Learning Objectives. APNA 30th Annual Conference Session 4015: October 22, Kverno 1

Transcription

1 Responding to the IOM Report on Psychosocial Interventions: Application of the Perspectives of Psychiatry Karan Kverno, PhD, PMHNP-BC and Tamar Rodney, MSN, PMHNP-BC The speakers have no conflicts of interest to disclose. Learning Objectives Upon completion of this presentation, participants will be able to: Describe key explanatory concepts from each of the four Perspectives of Psychiatry. Utilize the Perspectives of Psychiatry conceptual framework to match elements of evidence-based psychotherapeutic interventions to the needs of individual patients. Take part in the recommendations of the IOM (2015) report on psychosocial interventions for mental and substance use disorders. The Need for an Elements Approach to Evidence-based Psychosocial Interventions Psychopharmacology alone is often insufficient for complete recovery. Psychosocial interventions are effective, yet there has been a decline in their use. Evidence based, psychosocial interventions are made up of multiple elements. We don t know what elements are effective at improving specific symptoms, functioning or wellbeing. (Delaney & Handrup, 2011; Institute of Medicine, 2015; Janicak, Marder & Pavuluri, 2011) Kverno 1

2 Psychosocial Intervention Concepts Elements: activities, techniques or strategies Non-specific elements Specific elements How change is affected: Mechanisms: Biological, behavioral, cognitive, emotional, interpersonal Moderators: Person-specific factors such as sex, race, class Outcomes: Symptoms, functioning and well-being (IOM, 2015) IOM Framework for Developing Standards for Psychosocial Interventions Strengthen the evidence base Implement interventions and improve outcomes Engage Consumers Identify elements of interventions Develop quality measures Conduct systematic reviews to inform clinical guidelines (IOM, 2015) Application The application of effective interventions involves assembling combinations of elements that, based on evidence, are targeted to particular disorders and other patient characteristics. (IOM, 2015, p. 10) Case formulation is key in matching elements to patient characteristics. Kverno 2

3 Case Formulation and Treatment Implications DSM-5 Approach Considers whether symptoms fit into a recognizable disorder or syndrome - or not. Perspectives of Psychiatry Considers the presentation from each of four perspectives. Bird Life: A Guide to Study of Our Common Birds (1897). (APA, 2013; Chisolm & Lyketsos, 2012; McHugh & Slavney, 1998) HIDE Diseases what a patient... Has Dimensions what a patient... Is Behaviors what a patient... Does Stories what a patient... Encountered Disease Perspective Example: Schizophrenia Treatment: Medication Kverno 3

4 Dimensional Perspective Example: Wild Boy of Aveyron (circa 1798) Treatment: Guidance Behavior Perspective Example: Anorexia Treatment: Interruption Life Story Perspective Example: Bandura s Bobo Doll Experiment (1961) Treatment: Rescripting (Bandura, Ross & Ross, 1961; McHugh & Slavney, 1998) Kverno 4

5 Examples of Disorders and Syndromes Across the Perspectives Diseases Behaviors Dimensions Life Stories Delirium Alcohol Subnormal IQ Demoralization dependency Dementia Drug dependency Personality disorders Grief Schizophrenia Paraphilias Excessive emotional responses ( neurosis ) Adjustment disorder Bipolar disorder Anorexia / bulimia PTSD Panic disorder Sleep disorders False memory syndrome Case Example: Personalizing Treatment Disease Bipolar Dimensional Unstable extroversion Medicate Guide Interrupt Rescript Behavioral Risky alcohol use Life Story Demoralization Case Example: Evidence-based Psychosocial Elements Nonspecific (Examples) Behavior: Risky alcohol use Therapeutic alliance Engagement Health literacy Dimensional: Unstable extroversion Therapeutic alliance Engagement Health literacy Life Story: Demoralization Therapeutic alliance Engagement Health literacy Specific (Examples) Brief intervention (SBIRT) Problem solving for conflict resolution Use of thought records to identify and reframe distorted cognitions Psychosocial elements (IOM, 2015) Kverno 5

6 LEADERSHIP Do not wait to be invited to have a seat at the table, find ways to be an active participant and take full advantage of the opportunities to establish psychiatric mental health nursing s expertise in psychosocial interventions. (Susie Adams, PhD, PMHNP/CNS-BC, FAANP, 2015, p. 347) Take Part in Building an Elements Based Framework Consider the nonspecific and specific interventions that you provide for patient-specific problems. Do a systematic review of the literature to strengthen the evidence base. Conduct clinical studies to identify and validate elements of psychosocial interventions. Use quality measures to track effectiveness. Participate in developing an elements framework, with a common language, whereby strategies and techniques can be applied across target problems, disorders, or contexts. Future: Implications for Teaching and Practice An elements framework will: advance training in and implementation of evidence-based psychosocial interventions. provide guidance as to what models of training are most effective determine how the acquisition of core competencies should be assessed. (IOM, 2015) Kverno 6

7 Conclusions The IOM committee recommends that psychosocial interventions be elevated to a position of equal regard as physical health care. Nurses have an important role in identifying key elements and examining the evidence to build a framework to improve the outcomes of psychosocial interventions. The Perspectives of Psychiatry provide an approach for matching elements of evidence-based psychosocial interventions to the needs of individual patients. Participant Discussion What is your system of case formulation? How do you determine the appropriate elements of psychosocial care? How can we work together to contribute to an elements based framework to improve the outcomes of psychosocial interventions? How will this framework inform nursing practice? Generalist APRN Nonspecific Specific References Adams, S. (2015). The IOM report on psychosocial interventions for mental and substance use disorders. Opportunities for psychiatric-mental health nurses. Journal of the American Psychiatric Nurses Association, 21(5), doi: / American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. ISBN: Bandura, A., Ross, D., & Ross, S. A. (1961). Transmission of aggression through imitation of aggressive models. Journal of Abnormal and Social Psychology, 63, Chisolm, M. S., & Lyketsos, C. G. (2012). Systematic psychiatric evaluation. A step-by-step guide to applying the Perspectives of Psychiatry. Baltimore: The Johns Hopkins University Press. ISBN: Delaney, K. R., & Handrup, C. T. (2011). Psychiatric mental health nursing's psychotherapy role: Are we letting it slip away? Archives of Psychiaric Nursing, 25(4), Doi: /j.apnu Institute of Medicine. (2015). Psychosocial interventions for mental and substance use disorders: A framework for establishing evidence-based standards. Retrieved from Interventions-Mental-Substance-Abuse-Disorders.aspx Janicak, P. G., Marder, S. R., Pavuluri, M. N. (2011). Principles and practice of psychopharmacotherapy (5 th ed.). Riverwoods, IL: Wolters Kluwer Health. ISBN McHugh, P. R., & Slavney, P. R. (1998). The perspectives of psychiatry (2 nd ed.). Baltimore, MD: The Johns Hopkins University Press. ISBN: Substance Abuse and Mental Health Services Administration, & U.S. Department of Health and Human Services (SAMHSA- HRSA). (n.d.). SBIRT: Screening, brief intervention, and referral to treatment. Available online: Kverno 7