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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 Control and Prevention [CDC], 2016). Children that continue to struggle

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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Date Created
2020-05-02

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Advocating for Routine ADHD Screening in Young Girls

Description

Objective: Attention Deficit Hyperactivity Disorder is a pervasive neurodevelopmental disorder among children. Research has shown that young girls are underserved in diagnosing and treating ADHD or never diagnosed compared males. Utilizing the Health Promotion Model, this project aims to determine

Objective: Attention Deficit Hyperactivity Disorder is a pervasive neurodevelopmental disorder among children. Research has shown that young girls are underserved in diagnosing and treating ADHD or never diagnosed compared males. Utilizing the Health Promotion Model, this project aims to determine if primary care providers are aware of sex differences in ADHD and if a brief education on sex differences in ADHD affects the primary care setting's screening rate.
Design/Methods: With the Arizona institutional review Boards' approval, primary care providers (PCP) in a Southwest family practice in Arizona (n=35) are provided with virtual education on sex differences in ADHD. Pre- post-intervention surveys were electronically administered to five PCPS. Data were deidentified. A two-tailed paired t-test was conducted to examine the mean difference of responses.
Results: Analysis of responses demonstrate that primary care providers are well aware of sex differences in ADHD but screened less for ADHD before the education intervention. Major themes emerged from provider comments on ADHD symptom recognition, time constraints, and increased screening to identify girls in the primary setting. A significant increase in ADHD screening is seen four weeks post-intervention t(4) = -6.32, p = .003.
Conclusion: Future research is needed to identify other factors that could strengthen ADHD screening during well-child visits overall. Also, the use of a pediatric screener which can highlight inattentive symptoms would assist in the process of identifying girls with ADHD.

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2021-04-27

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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. Restrictive interventions place patients and healthcare staff in hostile situations

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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2020-04-21

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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 those who use substances, their friends, family members, communities and

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

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Date Created
2019-05-02

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Reducing Polypharmacy with Mobile Apps Among Mental Health Patients

Description

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions,

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?

The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.

Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.

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2019-04-29