Matching Items (22)

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Implementation of Adolescent Depression Care Guidelines into the Electronic Health Record at a Rural Pediatric Primary Care Clinic

Description

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

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Created

Date Created
  • 2020-05-01

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Mental Health Training: Pathway to Early Mental Health Intervention

Description

There is an increase in the prevalence of mental health problems in the United States. Healthy People 2020’s leading mental health indicator is to increase the delivery of care to

There is an increase in the prevalence of mental health problems in the United States. Healthy People 2020’s leading mental health indicator is to increase the delivery of care to those with mental health issues and lower the number of youth who experience a major depressive disorder. Teachers and non-teaching staff are well placed in the community to identify youth undergoing emotional distress and facilitate early interventions, yet do not receive adequate training in mental health.

A project was undertaken to determine if a mental health training intervention affected the community youth mentors knowledge, attitude and self-efficacy towards helping youth with mental health issues. Three instruments with good validity and reliability namely Mental Health Literacy Scale (MHLS), Attitudes to Severe Mental Illness (ASMI) scale, and Gatekeeper Behavior Scale were used in pre intervention, immediately post intervention and two weeks post intervention questionnaires. The Wilcoxon Signed Ranks test indicated changes in the pre and post intervention scores as significant in knowledge, and attitude between pre intervention and immediately post intervention time periods. Cohen’s effect size value suggested large, medium, small, and minimum clinical significance in the variables over period of time.

Mental health literacy narrows the gap between symptom onset and intervention. Numerous mental health trainings are currently available worldwide. Schools and after school clubs in collaboration with hospital mental health and other community agencies are better equipped to bridge the gap. School staff report better confidence in addressing mental health and behavioral health issues among youth when equipped with additional resources within the school in the form of psychologists, social workers, and counselors.

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Created

Date Created
  • 2020-05-03

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Improving Adolescent Human Papillomavirus Vaccination Rates Through Provider Education

Description

Human papillomavirus (HPV) is a prevalent sexually transmitted infection that affects many adolescents and adults worldwide. The consequences of contracting HPV have proven to be devastating, potentially leading to a

Human papillomavirus (HPV) is a prevalent sexually transmitted infection that affects many adolescents and adults worldwide. The consequences of contracting HPV have proven to be devastating, potentially leading to a variety of life-threatening genitourinary and oral cancers. As such, prevention via vaccination is critical. HPV vaccination is recommended for all adolescents beginning at 11 years of age. Although the immunization has proven to be safe and effective, HPV vaccination rates are substantially below target goals worldwide.

A literature review of evidence from the last five years was conducted to examine barriers and facilitators to HPV vaccine uptake. The most commonly cited barriers to vaccination included lack of knowledge about the vaccine and inadequate provider recommendation. Current evidence regarding interventions to increase HPV vaccine uptake reveal that best practices are multi-factorial and should include a combination of provider education and recommendation training. These findings led to the proposal of an evidence-based intervention aimed to increase adolescent HPV vaccination rates.

A one-hour educational program was conducted at a local pediatric primary care facility. Five healthcare providers participated in the program, which consisted of a PowerPoint presentation outlining the benefits of HPV vaccination and use of an interactive application from the CDC. The app taught participants how to offer a strong recommendation for the vaccine through active participation. Pre and posttests were administered to determine the providers’ intent to vaccinate and vaccination rates were monitored. Analysis of the data collected revealed a statistically significant rise in vaccination rates. These results reveal that provider education can improve recommendation techniques and therefore increase vaccine coverage. Further research is needed to see if one-time education is sustainable.

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Created

Date Created
  • 2020-04-28

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Feasibility of Cognitive Behavioral Therapy in the Treatment of Suicidality of Children

Description

Background: Suicidal ideation and attempts are increasing in the adolescent population and suicide is now the second leading cause of death for youth 10-24 years of age (Center for Disease

Background: Suicidal ideation and attempts are increasing in the adolescent population and suicide is now the second leading cause of death for youth 10-24 years of age (Center for Disease Control and Prevention [CDC], 2016). Children that continue to struggle with suicidality and depression after treatment as usual have an increased length of stay, from an average of five days to nine days per admission. Recidivism rates are also increasing, with some patients
requiring readmission the same day as discharge.

Method: The purpose of project was to check the feasibility of the use of cognitive behavioral therapy-based group called Creating Opportunities for Personal Empowerment (COPE) in the treatment of children with depression and suicidality. The study patients participated in up to 7 groups of a 60-minute lesson of COPE each day, combined with interactive activities that helped
them practice problem solving and coping skills. The feasibility of the COPE groups were measured by the consistent decrease of Columbia Suicide Severity Rating Scale at the beginning and conclusion of lessons as well as consistency of engaged participation in the COPE groups on the unit based of staff observation obtained from Staff Survey.

Results: The results analyzed using the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -3.64, p < .001. This indicated that the differences between Pre-CSSR and Post-CSSR were not likely due to random post variation. The median of Pre-CSSR (Mdn = 1.00) was significantly lower than the median of Post-CSSR (Mdn = 2.00).

Discussion: The results proved feasibility of a cognitive behavioral therapy-based group in the treatment of depression and suicidality of children in an inpatient unit.

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Created

Date Created
  • 2020-05-02

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Reducing Seclusion and Restraints in Adolescent Patients

Description

Seclusion and restraint (SR) continue to be used in psychiatric settings when a patient is a harm to self or others despite growing concern and calls to eliminate the practice

Seclusion and restraint (SR) continue to be used in psychiatric settings when a patient is a harm to self or others despite growing concern and calls to eliminate the practice due to its harmful, potentially life-threatening effects on patients. The purpose of this evidence-based project was to assist a hospital in the southwestern United States decrease their seclusion and restraint rates among their adolescent patients. Trauma-informed care approaches have been shown to significantly reduce the incidence of SR in inpatient settings.

The nurses and behavioral health technicians (BHTs) received a two-hour trauma-informed care training in November of 2019. SR rates three months pre-training and post-training were compared. In the three months prior to the training, SR rates averaged 23.4 events per 1000 patient days. Comparatively, the three months after the training SR rates averaged 19.5 events per 1000 patient days. This shows a clinically significant decrease in SR rates after the TIC training. This evidence-based project (EBP) highlights the need to address this problem and gives an intervention option that can reduce harm for patients and address the needs of healthcare organizations seeking to improve patient care.

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Created

Date Created
  • 2020-05-03

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Adolescent Aggression and Restrictive Interventions

Description

Seclusion and restraint are restrictive interventions that continue to be used in both physical care and mental health care settings as a means of controlling dangerous behavior such as aggression.

Seclusion and restraint are restrictive interventions that continue to be used in both physical care and mental health care settings as a means of controlling dangerous behavior such as aggression. Restrictive interventions place patients and healthcare staff in hostile situations that can lead to physical, mental, and emotional injuries that can last a lifetime. Unfortunately, restrictive interventions continue to be used in many healthcare organizations around the world and the number of patient and staff injuries continue to rise. Stakeholders at a Phoenix area psychiatric inpatient hospital conducted an internal audit on the number of seclusion and restraint episodes in 2019, which revealed an increase in the number of seclusion and restraints episodes on the adolescent unit.

The result of this audit led to the project question: For nurses on an acute adolescent inpatient unit, is a seclusion and restraint education program more effective than usual
practice in changing the knowledge and attitude regarding seclusion and restraint? The purpose of this practice change project was to provide staff education that focused on trauma informed care, de-escalation techniques, and therapeutic communication to improve staff confidence to ultimately lead to the reduction of seclusion and restraint use on an adolescent inpatient unit. A
pre and posttest questionnaire designed to better understand nurse attitude and knowledge regarding restrictive interventions prior to the education session was provided. A convenience sample of nurses (N=9) participated in the project. The findings from the pre and posttest questionnaire suggest that seclusion and restraint education for nurses may improve nurse knowledge and attitude regarding the use of restrictive interventions and reduce rates of use.

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Created

Date Created
  • 2020-04-21

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Adolescent Depression: Integrating Behavioral Healthcare in a Pediatric Primary Care Setting

Description

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to result in suicide, the second leading cause of death in adolescents. Referring all patients with a positive depression screen to a mental health specialist creates treatment delay and burdens already limited community resources.

Objective: The objective of this primary care practice transformation was to improve pediatric primary care provider confidence and behavior to support and deliver evidence-based behavioral healthcare for adolescents with mild to moderate depression.

Methods: An evidence-based adolescent depression education program was delivered to pediatric primary care providers in a small community setting. The program’s components included measures to identify and manage mild to moderate depression. Outcome measures included: 1. Provider knowledge, beliefs, and confidence measured pre- and post-intervention; and 2. Electronic health record documentation of provider adherence to guideline recommendations one, two, and three months post-intervention.

Results: Four providers participated in the intervention. The mean total score for the provider beliefs and knowledge from a 5-point Likert scale demonstrated a positive increase after the intervention (14.75 vs. 23.25, p = .068). The mean total provider confidence score achieved near significance as well (12.25 vs. 21.75, p = .066). Resultant behavior change in the providers did not reach statistical significance when the electronic health records of all adolescent well visits over a three-month period were assessed. Screening for depression at adolescent well visits
Adolescent Depression 3 increased from 0% to 84-90% post-intervention. Setting treatment goals upon detection of depression increased from 0% to 41% (p = .089). Providers appropriately administered active support 67% of the time when a patient was identified with mild depressive symptomology post-intervention. Providers complied with guideline recommendations with identified cases of moderate and severe depression (n = 2).

Conclusions: Pediatric primary care providers demonstrated some positive behavioral changes towards integrating behavioral healthcare into their practice after an educational session on the guidelines for adolescent depression.

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Created

Date Created
  • 2017-04-04

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Screening, Brief Intervention and Referral to Treatment (SBIRT): Implementation in the Adolescent Inpatient Psychiatric Setting

Description

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders

Contributors

Agent

Created

Date Created
  • 2019-05-02

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Adolescent motivation for healthy behaviors: a theory-based enhanced health curriculum for adolescents

Description

ABSTRACT

Adolescence is a period marked by significant physical, developmental, cognitive, and social changes, all of which contribute to health concerns for teens. A steady rise in life expectancy over

ABSTRACT

Adolescence is a period marked by significant physical, developmental, cognitive, and social changes, all of which contribute to health concerns for teens. A steady rise in life expectancy over the past two centuries is potentially diminishing due to the increase in prevalence, severity, and consequences of obesity in children and adolescents related to unhealthy lifestyle behaviors. Health behaviors are often established during childhood and adolescence that continue into adulthood. The development and integration of healthy lifestyle behaviors are vital through adolescence. Self-determination theory (SDT) offers a theoretical framework for attempting to understand individual differences in motivation and behavior. Recent studies have primarily focused on how adolescents make choices related to eating behaviors, physical activity, and self-care habits, and how the resultant behaviors are measured. Participants in this study were 63 healthy adolescents enrolled in 9th grade health class. All participants provided baseline data at Time 1 and again following the five-week pretest posttest intervention study at Time 2. This study examined the utility of SDT in the development of the Adolescent Intrinsic Motivation, a healthy lifestyle behavior intervention, using the tenets of SDT to explain healthy lifestyle motivational beliefs in adolescents, along with healthy lifestyle behaviors and knowledge. The AIM intervention study introduced basic health recommendations to adolescents in an autonomy-supportive environment, which has been shown to encourage the adolescent to make healthy behavior choices based on their own interest and enjoyment. Preliminary effects of the study indicated that participants receiving the AIM intervention demonstrated significant differences in motivational beliefs, healthy lifestyle knowledge, as well as healthy lifestyle behaviors from Time 1 (baseline) to Time 2 (post-intervention). Results of this study provide support for the use of SDT to address the competence, relatedness, and autonomy of adolescents in the development of health education material. Testing this intervention in a larger, random sampling of schools within the state, or even in more than one state, with a three- or six-month follow-up would be useful in determining the longer-term effects of the intervention.

Contributors

Agent

Created

Date Created
  • 2015

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Conceptualizing Offending, Victimization, and Gender: Three Studies on Juveniles

Description

General theories of crime have frequently been used to explain a variety of offending and victimization experiences for a wide range of samples. However, feminist criminologists question whether the same

General theories of crime have frequently been used to explain a variety of offending and victimization experiences for a wide range of samples. However, feminist criminologists question whether the same causal mechanisms exert similar effects for males and females—a criticism that points to the need for sex-specific analyses. Toward that end, this dissertation examines variables derived from several different general theories of crime in three separate studies. Each of the studies uses split-sample analyses to investigate potential sex-based differences. The first study uses three-level meta-analytic methods to determine if predictor variables derived from general theories explain victimization for both adolescent males (n = 138,848) and adolescent females (n = 176,611). Additionally, it examines both within-dataset and between-dataset differences. The second study uses a sample of high school students in Arizona (n = 2,738 males, n = 2,932 females). It examines the role of parental social ties in explaining the overlap of adolescent dating violence (ADV) offending and victimization. The third study uses two waves of a longitudinal dataset of high-risk adolescents (n = 182 males, n = 203 females). It focuses on the relationship between negative emotions and delinquency, and the role of avoidant coping. In each of the studies, both gender-neutral and gender-specific explanations of offending and victimization were found. In the first study, while predictor variables derived from criminological theory explained victimization for both males and females, larger effect sizes were found for risky lifestyle variables. In the second study, an overlap between ADV offending and victimization was found for both males and females, and social ties explained some of the overlap. However, paternal attachment was only significant for females, and involvement was only significant for males. In the third study, avoidant coping was associated with an increase in substance abuse, and anger was associated with an increase in violent behavior for both males and females. Avoidant coping partially mediated the relationship between anger and substance use, but only for males. Implications for practice and future research are discussed.

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Agent

Created

Date Created
  • 2020