deliver CDSMP workshops within their local jurisdictions. LHDs may choose to offer CDSMP themselves or partner with a community organization who will offer the workshops. The program requirements are as follows:

3 P a g e 3 Funds must be used to support start-up costs to establish CDSMP workshops in a new area of the local jurisdiction, if CDSMP is currently being offered by the LHD, or to establish a CDSMP within the LHD. Start-up costs include but are not limited to: o LHD staff time to attend leader training and conduct outreach to health care providers. LHD must have 3-4 leaders trained. One of the leaders must be an LHD staff while others may be community partners, providers or lay volunteers. CDSMP leader training requires four and a half days, which may be sequential or spread over two weeks; o Purchase of materials (books, marketing materials etc. necessary to implement CDSMP; o LHDs that successfully complete the training and program requirements must submit licensing requirements to NACCHO to be licensed as Stanford University CDSMP multi/single site CDSMP provider prior to offering the CDSMP workshops, if a license is needed and/or expired; o LHD must develop a clinical linkage/outreach system with local clinical providers to recruit and retain persons diagnosed with a chronic condition to participate in the workshops; this system must include formal referrals to the workshops and provider feedback; A clinical linkage/outreach system includes but is not limited to: outreach to four to six clinical/primary care providers to explain the benefits/successes of patients who complete CDSMPs and to encourage patient referrals to CDSMP workshops informal or formal referral process (with documentation) to send/receive provider recommendations of patients to the CDSMP informal/formal follow-up process where provider will receive feedback on patient progress a process for continuous engagement of new and existing providers LHD must show how they will partner with an existing community coalition, or provider network to establish community/provider referrals to the CDSMP; LHD must use community partners to identify and secure appropriate locations within the local community for CDSMP workshops, recruit leaders to be trained, recruit workshop participants, coordinate registrations, data collection, and other logistics; Newly trained CDSMP leaders must initiate at least two CDSMP workshops within the community, prior to May 31, 2014 (Phase 1). LHD must initiate and complete at least four additional workshops prior to May 31, 2015 (Phase 2). LHD must adhere to the CDSMP training and workshop requirements set-forth by the Stanford University s CDSMP. o Trainer policy: o Training certification guideline: pdf o Implementation manual:

4 P a g e 4 LHD must attend required NACCHO on-line orientation, post award, technical assistance trainings, conference calls, and peer-network discussions. LHD must adhere to NACCHO technical assistance, grantee calls, grantee reporting and evaluation activity requirements LHD must adhere to NACCHO contract timeline and requirement: o A funding total amount for the entire project shall not exceed $13,500 o Funds will be disseminated via two contractual agreements o Each contract period will have a set of specified deliverables and project periods o Contract #1: Infrastructure set-up, provider outreach, training costs, and initial workshop costs o Contract #2: Provider outreach, and additional workshops implementation costs This project will be measuring: Effectiveness of LHDs in serving as the CDSMP provider (recruiting participants, attendance, and participant success in completing the program); Satisfaction of workshop participants with the quality of the workshops conducted; LHDs implementation of the CDSMP LHD implementation/coordination of workshops or the collaboration between community partners and LHDs to coordinate the workshops and logistics; Creation of provider outreach strategy and execution Creation of clinical provider linkage/outreach system to recruit, monitor, and retain participants; Activities conducted to recruit participants and conduct the workshops within the community; Maintenance of program integrity standards and requirements; Number of workshops held; Number of participants enrolled in the workshops; Number of participants who successfully complete the workshops; Number of LHDs and community leaders who successfully complete the leader training; Number of physician/clinical providers providing referrals to CDSMP workshops; and DESCRIPTION OF SUPPORT & EXPECTATIONS NACCHO will provide financial support to selected LHDs in the amount of no more than $13,500. In return, the selected LHDs will: Arrange to have a licensed- Master trainer to conduct the CDSMP lay-leader training for at least 3-4 leaders to provide workshops under the LHD auspices. LHDs can sponsor their own training, or send leader candidates to CDSMP Stanford certified trainings sponsored by other organizations; Participate in networking with LHD-CDSMP providers and national partners; Participate in NACCHO s orientation, on-line trainings, and technical assistance conference calls to assist LHDs with marketing, provider outreach, recruitment, coalition building and support for CDSMP, workshop logistics, and sustainability after the completion of the project

5 P a g e 5 Initiate two (2) six-week CDSMP workshops with participants in each workshop (in a community setting) before May 31, 2014; Initiate and complete at least four (4) additional workshops before May 2015; Participate in all evaluation activities and qualitative/quantitative evaluation of workshops completed; Participate in NACCHO s data collection and reporting on the LHD-CDSMP (including persons reached by workshops, locations of workshops, quantitative and qualitative evaluation of workshops, etc.); Work with community agencies and health care providers within the community to encourage recruitment, participation and/or retention in community CDSMP workshops; Coordinate efforts with state department or health and/or state unit on aging if those organizations are involved in the dissemination of CDSMP; Conduct outreach to at least 4-6 primary care practices to encourage referrals/recommendations to attend CDSMP using the CDC approach to Provider Outreach marketing toolkit; and Develop plans to maintain the delivery of CDSMP after the end of the project period. Funding from NACCHO will be disseminated based upon the successful receipt of federal funding, the initiation and successful completion of deliverables. Award recipients will be expected to complete all required activities. Award recipients will be classified as consultants and expected to complete activities/submit deliverables and reports within the specified timeline. Specific use of funds will be tracked to ensure monies are spent on activities related to provision of CDSMP workshops. ELIGIBILITY CRITERIA Only local health departments are eligible to apply. If a health department is currently providing CDSMP, they must demonstrate the expansion of their CDSMP to a new jurisdiction or community. A clear demonstration of the LHD organization s dedication and support of the delivery of CDSMP within the prescribed timeframe, and whose plans include the continuation of workshops for the community after the end of project period. Available documentation (including community health assessment or action plan) indicating relevance of CDSMP to community needs. Capacity to implement CDSMP and report data. Capacity to initiate at least two CDSMP workshops by end of Year 1. Capacity to initiate and complete at least four additional workshops by end of Year 2. Capacity to track workshop data and activities. Capacity to develop and implement clinical provider linkage, tracking, and follow-up. Capacity to work with the clinical providers to encourage patient participation in the CDSMP workshops.

6 P a g e 6 PHASE 1 TIMELINE Due Date January 27, 2014 February 17, 2014 February 20-21, 2014 March 7, 2014 March 14, 2014 June 30, 2014 Deliverable Request for Application (RFA) available online Applications due by 10:00 AM EST Awardees notified( tentatively) Contracts submitted to awardees (LHDs) with acceptance letters (tentative) Invoice due/ Signed Contracts due 3-4 leaders trained and at least two workshops initiated Progress report due Phase 1 concludes PHASE 2 TIMELINE Due Date July 7, 2014 September 26, 2014 January 30, 2015 June 30, 2015 Deliverable Contract initiation; Invoice due Progress report due Progress report Four or more additional workshops completed Phase 2/Grant period concludes APPLICATION SUBMISSION All applications must be received by 11:59 PM EST, February 16, Incomplete or late applications will not be reviewed. Please submit applications electronically to: Truemenda Green Senior Director, Chronic Disease Prevention and Healthy Communities National Association of County and City Health Officials tgreen@naccho.org You will receive an confirmation of receipt of your application. SELECTION PROCESS Each application will be reviewed and rated by a panel local health departments will be selected. Applications will be rated based on the following criteria: Application completeness and clarity; Demonstration of need; (If the LHD is a current CDSMP provider) Demonstration of a willingness to implement CDSMP in a new jurisdiction/county; Plans to establish provider outreach strategy for participant recruitment; Perceived ability to implement CDSMP workshops; Evidence of and perceived ability to collect and report on requested data. Plans to sustain CDSMP workshops after the conclusion of the funding period.

7 P a g e 7 LHDs will be notified tentatively, February 20, Any questions should be directed to Truemenda Green at tgreen@naccho.org ( ). APPLICATION GUIDELINES Note: Applications should be no longer than 5-10 single spaced pages. Only 2 attachments are allowed. Any additional material submitted will not be reviewed. HEALTH DEPARTMENT CHARACTERISTICS and CAPACITY Contact Information: Person completing application (primary contact at health department) Health Department Title Counties/Towns Served City, State Daytime Phone Fax Number Name of Health Director Person having authority/responsibility for program requirements: Preferred method of communication: What is the name of the fiscal agent for contracts and invoices with the health department? 1. Local Health Department (LHD) Type: (select one answer) City County City-County Multi-county, city, township district or region Other (please specify): 2. Approximate Population Sized Served by Applicant LHD (number): 3. Current number of LHD staff who work in chronic disease programs (expressed in full-time equivalents or FTEs): 4. Primary type of Population Served (description): (check all that apply) Urban Rural Suburban Frontier Other (please describe): 5. Governance Structure: Centralized (local health department reports to state health department)

8 P a g e 8 Decentralized (locally-governed local health department(s) Other (please specify): 6. Does your LHD currently provide CDSMP? Yes No ASMP Tomando Control de su Salud ( Spanish version of CDSMP) 7. If your LHD currently provides CDSMP, is your site license current? Yes No SELECTED CHRONIC DISEASE CONCERN AND NEED 1. Statement of need/justification- Indicate the public health concern relative to chronic disease in your jurisdiction, current chronic disease surveillance and describe the populations/communities impacted by chronic disease. Include a description of any community health assessment data you have collected related to your project, including disease rates, the demographics of your target audience, the risk factors/behaviors that affect their health status, and the cognitive, attitudinal, and cultural factors that affect their health status. 2. Describe (if any health department, state or community-led) existing chronic disease management or prevention programs currently in place. Include key activities and outcomes resulting from the CDSMP work. Demonstrate plans to offer CDSMP to a new jurisdiction/community, if the health department is a current provider of CDSMP. 3. Discuss jurisdiction/community that would benefit from the CDSMP. PLANNING AND MARKETING EFFORTS 1. Describe your priorities for the future direction of your chronic disease self-management program, if selected for this opportunity. Indicate how you would like to expand your activities to enhance your efforts to sustain CDSMP after this project ends, and how those future activities will be supported. 2. Please share your proposed staffing/management plan for the project 3. Describe how your marketing plans, such as the Approach to Provider Outreach and the Spread the Word marketing approach using community ambassadors (optional), will be used to solicit provider and participant referrals, advertise workshops, and encourage

9 P a g e 9 CDSMP as a viable/credible/evidence-based program that offers life skills and provides education support for those who are chronically ill. 4. Please describe how you plan to obtain training for your leader candidates. 5. Describe any barriers or challenges (programmatic, environmental, etc.) that you anticipate for this project (ie recruitment, referrals, advertising staffing, etc) and indicate how you will mitigate these issues if they arise. PARTNERSHIPS AND LINKAGES: 1. Please describe in detail how you will develop and implement a clinical provider linkage/outreach system to screen, recruit and retain workshop participants for the CDSMP. ( NOTE: If you currently have a system in place to screen, refer and provide progress on participants, please provide a detail description how this system will be used for the new CDSMP) (NOTE: Though not all of the workshop participants need to be recruited through health care providers, each LHD should have a plan for outreach to providers in an effort to get referrals into the workshops.). 2. If you are planning to work with community partners to conduct and promote the CDSMP workshops, please describe the community partnerships and/or community coalition that you currently have that would be valuable to this program or that you wish to establish. 3. If planning to partner with community-based partners to host, coordinate the logistics of, and assist with the screening/recruitment of workshop participants, provide detail on how the LHD will establish a new partnership or expand an existing relationship with a communitybased partner to carry out these activities.. For existing partnerships please provide detail on the organizations capacity/success with previous LHD collaborations. For a new partnership, please provide detail on the organizations capacity to partner with the LHD. BUDGET AND RESOURCES: 1. Please provide a budget narrative summary of how the funds will be used to support the project. 2. Please include the following line items (do not hesitate to add others if necessary): a. Travel (for workshop training) b. Equipment c. Supplies/Materials for CDSMP Workshops d. Other costs: i.e. Printing, postage, stipend to CBO( i.e workshop location costs and logistics) e. Marketing/Advertisement f. Other (please explain) APPENDIX This chart gives a detailed summary of the CDSMP leader training and workshop requirements.

10 P a g e 10 Chronic Disease Self-Management Program (CDSMP) Self-Management Education Intervention Program Description Program Outcomes Target Audience Key Activities Setting Mode of Delivery The Chronic Disease Self-Management Program (CDSMP) is an interactive workshop for people with one or more chronic health conditions (e.g., arthritis, diabetes, heart disease, depression or lung disease) that focuses on chronic disease management skills including decision making, problem-solving and action-planning. Designed to increase self-confidence, physical, and psychosocial well-being and motivation to manage chronic disease challenges. People with one or more chronic health conditions including those with arthritis; appropriate for older adults. Interactive education includes discussion, brain storming, and practice of actionplanning and feedback, behavior modeling, problem-solving techniques and decision making. Symptom management includes exercise, relaxation, communication, healthy eating, medication management and managing fatigue. Community Interactive small group with a recommended workshop size: participants. and Class Size Duration and 2 2½-hour workshops offered once per week for 6 weeks. Number of Sessions Program Requirements Capacity Leader Qualifications Training and Training Source License(s) and License Source Each workshop requires a pair of trained leaders. Leaders may include either two lay (peer) leaders or one health professional and one peer leader. One of the peer leaders should have a chronic condition. Leader training is 4½ days. Training may be provided at Stanford University or locally by Stanford-certified master trainers (widely available in the United States). License must be purchased from Stanford University before the start of the program. License must be renewed every 3 years. License can be purchased specifically to offer CDSMP as a single program license, or CDSMP can be licensed through a multiple program license along with ASMP and other Stanford Patient Education Research Center Programs. Information about current Stanford license fees is available at

11 P a g e 11 Chronic Disease Self-Management Program (CDSMP) Self-Management Education Intervention Physical Space Equipment Community room that is Americans with Disabilities (ADA) accessible with enough space for leaders, participants, flip charts, white board, and comfortable chairs. Flip charts, markers, and a CD player. Implementation Costs Quality Assurance Licensing: Single Program License: $500 for offering 10 or less workshops per year; $1000 for offering 30 or less workshops per year; offering over 30 workshops per year must be negotiated with Stanford University Office of Technology Licensing. Multiple Program License: $1,000 for offering up to 25 workshops per year; $1,500 for offering up to 40 workshops per year. Available at Training: CDSMP training options include: o Send leaders to training held locally and hosted by another organization (costs vary). o Send leaders to training offered at Stanford. Registration fees for training are $1,600 for each health professional, $900 for a lay person with a chronic disease. o Host a leader-training by using local master trainers (costs vary), or bring Stanford master trainers to your location: $16,000 plus travel costs for trainer for training up to 26 leaders per course. Leader Materials: Leader manuals are provided with license (may be reproduced). CDSMP books: Living a Healthy Life with a Chronic Condition: $10-$15 each plus CDs $12 each. Program materials are available from Bull Publishing Company. Equipment: Flipchart, flipchart stand, and other training-related equipment. Participant Materials: CDSMP book Living a Healthy Life with a Chronic Condition: $19.00 plus CD: $12 each. Monitoring Data Reporting Site visits are recommended to assure fidelity to CDSMP. A Fidelity Manual is available. Every licensed organization must submit a yearly report to Stanford that includes the number of workshops offered, dates of each workshop and the number of participants. If applicable, the number of leader trainings or master trainer trainings conducted is identified. Outcome Evaluation Optional Sustainability Programs may consider covering the cost of materials by charging a small participant registration fee. Establishing a lending library is another option. Contact Information Developer Distributor Contact Stanford University Patient Education Research Center Stanford University Patient Education Research Center Stanford: Evidence Base

12 P a g e 12 Chronic Disease Self-Management Program (CDSMP) Self-Management Education Intervention (Selected References) Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization a randomized trial [abstract].medical Care. 1999; 37(1):5-14. Available at The study was a 6-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients aged 40 years or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service use as determined by mailed, self-administered questionnaires, were measured. Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being. An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization. Lorig K, Ritter PL, Plant K. A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis and Rheumatism. 2005; 53(6): PMID: Available at Both the Arthritis Self-Management Program (ASMP) and the generic Chronic Disease Self-Management Program (CDSMP) have been shown to be successful in improving conditions in patients with arthritis. This study compared the relative effectiveness of the two programs for individuals with arthritis. Patients whose primary disease was arthritis were randomized to the ASMP (n = 239) or to the CDSMP (n = 116). The disease-specific ASMP appeared to have advantages over the more generic CDSMP for patients with arthritis at 4 months. These advantages had lessened slightly by 1 year. The disease-specific ASMP should be considered first where there are sufficient resources and participants. However, both programs had positive effects, and the CDSMP should be considered a viable alternative. Brady T, Murphy L, Beauchesne D, Bhalakia A, Chervin D, Daniels B, et.al. Sorting through the evidence for the arthritis self-management program and the chronic disease self-management program. [Executive Summary] May. Available at A quantitative synthesis of patterns across empirical studies to determine the effectiveness of ASMP and CDSMP interventions on health status, health behaviors, and health care use in both short-term and long-term follow-up. These meta-analyses used data from 24 studies of ASMP and 23 studies of CDSMP. The findings suggested that ASMP and CDSMP contribute to improvements in psychological health status, self-efficacy, and select health behaviors and that many of those improvements are maintained over 12 months. While the effects are modest, they have great public health significance when the cumulative impact of small changes across a large population is considered. Furthermore, if sustained, these shifts may have a substantial effect on health-related quality of life and the physical, psychological, and psychosocial impact of chronic health conditions.

13 P a g e 13

14 P a g e 14 Arthritis Self-Management Program (ASMP) Self-Management Education Intervention Program Description Program Outcomes Target Audience Key Activities Setting Mode of Delivery and Class Size The Arthritis Self-Management Program (ASMP) is an interactive workshop for people with arthritis that is focused on chronic disease management skills including decision making, problem-solving and action-planning. (Formerly known as Arthritis Foundation Self-Help Program or the Arthritis Self Help Course.) ASMP is designed to increase self-confidence, physical and psychosocial well-being and motivation to manage chronic arthritis challenges. People with arthritis; appropriate for older adults. Interactive education including discussion, brain storming, and practice of actionplanning and feedback, behavior modeling, problem-solving techniques and decision making. Symptom management includes exercise, relaxation, communication, healthy eating, medication management and managing fatigue. Community Interactive small group recommended workshop size: participants. Duration and 2 2½ hour workshops offered once per week for 6 weeks. Number of Sessions Program Requirements Capacity Leader Qualifications Leader Training/Training Source License(s) and License Source Physical Space Each workshop requires a pair of trained leaders. Leaders may include either two lay (peer) leaders or one health professional and one peer leader. One of the peer leaders should have a chronic condition. Leaders must first complete CDSMP leader training, a 4½-day training provided by CDSMP-certified master trainers (widely available in the U.S.). Following CDSMP training, leaders must complete a ½ day ASMP specific Webinar offered by Stanford University. License must be purchased from Stanford University before the start of the program. License must be renewed every 3 years. License can be purchased specifically to offer ASMP as a single program license, or ASMP can be licensed through a multiple program license along with CDSMP and other Stanford Patient Education Research Center Programs. Information about current Stanford license fees is available at Community room that is Americans with Disability Act (ADA) accessible with enough

15 P a g e 15 Arthritis Self-Management Program (ASMP) Self-Management Education Intervention space for leaders, participants, flip charts, white board, and comfortable chairs. Equipment Flip charts, markers, and a CD player. Implementation Costs Quality Assurance Licensing: Single Program License: $500 for offering 10 or fewer workshops/year; $1,000 for offering 30 or fewer workshops per year. Offering more than 30 workshops per year must be negotiated with Stanford University Office of Technology Licensing. Multiple Program License: $1,000 for offering up to 25 workshops per year; $1,500 for offering up to 40 workshops per year. Training: Leaders must complete CDSMP training as prerequisite to being trained in ASMP: o ASMP specific follow up training via Webinar: $350 per leader. CDSMP Training Options include o Send leaders to training held locally and hosted by another organization (costs vary). o Send leaders to training offered at Stanford. Registration fees for training are $1,600 for each health professional, and $900 for a lay person with a chronic disease. o Host a leader-training by using local master trainers (costs vary), or bring Stanford master trainers to your location: $16,000 plus travel costs for trainer for training up to 26 leaders per course. Available at: Leader Materials: Leader manual is provided with license and may be reproduced. Equipment: Flipchart, flipchart stand, and other training-related equipment. Participant Materials: The Arthritis Helpbook is available for $18.95 from a local book store. Price may be less if purchased in bulk Monitoring Data Reporting Outcome Evaluation Sustainability Site visits are recommended to assure fidelity to ASMP. Every licensed organization must submit a yearly report to Stanford that includes the number of workshops offered, dates of each workshop and the number of participants. If applicable, the number of leader trainings or master trainer trainings conducted is identified. Optional Programs may consider covering the cost of materials by charging a small participant registration fee. Establishing a lending library of participant books is another option. Contact Information Developer Distributor Stanford University Patient Education Research Center. Stanford University Patient Education Research Center.

16 P a g e 16 Arthritis Self-Management Program (ASMP) Self-Management Education Intervention Contact Stanford: Contact Frank Villa or Gloria Samuel at or selfmanagement@stanford.edu. Evidence Base (Selected References) Lorig K, Lubeck D, Kraines RG, Seleznick M, Holman HR. Outcomes of self-help education for patients with arthritis [abstract]. Arthritis and Rheumatism 1985; 28(6): Epub Available at Behavioral and health status outcomes of an unreinforced, self-help education program for arthritis patients taught by lay persons were examined in 2 ways: a 4-month randomized experiment and a 20- month longitudinal study. At 4 months, experimental subjects significantly exceeded control subjects in knowledge, recommended behaviors, and in lessened pain. These changes remained significant at 20 months. The course was inexpensive and well-accepted by patients, physicians, and other health professionals. Goeppinger J, Armstrong B, Schwartz T, Ensley, D, Brady T. Self-management education for persons with arthritis: managing co-morbidities and eliminating health disparities. Arthritis and Rheumatism. 2007; 57(6): Available at The study compared short-term and long-term effectiveness of the Arthritis Self-Help Course (ASHC) and the Chronic Disease Self-Management Program (CDSMP) for persons with arthritis concerning health care use, health-related quality of life, health behaviors, and arthritis self-efficacy. At 4 months all ASHC participants including African Americans, had significant improvements in self-efficacy, stretching and strengthening exercises, aerobic exercises, and general health. Significant results at 1 year within and between programs were minimal for both groups. When populations with arthritis and multiple comorbid conditions are targeted, the CDSMP may be most cost effective. Brady T, Murphy L, Beauchesne D, Bhalakia A, Chervin D, Daniels B, et.al. [Internet] Sorting Through the Evidence for the Arthritis Self-Management Program and the Chronic Disease Self-Management Program (Report), Executive Summary of ASMP/CDSMP Meta-Analysis; May, Available at This study provided a quantitative synthesis of patterns across empirical studies to determine the effectiveness of ASMP on health status, health behaviors, and health care use in both short- and logterm follow-up. These meta-analyses used data from 24 studies of ASMP and 23 studies of CDSMP. The findings suggested that ASMP and CDSMP contribute to improvements in psychological health status, self-efficacy, and select health behaviors and that many of those improvements are maintained over 12 months. While the effects are modest, they have great public health significance when the cumulative impact of small changes across a large population is considered. Furthermore, if sustained, these shifts may have a substantial effect on health-related quality of life and the physical,

17 P a g e 17 Arthritis Self-Management Program (ASMP) Self-Management Education Intervention psychological, and psychosocial impact of chronic health conditions.