Programming Model for the Emergency Department

Transcription

1 Programming Model for the Emergency Department Tammi W Plantan, MA, MSN, RN Virginia i i Fox, PMHCNS-BC Declaration of Interest: The speakers have no conflicts of interest to disclose. 1 Behavioral Health Treatment in the Emergency Department The realities: It s not a pretty picture! The ED as default Crisis Stabilization Unit SBIRT What can we do while waiting for that bed to open? 2 Goals of Brief Focused Intervention Reduce Anxiety, Agitation and Frustration Promote Problem Solving and Engagement in Treatment from the Outset Improve Patient Satisfaction 3 Plantan & Fox 1

2 Theoretical Framework Yalom s Working Model - Lower-Level Psychotherapy Group Framework (Yalom, 1983) Illness Management and Recovery Model Topics (IMR, 2006) Person-Centered Therapeutic style (Wheeler, 2008) 4 Specific concerns in ED Patient population changes day to day Patient population is diverse Patient population may be volatile ED may have limited resources Single or multiple people in group 5 Sample Sessions Orientation & Preparation (2-5 minutes) Warm-up (5-10 minutes) Structured Exercises (20-30 minutes) Review of Session (5-10 minutes) Yalom, I. D. (1983). Inpatient group psychotherapy. New York: Basic Books, Inc. 6 Plantan & Fox 2

3 Warm-Up/Ice-Breakers (refer to handout Warm-up exercises ) Question of the Day Each person answers the same question Colored Indexed Card Each person answers a different question At My Best Activity Sentence completion 7 Stress Management Signs that you are stressed (refer to Stress Exhaustion Symptoms handout) In/Out Activity Stress Relievers (refer to Stress Relievers handout) My Plan for Coping with Stress 8 9 Plantan & Fox 3

4 Stress Management IN Listening to music Playing my guitar Exercising Playing video games OUT Fighting Getting drunk Quitting/walking out of my job Keeping to myself 10 My Plan for Coping with Stress 1. Stressful situation that I am aware of: 2. Signs that I am under stress: 3. My strategies for preventing stress: 4. My strategies for coping with stress once it happens. 11 Individual Goals Backpacking activity (based on a 1-week trip alone) Maslow s Hierarchy 12 Plantan & Fox 4

5 Machete water knife Cell phone Canned food security survival Survival/security Social/security survival 13 Symptom Management Discussion of incidents before hospital admission Examples of Early Warning Signs (refer to Examples of Common Early Warning Signs handout) Responding to Early Warning Signs (refer to Responding to Early Warning Signs handout) 14 Symptom Not taking medication regularly Drinking or using drugs Symptom Management Possible Solutions Make sure you have a supply of the pills you need Ask for help in remembering to take medication Use reminders (e.g. putting your medication next to your toothbrush or putting up post-it-notes) Removing alcohol, drugs and OTC meds from your home or room Figuring out other activities you can do that don t involve drinking or using drugs Going to AA, NA or Dual Recovery Group 15 Plantan & Fox 5

6 Rating & Review of Session Group Topic: Stress Date: Describe your current mood: Rate your level of stress: BEFORE No Distress Slight Distress Moderate Distress Extreme Distress Describe your current mood: Rate your level of stress: AFTER No Distress Slight Distress Moderate Distress Extreme Distress Wrap-Up/Conclusion More data is needed on outcomes Does it meet goals of improving care, patient satisfaction, and increasing engagement Does it help ED staff heel less helpless and more confident/competent with this population Fulfilling the BI of the SBIRT model Begin Biological Treatment with medications Begin Psychosocial Treatment with focused modules 17 References Illness Management and Recovery Evidence-Based Practice (2006). Retrieved from oolkits/illness/ Larkin, G., Beautrais, A., Spirito, A., Kirrane, B., Lippmann, M., & Milzman, D. (2009). Mental health and emergency medicine: a research agenda... 10th annual Academic Emergency Medicine (AEM) consensus conference, "Public Health in the Emergency Department: Surveillance, Screening, and Intervention," May 13, 2009, New Orleans, Louisiana. Academic Emergency Medicine, 16(11), doi: /j x Wheeler, K. (2008). Psychotherapy for the advanced practice psychiatric nurse. St. Louis, Missouri: Mosby. Yalom, I. D. (1983). Inpatient group psychotherapy. New York: Basic Books, Inc. 18 Plantan & Fox 6