Behavioral health coaching for diabetes: But when it happens to yourself!

Angela A’s story:
     In the last 3 – 4  years, I had some issues about walking without difficulty, and some acceptance issues with my health, and the decline in my health.  I went into the doctor’s office to get a checkup, and ended up in the hospital for three weeks.  It was kind of scary!  Every time, they found something else!  I didn’t realize how despondent and depressed I was becoming. I work full-time at home, though I hadn’t wanted to do that initially.  I’m pretty sedentary, so going to work was the social thing I did that gave me a sense of camaraderie.

     It felt like things weren’t worth it.  I was having issues with depression and my newest diagnosis, diabetes.  And I had other things going on with my hospitalization, bing, bing, bing, boom!  There were too many other very emotional things going on then.

     I’m a nurse, so I know you can help others.  I do that all day long in their journey to get healthy again.  I know all about diabetes, but when it happens to yourself!  You can’t help yourself—I found that out.

     My health issues triggered a call from AbleTo.  A nurse would call me every three months, so I got to talking with them.    We could do it over the phone, which was very convenient.  They connected me with a social worker, JoAnna, and a nurse, Marta.  They do an assessment the first time, and the two of them collaborate.

     They had an eight-week course so we could dig in, and teach mindfulness and other strategies to get myself in a better place.  Now I talk to each of them once a week:  the social worker on Monday, and the nurse on Wednesday.  The social worker looks at the social aspects.  The nurse is a teacher.  She was fundamental in giving me online places to read about the mindfulness technique, relaxation, and learning to eat in a different way, with the diabetes.

     I can’t do all the things I used to be able to do, but I can look forward to things I can do.  I lost quite a bit of weight.  I had lost some, but then I lost 46 pounds, which was easier with help on the phone.  They motivated me.  I didn’t realize how badly I had not taken care of myself emotionally.  I’d been avoiding getting out and seeing my friends and family outside the house, having them come to mine.  Marta and JoAnna encouraged me to schedule times and to set goals like to at least go out once a month, like attending a function with friends a couple of times a year to meet up with old nurses I used to work with, which I do now.

     I got tons of grandchildren.  I’m on oxygen, with a walker.  I’m not vain, I’m just not used to people seeing me outside the home.  My son and daughter-in-law moved in with me, and assist me with a lot of things.  There gets to be conflict with that, with communication, for example, so I’m setting goals with that too.  Now I’m able to communicate better with my son.

     Life is better now.  I’m more active.  I go out to birthday parties.  The last one was for three of my grandchildren, ages 4, 7 and 17.  The best thing was the fact that I went and enjoyed myself.  I had so much fun!  I went by myself for the first time.  That was kind of daunting because I have oxygen and a walker, and it was 25-30 miles away at my oldest son’s house.  The biggest problem for me was in asking for help, for me to realize, Hey, if you can’t assist me, I’ll do it myself.  I did!  I’m taking back my life a little bit, at a level that I can.  I’m meeting up with friends, and I have a better social life.

Dr. Reena Pande’s comments:
     I’m the Chief Medical Officer at AbleTo. As a cardiologist, I spent a lot of time with my patients focused on lifestyle and behavior change. But I also quickly recognized that as physicians we are really quite good at telling people what to do, but not as good at helping them figure out how to do it, or at helping them identify and overcome the barriers that are standing in their way! And for so many people, it became clear that that barrier was in fact a real mental health challenge like depression or anxiety.

     So at AbleTo, a national behavioral health provider, we do just that. We pair each patient with a therapist and a coach who they meet with weekly by phone or video.  The treatment program uses protocols and is tailored around a specific clinical condition and uses Cognitive Behavioral Therapy (CBT) at its core.  The coach really helps the patient translate what they’ve learned in the therapy sessions into something actionable.

     A lot of my work is focused on measuring outcomes and proving the benefits of our treatment for patients and our partners. For example, we’ve found a consistent decrease in depression in the range of 50 – 65%, fewer admissions to the hospital and better diabetes management as shown in our articles in AJMC and Telemedicine and e-Health.

     I sometimes joke that the care isn’t rocket science; what's rocket science is finding the right people at the right time, keeping them engaged, and ensuring the treatment is easy to access and very high quality.  For example, we have a proactive outbound screening program, since so many people aren’t identified otherwise.  We use our clinical algorithms based on claims data, pharmacy data, and other health-related information to identify who’s at risk. Our engagement specialists  are trained to reach out to people in a very empathic and destigmatized way. We make it ok to accept the help they might need. It's very satisfying to know we are making a difference.

Ken’s note:  The journal article describes a study that looked back at 466 people with diabetes who had gone through the AbleTo program.  Among people who had had highly severe depression, anxiety, and stress beforehand, they had major reductions in depression (67%), anxiety (59%),and stress (70%). More of them started measuring their morning glucose levels.  The people who had had the highest morning blood sugar levels had the greatest reductions in them.

     Read a story of another innovative approach for a person with diabetes.  Thanks to John Pelle of AbleTo for connecting us.