Enhancing outpatient anxiety treatment with mobile technology: A quality improvement study.

INTRODUCTION: Mobile mental health applications are a novel treatment method with unique qualities and capabilities for enhancing existing psychiatric treatments. Outpatient settings such as Mile Square Health Clinic have identified a need to leverage this new technology into their routine care. BACKGROUND: In the U.S., over 40 million people suffer from an anxiety disorder, however, only 1 in 4 responds to pharmacological treatment. Preliminary research indicates mental health apps are acceptable, feasible, and can improve patient outcomes for those with anxiety. METHODS: Participants from two different outpatient psychiatric clinics locations with generalized anxiety disorder were identified and recruited by participating nurse practitioners. Participants were instructed on how to download and use IntelliCare by the Project Lead. The Project Lead administered a semi-structured interview to collect qualitative data at three weeks and six weeks follow-up. RESULTS AND CONCLUSIONS: Survey responses at three and six weeks showed relevant themes of increased journaling, increased feelings of connectedness, positive associations with gamification, and IntelliCare being most useful for a moderate to severe level of anxiety. RECOMMENDATIONS: The results of this QI project demonstrate the clinical utility of incorporating the IntelliCare app into regular outpatient practice. IntelliCare should be used with those with moderate to severe anxiety and journaling features should follow research developments to incorporate best-practice guidelines.

Improving Knowledge and Increasing Use of a Screening Tool in an Outpatient Psychiatric Clinic.

Less than half of providers use screening tools to diagnose adult psychiatric patients. The bipolar population is specifically vulnerable to an inaccurate diagnosis. The goal of this project was to improve use of screening tools, specifically the HCL-32 in a rural adult psychiatric clinic. Following the end of the project, guidelines were analyzed to determine factors that could have improved the outcome. A pre-survey was administered to the 11 participating providers. Following the survey, a 10-minute educational session was given to each provider. Two months following the education, a post-survey was conducted. A chart review was completed to confirm post-survey results.

Nursing Advocacy and Long Acting Injectables to Reduce High Readmission Rates: Quality Initiative.

INTRODUCTION: Nonadherence to medications for schizophrenia relates to frequent readmissions. Long-acting injectable (LAI) medications are shown to increase adherence and reduce admissions. AIMS: (1) Identify frequent readmissions to psychiatry. (2) Improve nursing advocacy for patients appropriate for LAIs through in-service. METHODS: Chart audits were employed for data collection. Academic detailing and dashboards were used for voluntary nursing education. The chart audit spanned 90 days pre and post in-service. All admissions to psychiatry were screened; patients with readmissions under 30 days (with the same admitting diagnosis), a schizophrenia spectrum diagnosis, and nonadherent with oral antipsychotics were included. Results: Forty-four patients met criteria and amassed 49 frequent readmissions. For inclusion criteria, the admission rate decreased by 53% and LAI prescriptions increased by 9%. Three patients from the first audit group and one from the second were initiated on LAIs. CONCLUSIONS: Attitudes toward LAIs may be improving based on RN advocacy and collaboration.

Challenges in Treatment of Comorbid Chronic Pain, Depression, and Anxiety.

Meeting the needs of patients who experience physical pain and a psychiatric illness presents challenges as well as opportunities to optimize collaborative partnerships between specialty and primary care services. It is imperative that patients with pain be evaluated for depression and those who present with depression be evaluated for pain to prevent chronic opiate overuse. Given the overlap in symptomatology patients can present in either primary care or psychiatric care, an understanding of the comorbid presentation and lived experience of these patients is essential to holistic and complementary care. The current article examines the nature of pain and comorbid depression and anxiety along with suggested treatment modalities that can modify psychological processes and behavior that perpetuate the pain experience and increase need for opiate medication. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 17-21.].

Addressing Principles of Recovery to Engage Consumers in Outpatient Treatment.

Mental illness often requires hospitalization, with high readmission rates. One way to improve outcomes and reduce readmission rates is for consumers to attend outpatient appointments. However, a major challenge in delivery of mental health outpatient treatment is missed appointments. When consumers miss appointments for outpatient follow-up, they also miss an opportunity for recovery. Non-attendance rates in psychiatric outpatient clinics have been a topic of considerable interest and attendance at appointments has been used as an indicator of quality of service provision. Strategies used to address missed appointments have been met with minimal success in improving engagement in treatment and do not offer evidence-based guidance regarding solutions to this challenge. Simple measures to gain consumer feedback on levels of therapeutic alliance and engagement in shared decision-making are available and can be used in clinical sessions to support recovery-based care. Psychiatric mental health nurses can engage consumers in recovery-based services that have salience to motivate them to engage in treatment.

Substance use and brain reward mechanisms in older adults.

Substance use among older adults is on the rise, with statistics indicating this to be a growing health problem. Brain changes in the reward center of the brain that naturally occur with aging are offered as one source of these statistics. Aging is generally associated with increased prevalence of chronic disease, disability, and death, and therefore a public health goal for older adults is to maintain health, independence, and function. Psychiatric-mental health nurses are uniquely positioned to assist older adults in achievement of these goals through health assessment and promotion. The use of client-centered counseling approaches that recognize the older adult's developmental need for autonomy and choice in decision making have been shown to be effective in increasing motivation in this adult population.

Integrated primary and mental health care services: an evolving partnership model.

TOPIC: Persons with serious psychiatric disabilities experience high rates of medical co-morbidities that, if properly treated, could improve overall well-being and the course of recovery. PURPOSE: This brief reports describes how two organizations-Thresholds Psychiatric Rehabilitation Centers and University of Illinois College of Nursing-partnered to offer integrated behavioral and physical health care responsive to the needs of the population and committed to consumer-centered, holistic and preventative care. Most recently, the partnership offers primary care in different community settings through different service models-tele-monitoring, home visits, group visits. SOURCES USED: A combination of published literature, staff report, and quality assurance data informs this report. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors conclude that primary care outreach is a promising strategy in mental health settings and that the Chronic Care Model (CCM) provides a set of guidelines for designing and monitoring quality integrated care for a partnership model of integrated care.

Reducing Barriers That Hinder Obstetric Providers From Addressing Perinatal Depression: A Provider Education Module.

BACKGROUND: Perinatal depression affects approximately one in seven women and is one of the most common complications that occurs during pregnancy and the postpartum period. Untreated depression can have devastating consequences for the mother and her children. Despite the high prevalence and negative effects, pregnant and postpartum women face barriers to establishing adequate care and thus many go untreated. Many obstetric providers lack the understanding and confidence needed to manage and treat women who screen positive. OBJECTIVE: The purpose of this quality improvement project was to create and deliver an education program to obstetric providers on depression screening, assessment, and treatment. The objective was to increase knowledge and confidence levels needed to affect recognition and management of perinatal depression. METHODS: A PowerPoint presentation was utilized to educate providers on assessment and management of perinatal depression. A pre- and post-test design was used to evaluate the impact on knowledge and confidence levels. RESULTS: Mean scores on knowledge and confidence levels were increased following the PowerPoint presentation. CONCLUSION: This intervention appeared to have a positive impact on depression knowledge and confidence levels in obstetric providers. IMPLICATIONS FOR NURSING: This project is anticipated to promote early identification and intervention for perinatal depression.

Smoking cessation and serious mental illness.

A focus group methodology was employed to identify personal, social, and environmental factors that affect smoking cessation in persons with serious mental illness. Four focus groups were held: two for those who had attempted to quit smoking and two for those who had never attempted to quit. Smoking is central to daily survival in patients with serious mental illness. Social and environmental reinforcement can both assist and hinder efforts to stop smoking. Smoke-free environments influence decisions to quit smoking if positive social comparisons with nonsmokers occur. Peer modeling and interpersonal connections with nonsmokers can offer links to forming supportive nonsmoking relationships.

Late-onset posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a complex psychological response to a perceived life-threatening trauma that includes re-experiencing the trauma, avoidance, intrusive thoughts, hyperarousal, and dissociation. Exposure to trauma in early adulthood increases the potential for further psychological threats throughout life. In older adult populations, PTSD is an underrecognized and undertreated disorder that can result in psychosocial disability, substance use, and other negative health outcomes. This article examines the range of symptoms related to PTSD in older adults and expands on health care provider sensitivity to the interrelationship of mental and physical health when addressing the needs of older adults with this disorder.

Integrated primary and mental health care: evaluating a nurse-managed center for clients with serious and persistent mental illness.

Nurse-managed centers have been at the forefront of providing ambulatory care alternatives for underserved populations lacking access to care. Following this model, the Center for Integrated Health Care of the College of Nursing at the University of Illinois in Chicago delivers primary and mental health care services to a population of people with serious and persistent mental illness. The authors' experience illustrates the many rewards and challenges that nurse-managed centers face. This article describes their center's model of integrated care, examines selected performance indicators, and discusses the implications, opportunities, and challenges ahead.

Changing the tide: stigma, school youth, and mental illness.

Schools are in a key position not only to identify mental health concerns early but to address issues of stigma that prevent both children and their parents from seeking help with mental illness. Stigma associated with mental illness perpetuates isolative behavior and poor engagement within the academic community. Programs within schools that address mental health issues and support open communication with families can reduce the pain and isolation that is often the experience of youth with undiagnosed and untreated mental and emotional disorders.

Center for Integrated Health Care: primary and mental health care for people with severe and persistent mental illnesses.

The Center for Integrated Health Care capitalizes on the abilities, drive, and autonomy of advanced practice nurses, resulting in an exciting, timely academic nursing center exemplar. People with severe and persistent mental illnesses receive care that is targeted specifically to a population with chronic mental illnesses and tailored to the unique individual by integrating primary and mental health care. This Center is a partnership between Thresholds, a psychosocial rehabilitation center, staff and University of Illinois at Chicago, College of Nursing faculty. The Center's goals are to provide quality care, support teaching and learning for nursing and other health professional learners, and generate new knowledge related to the integration of mental and physical health care. To achieve long-term sustainability, the Center must partner with a federally qualified health center.

Serious mental illness and smoking cessation.

Persons with serious mental illness (SMI) are faced with substantial challenges to their health. This population is two to three times more likely to smoke cigarettes than persons who do not suffer from mental illness. In particular, young adults are at high risk for vulnerability to both SMI and cigarette smoking. Although there are proven methods for smoking cessation, both pharmacologic and non-pharmacologic interventions show limited usefulness for SMI who smoke. Alternative health care options as well as support groups and physical exercise are discussed as methods that may be useful in smoking cessation. Finally, integration of smoking cessation programming into existing mental health treatment services may offer the greatest opportunity for client success.

Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation.

PURPOSE: To explore perceived barriers and benefits to physical activity in people with serious and persistent mental illness (SPMI) who were enrolled in community-based psychiatric rehabilitation. DESIGN AND METHODS: Four focus groups, two for men and two for women, were held with a total of 34 outpatients from two program sites. The investigators used a semistructured interview guide to facilitate the discussions. Audiotapes of the discussions were transcribed and analyzed for concepts and themes. FINDINGS: Significant barriers to physical activity were: mental illness symptoms, medications, weight gain from medications, fear of discrimination, and safety concerns. Being in a psychiatric rehabilitation program offered comfort and belonging, but it also had the effect of leaving activity initiation up to the program staff, which some participants perceived was part of required program compliance. However, participants viewed physical activity positively, and they linked being active to improved mental health. CONCLUSIONS: Outpatients in psychiatric rehabilitation valued physical activity, but mental illness symptoms, medication sedation, weight gain, fear of unsafe conditions, fear of discrimination, and interpretations of program compliance were barriers. Confronting how attitudes and barriers specific to this population can affect activity and reframing program compliance to include the independent initiation of activity as part of improving health might help clients of mental health services to become more active.