Behavioral health operational resources toolkit

Behavioral health operational resources toolkit

BEHAVIORAL HEALTH OPERATIONAL RESOURCES TOOLKIT OPERATIONAL RESOURCES TASK FORCE Bryan A. Dovichi, MA, Chair Rachel Broudy, MD Auria Chamberlain, MSW Sheri Gibson, PhD Allison Ilem, PhD, BCBA Katherine Jones Brenda King, PsyD Mary Maina, CTRS Mary Beth Tubbs, BSN, MS BEHAVIORAL HEALTH WORKGROUP MAUREEN NASH, M.D. CHAIR Terry Anderson Sheri Gibson

Victor Lee Nancy Seigal Ashton Andrews Irena Ginsburg Mary Maina Adria Smith Nancy Barkowski Melyssa Harmon Carol McGlone Kristin Springfield

Elisabeth Broderick Carrie Hays McElroy Matthew McNabney Joe Stanley Rachel Broudy Allison Ilem Mary Maxine Mello Laurie Strom Jessica Burt Katherine Jones

Holly Onsager Carmarthen Swift Kelly Cervenka Linda Kasparian Theresa Auria Chamberlain Kendra Kerr Yasiri Perez Mary Beth Tubbs Lynda Davis

Brenda King Sharon Petitjean Lauren Vessella Nicole Desabrais Bill Kirkpatrick Luz Ramos-Bonner Melissa Michael DiBiase Lorelei Landau Arun Rao

Paola Wierzbicki Bryan Dovichi Ian LaRose Suzanne Ribero-Balassone Theresa Alicia English Heather Laughland Rebecca Riley Pamela Fenstemacher Martha Frost Curran Gaughan

Paylor Mary Ann Roberts Misty Taylor-Paladino Weisel Wright CONTENTS Purpose Statement Development Process I. Introduction A. Behavioral Health definition B. Integration of Behavioral Health and Primary

C. D. E. F. G. Care Levels of Integration Behavioral Health Providers Behavioral Health Services Rationale for Integrating Behavioral Health and Primary Care The Need for Behavioral Health in PACE II. Behavioral Health in PACE: Recommendations for Best Practices A. Referrals, Inclusion Criteria, and Confidentiality B. Assessment and Care Planning

i. Clinical Interview ii. Mental Status Examination iii. Cognitive Screening iv. Mood Functioning Measures i. Risk Assessment and Crisis Intervention ii. Psychoeducation iii. Individual Psychotherapy iv. Motivational Interviewing v. Group Psychotherapy vi. Substance Abuse Treatment vii. Psychiatric Pharmacotherapy viii.Psychiatric Admissions A. Special Considerations i. Dementia ii. Severe Mental Illness iii. Elder Abuse iv. Collaborating with Community-Based Behavioral Health Services

B. Outcomes and Measurement-Based Care I. Closing Statement II. References III. Appendix A. Assessment Forms and Policy and Process Examples PURPOSE STATEMENT It was not until recently that Program of All-inclusive Care for the Elderly (PACE) organizations began to recognize the need for Behavioral Health Services and add to their traditional model of care by including various professionals specializing in the discipline. The purpose of this toolkit is to provide a resource and a guide of best practices for PACE organizations looking to achieve a greater level of behavioral health integration. The National PACE Association (NPA) Behavioral Health Operational Resources Toolkit is not intended to be construed or to serve as a standard of care. Standards of care are determined on the basis of an organizations resources. Every PACE organization will differ in its level of integration and implementation of new practices will be successful only if attempted within ones reasonable ability to do so. These recommendations for best practice should be considered guidelines only. Adherence to them will not ensure a successful outcome of implementing Behavioral Health Services, nor should it be interpreted as including all

proper methods of care or excluding of other acceptable methods of care aimed at successful treatment outcomes of PACE participants. DEVELOPMENT PROCESS The NPA Behavioral Health Workgroup was formed in December 2015. Upon formation of the group, the work began by surveying PACE organizations regarding their use of Behavioral Health Services. Based on a thematic analysis of the results, the workgroup was broken down into three taskforces: Education, Operational Resources, and Outcomes. The Operational Resources Taskforce held its first meeting by conference call on June 8, 2016, during which time a work plan and working agenda were developed. It was also during this initial meeting that a call for forms was communicated to taskforce members in order to solicit policies, procedures, and assessment tools being used at members respective PACE organizations. Subsequent monthly meetings were held via conference call (with the exception of November 2016). Each meeting involved members discussing items according to its work plan. The taskforce began by developing and/or selecting definitions for Behavioral Health and levels of integration, providers, and services provided by the discipline. The task force then shifted its focus to developing recommended best practices for the following areas: (1) Referrals and Inclusion Criteria; (2) Assessment and Care Planning; (3) Treatment and Interventions; (4) Special Considerations; and (5) Outcomes and Measurement-Based Care. Time outside of the monthly conference calls included review of the solicited forms and supporting empirical literature and writing, reviewing, and editing this toolkit. INTRODUCTION

Behavioral Health definition Behavioral Health Services offer assistance not just with diagnosable mental illnesses, but also when habits, behaviors, stress, worry, or emotional concerns about physical or other life problems are interfering with a persons daily life and/or overall health. This is achieved by performing a variety of mental health activities within a primary care setting. Integration of Behavioral Health and Primary Care Integrated health care is the systematic coordination of physical and behavioral health care. The idea is that physical and behavioral health problems often occur at the same time. Integrating services to treat both will yield the best results and be the most acceptable and effective approach for those being served. INTRODUCTION INTRODUCTION Behavioral Health Providers Primary (Traditional) Psychologists Psychiatrists

Secondary (Supportive) Primary Care MDs, NPs, and PAs Recreational Therapists/Activities Coordinators Social Workers Physical Therapists/Occupational Therapists Licensed Professional Counselors Chaplain Licensed Marriage and Family Therapists Behavior Analysts INTRODUCTION Behavioral Health Services

Evaluation Assessment Treatment Planning Recommendations Neuropsychological Evals Treatment Short and Long Term Behavioral Medicine Crisis Interventions Individual and Group Education Consultation Didactics Staff Trainings Caregiver / Facility

INTRODUCTION Rationale for Integrating Behavioral Health and Primary Care 1. The burden of mental disorders is great. 2. Mental and physical health problems are interwoven. 3. The treatment gap for mental disorders is enormous. 4. Primary care settings for mental health services enhance access. 5. Delivering mental health services in primary care settings reduces stigma and discrimination. 6. Treating common mental disorders in primary care settings is cost-effective. 7. The majority of people with mental disorders treated in collaborative primary care have good outcomes. (WHO, 2008) INTRODUCTION The Need for Behavioral Health in PACE 59. 7% of participants diagnosed with at least 1 psychiatric disorder with a higher rate of mental illness in the younger age group (53-64: 77.6%) versus the older age groups (65-74: 68.1%; 75+: 53.8%). (PACE Data Analysis Center Report, 2014) 77% of organizations have no formal behavioral health programming in place. Common themes include: (1) Inadequate programing to serve high levels of need; (2) Fragmented communication with external behavioral health providers; (3) Unique challenges

associated with specific populations and diagnoses; (4) Need for staff education on specific topics; and (5) Need for development of policies and procedures. BEHAVIORAL HEALTH IN PACE: RECOMMENDATIONS FOR BEST PRACTICES At the greatest level of integration, Behavioral Health Services in a PACE organization ideally should aim to serve as an essential department integrated within the Interdisciplinary Team (IDT) with a focus on addressing the behavioral, cognitive, and emotional well-being of participants. Implementation should focus on several key areas: Integrated Primary Care Behavioral Health Trauma-Informed Care Culturally Competent Care Preventative Care Data and Information Driven Care BEHAVIORAL HEALTH IN PACE: RECOMMENDATIONS FOR BEST PRACTICES Referrals, Inclusion Criteria, and Confidentiality Identify participants BH needs pre- and post-enrollment (when available, consider inclusion of BH in

the pre-enrollment process). Presenting Issues Methods of referring (EHR vs. paper form) Referral Sources Confidentiality Coordination Limits Documentation; types of notes BEHAVIORAL HEALTH IN PACE: RECOMMENDATIONS FOR BEST PRACTICES Assessment and Care Planning Clinical Interview Mental Status Examination Cognitive Screening Mood Functioning Measures Substance Abuse Measures Other Measures

BEHAVIORAL HEALTH IN PACE: RECOMMENDATIONS FOR BEST PRACTICES Treatment and Interventions Risk Assessment and Crisis Intervention Psychoeducation (with participants, caregivers, and staff) Individual Psychotherapy Motivational Interviewing Group Psychotherapy Substance Abuse Treatment Psychiatric Pharmacotherapy Psychiatric Admissions SPECIAL CONSIDERATIONS Dementia PACE organizations without behavioral health integration have been successful at caring for its participants with dementia for a long time; however, behavioral health may be looked at as a way to help amplify and expand on existing programming. Day Center Programming Monitoring and Tracking Medication Utilization

SPECIAL CONSIDERATIONS Severe Mental Illness Due to the growing number of participants suffering from severe mental illness (e.g., schizophrenia; bipolar disorder), it is important for organizations to develop programming to ensure proper care and treatment for these individuals. There are several areas that often provide difficulties which programs can proactively develop programming to provide effective and quality care: Medication Management Day Center Programming Living Environment and Safety SPECIAL CONSIDERATIONS Elder Abuse There are various forms of elder abuse that PACE professionals should be aware of, including physical abuse, sexual abuse, psychological abuse, neglect, financial exploitation, and abandonment. Abuse occurs in the context of a trusted relationship, and may involve the targeting of older adults specifically because of their age and/or disability status. Another issue that PACE organizations may encounter is that of self-neglect. Who is considered a vulnerable adult?

Not sure whether to report? Consult. Who should report? Person-centered reporting. Reporting responsibility. Other Resources. SPECIAL CONSIDERATIONS Collaborating with Community-Based Behavioral Health Services As the majority of PACE organizations recently surveyed indicated that they have none or are in the very beginning stages of developing and implementing behavioral health programming, effective working relationships with community-based Behavioral Health Services, including counseling and psychiatry, are vital in serving the mental health needs of participants for these organizations. Bringing Behavioral Health Care to the PACE Model When Integration is Limited Psychotherapy Outpatient Psychiatry Specialty Care Settings Non-clinical Resources PACE Behavioral Health Services Outcome Measures

Organization Individual Enrollment Hospitalizations Treatment Outcomes/ Measurement-based Care Participant Satisfaction Hospital Re-admissions Growth/Market Share Avoidable ED Visits Staff Training Psychiatric Admissions

Provider Satisfaction Medication Utilization Placements OUTCOMES AND MEASUREMENT-BASED CARE Frequently referred to as measurement-based care or routine outcome measurement. Use of standardized tools or instruments to obtain objective data to monitor the impact of and inform decisions related to individual plans for care, treatment, or services. Data may also used for organizational performance improvement efforts. Demonstrates the value of services and increases the quality of care provided. CLOSING STATEMENT The PACE model of care and its individual organizations historically have proven to be very effective at caring for older adults since its humble beginnings in 1971 at On Lok in San Francisco, California. It was inevitable that other populations would learn about and gravitate toward this all-inclusive approach to care.

Recently, we have come to see the average PACE participant not only become younger, but also present with more of a need for mental health services. Moreover, as community mental health organizations across the country have demonstrated difficulties in caring for the needs of their patients, it appears that the PACE model of care continues to increasingly grow as an attractive option for many of the individuals served by related agencies. Accordingly, the National PACE Association has recognized the need to adjust and add to its model of care to serve the growing aging population in America. This toolkit seeks to serve as the first step in creating a new department within the existing model the PACE interdisciplinary team and also illustrate the need for PACE organizations to adapt their approach to providing the best care for all participants. As the population continues to evolve, it is the primary goal of the NPA Behavioral Health Workgroup Operational Resources Task Force to continue to provide PACE organizations with a resource to continue to learn, grow, and adapt. Looking to the future, it is recommended that PACE organizations approach the existing model of care with the belief that there is no health without behavioral health. APPENDIX Behavioral Health Referral Paper Form Generalized Anxiety Disorder 7-item (GAD-7) Clinical Interview Schedule

Geriatric Anxiety Scale (GAS) Mental Status Exam Rapid Record Form The Mood Disorder Questionnaire (MDQ) Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions Alcohol Use Disorders Identification Test (AUDIT) Montreal Cognitive Assessment (MoCA) Version 7.1 Original Version Montreal Cognitive Assessment (MoCA) Version 7.2 Alternate Version Montreal Cognitive Assessment (MoCA) BLIND Administration and Scoring Instructions Montreal Cognitive Assessment (MoCA) BLIND Version 7.1 Original Version

Michigan Alcoholism Screening Test-Geriatric Version (MAST-G) Current Opioid Misuse Measure (COMM) Participant Medication Agreement Form Life Events Checklist for DSM-5 (LEC-5) PTSD Checklist for DSM-5 (PCL-5) Clinician-Rated Dimensions of Psychosis Symptom Severity Abnormal Involuntary Movement Scale (AIMS) Mini-Mental State Examination (MMSE) Caregiver Burden Scale The Saint Louis University Mental Status (SLUMS) Examination Safety Plan Aid to Capacity Evaluation (ACE) Psychotherapy Outcome Reporting

Functional Assessment Staging (FAST) Treating Behavioral Disturbances and Intervention Grid Global Deterioration Scale (GDS) Behavior Logs for Tracking Behavioral Disturbance Associated with Dementia Clinical Dementia Rating (CDR) Behavioral Care Plan A SPECIAL THANK YOU TO NPA SUPPORT STAFF Teresa Belgin, (former) Member Services Manager Shawn Bloom, President and CEO Sam Kunjukunju, Director of Project Management

References Alexopoukos, G. S. (2002). The Cornell scale for depression in dementia: Administration and scoring guidelines. Retrieved from American Bar Association Commission on Law and Aging & American Psychological Association. (2005). Assessment of older adults with diminished capacity: A handbook for psychologists. Washington, DC: American Bar Association and American Psychological Association. American Psychiatric Association. (2013). Clinician-Rated Dimensions of Psychosis Symptom Severity. Retrieved from: File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Clinician-Rated-Dimensions-of-Psychosis-Symptom-Severity.pdf American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association. American Psychiatric Association. (2016). Practice guidelines for the assessment and treatment of patients with suicidal behaviors. In: Practice Guidelines for the Treatment of Psychiatric Disorders, (3rd ed.). Arlington, VA: American Psychiatric Association. Beck, J. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford. Blow F. C., Brower, K. J., Schulenberg, J. E., Demo-Dananberg, L. M., Young, J. P., & Beresford, T. P. (1992). The Michigan Alcoholism Screening Test Geriatric Version (MAST-G): A new elderly-specific screening instrument. Alcoholism: Clinical and Experimental Research 16(2): 372. Borson, S., Scanlan, J. M., Brush, M., Vitaliano, P., & Dokmak, A. (2000). The Mini-Cog: A cognitive vital signs measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry, 15(11): 1021-1027. Centers for Disease Control and Prevention (CDC). (2015). Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2015. Retrieved from: Cuijpers, P., Karyotaki, E., Pot, A. M., Park, M., & Reynolds, C. (2014). Managing depression in older age: psychological interventions. Maturitas,

79(2): 160169. Etchells, E., Darzins, P., Silberfeld, M., Singer, P., McKenny, J., Naglie, G., Katz, M., Guyatt, G., Molloy, W., & Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14(1): 27-34. Funk, M. & Ivbijaro, G. (2008). Integrating mental health into primary care a global perspective. Genevia, Switzerland: WHO Press. Retrieved from Garfield, R. L., Zuvekas, S. H., Lave, J. R., & Donohue, J. M. (2011). The impact of national health care reform on adults with severe mental disorders. Am J Psychiatry, 168(5): 486-494. Guy, W. A. (1976). Abnormal Involuntary Movement Scale (AIMS). In ECDEU Assessment Manual for Psychopharmacology (pp. 534-537). Washington, DC: U.S. Department of Health Education and Welfare. Heath, B., Wise-Romero, P., & Reynolds, K. (2013). A review and proposed standard framework for levels of integrated healthcare. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions. Hirschfeld, R. M. A. (2002). The mood disorder questionnaire: A simple, patient-rated screening instrument for bi-polar disorder. Journal of Clinical Psychiatry Primary Care Companion, 4: 9-11. Hogan, M. F. (2003). The President's New Freedom Commission: Recommendations to transform mental health care in America. Psychiatr Serv, 54(11): 1467-1474. Hogg Foundation for Mental Health. (2008). Connecting body & mind: A resource guide to integrated health care in Texas and the U.S. Austin, TX: Hogg Foundation for Mental Health Division of Diversity and Community Engagement The University of Texas at Austin. Retrieved from Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41(2):

159-64. Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140: 566-572. Hunter, C. L., Goodey, J. L., Oordt, M. S., & Dobmeyer, A. C. (2012). Integrated behavioral health in primary care: Step -by-step guidance for assessment and intervention. Washington, DC: American Psychological Association. Inflexxion, Inc. (2008). Current Opioid Misuse Measure (COMM). Retrieved from: Jeste, D. V. , Alexopoulos, G. S., Bartels, S. J., Cummings, J. L., Gallo, J. J., Gottlieb, G. L., Halpain, M. C., Palmer, B. W., Patterson, T. L., Reynolds, C. F. 3rd, & Lebowitz, B. D. (1999). Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades. Arch Gen Psychiatry, 56(9): 848-853. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry, 62(6): 617-627. Kroenke, K. & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32: 1-7. Lee, K. M., Camp, C. J., Malone, M. L. (2007). Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia. Clinical Interventions in Aging, 2(3): 477-483. Lopez, M., Coleman-Beattie, B., Jahnke, L., & Sanchez, K. (2008). Connecting body & mind: A resource guide to integrated health care in Texas and the US. Retrieved from McConkie-Erekson, D. (2013). Scheduled healing: The relationship between session frequency and psychotherapy outcome in a naturalistic setting. Dissertation Scholars Archive Brigham Young University, Nevada. Minett, N. D. (2011). Critical Review: The effects of Montessori-Based Dementia Programming on engagement of persons with dementia within

social contexts. Retrieved from: Molenaar, P. J., Bloom, Y., Peen, J., Schoevers, R. A., Van, R., Dekker, J. J. (2014). Is there a dose-effect relationship between the number of psychotherapy sessions and improvement of social functioning? British Journal of Clinical Psychology, 50(3): 268-282. Nasreddine, Z. (2010). Montreal cognitive assessment MoCA - Administration and scoring instructions. Retrieved from uploads/site-images/MoCA-Instructions-English_2010.pdf Patrick, J. (2000). Mental status exam - Rapid record form. Retrieved from %20State%20Exam%20-%20form.pdf Reisberg, R. (1984). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24: 653-659. Reisberg, B., Ferris, S. H., de Leon, M. J., & Cook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139: 1136-1139. . Rollnick, S., Miller, W. & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford. Rovner, B., & Folstein, M. (1987). Mini-mental state exam in clinical practice. Hosp Pract 22(1A): 99; 103; 106; 110. Sakauye, K. (2008). Geriatric psychiatry basics. New York: W. W. Norton & Company. Segal, D. L. (2013). Geriatric Anxiety Scale (GAS) Version 2.0. Retrieved from Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10): 1092-1097. Steward, S., O'Riley, A., Edelstein, B., & Gould, C. (2012). A preliminary comparison of three cognitive screening instruments in long term care: The MMSE, SLUMS, and MoCA. Clinical Gerontologist, 35(1): 57-75.

Tariq, S., Tumosa, N., Chibnall, J., Perry, H., III, & Morley, J. (2006). The Saint Louis University Mental Status (SLUMS) examination for detecting mild cognitive impairment and dementia is more sensitive than mini-mental status examination - A pilot study. J am Geriatri Psych, 10(46). Untzer, J., Patrick, D. L., Simon, G., Grembowski, D., Walker, E., Rutter, C., & Katon, W. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study. JAMA, 277(20): 1618-1623. Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T.M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at Weisberg, R. B. & Magidson J. F. (2014). Integrating cognitive behavioral therapy into primary care settings. Cognitive Behavioral Practice, 21(3): 247-251. World Health Organization. (1995). Alcohol Use Disorders Identification Test. Retrieved from Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982-83). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1): 37-49. Zarit, S. H, Reever K. E., Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist, 20: 649-655.

Recently Viewed Presentations

  • The Afterlife June 12, 2011 Is Hell Real?

    The Afterlife June 12, 2011 Is Hell Real?

    Luke 16:24 'Father Abraham, have pity on me and send Lazarus to dip the tip of his finger in water and cool my Is Hell Real? tongue, because I am in agony in this fire.' 25 "But Abraham replied, 'Son,...
  • Joint Services Support (JSS) Directorate Annie DeAndrea-TAA VA/Military

    Joint Services Support (JSS) Directorate Annie DeAndrea-TAA VA/Military

    Home Loans. GI Bill (Education) ... As a member in any branch of the armed forces of the United States, including the national guard and armed forces reserves, and has fulfilled his or her initial military service obligation. WA RCW...


    HEMOGLOBINA Y MIOGLOBINA PROTEINAS GLOBULARES HEMOGLOBINA Y MIOGLOBINA Hemoproteinas Grupo especializado de proteínas que contienen el grupo prostético hemo.
  • Are Tax Rulings Selective? - Chillin'Competition

    Are Tax Rulings Selective? - Chillin'Competition

    Santander) In any case, both advantage and selectivity must be established. Advantage and selectivity may be brothers but not 'identical twin brothers'. Individual aid vs. Aidschemes. Another important distinction: individual aid and aid schemes.
  • IEEE 802 40th Anniversary Public Visibility Campaign Proposal

    IEEE 802 40th Anniversary Public Visibility Campaign Proposal

    Strategy Overview. Create a broad and global awareness campaign of IEEE 802 LAN/MAN Standards Committee and how the Standards developed by thousands of IEEE 802 technical experts over the past 40 years has enabled the industry to connect the world,...
  • Analogies - Jefferson County Public Schools

    Analogies - Jefferson County Public Schools

    * * * * * * * * * Analogies test your ability to: Recognize the relationship between the words in a word pair Recognize when two word pairs display equal relationships Old Young To answer an analogy question you...
  • Transcription Factors - Imim

    Transcription Factors - Imim

    Helix-turn-helix (HTH) motifs are found in all known DNA binding proteins that regulate gene expression. The basic HTH motif is characterised by 2 alpha helices, which make intimate contacts with the DNA and are joined by a short turn (number...
  • Time Management - Rutherford County TN

    Time Management - Rutherford County TN

    The Management Series: Time Management Advantages of Time Management Time Management… Motivates and initiates Reduces avoidance Promotes review Eliminates cramming Reduces anxiety Time Management Tips Tips for more effective time management: Use a daily planner to stay on track Prioritize...