APNA 30th Annual Conference Session 4012: October 22, 2016 - - PDF document

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 1

Providing PMHNPs with Core Competencies and Specialization in Child and Adolescent Psychiatry Through Creative Education and Practice

Tina Walde, DNP, PMHNP APNA Annual conference Margaret Scharf, DNP, PMHNP October, 2016 Nicole Bennett, DNP, PMHNP Hartford, CT Oregon Health & Science University, Portland, OR

Disclosure

Speakers have no conflicts of interest to disclose.

Learning Outcomes

• Identify opportunities for expanding learning and

practice in child and adolescent psychiatry with a generalist curriculum

• Compare specialist and subspecialist opportunities at the

master’s and doctoral levels

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 2

Background: Unmet Needs of Youth

• Half of all lifetime MH disorders begin by age 14 years (Kessler et al., 2005)
• Average delays to initial treatment contact after onset of mental health

disorders ranges from 6-8 years for mood disorders and 9-23 years for anxiety disorders (Wang et al., 2005)

• Suicide is the second leading cause of death in Oregon youth ages 10-24

years (Oregon Health Authority, 2016)

Background: Mental Health Services

• 80% of youth ages 6-17 identified with needing mental health services do

not receive specialty care (Kataoka et al., 2002)

• More than one-third of children (34.8%) receive mental health services from

a primary care provider only (Anderson, Chen, Perrin, & Van Cleave, 2015)

• Children who had a visit with a PCP were twice as likely to be prescribed a

psychotropic than those who saw a psychiatrist (Anderson et al., 2015)

History of Dual Tracks

• Adult/Child CNS/NP Lifespan PMHNP curriculum
• Mirrored changes in ANCC certification
• Generalist expectations/all settings
• “Fit” of the program with current market needs

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 3

A Stepwise Approach to Change

• 1. Combine tracks
• 2. Faculty collaboration
• 3. Scaffold course content
• 4. Standardize content
• 5. Focus on core diagnoses and treatment
• 6. Provide exceptional clinical placements

Step 1: Combine Tracks

Considerations

• High need
• Lack of qualified providers
• Graduates being placed in jobs where they need to see kids

Challenges

• Limited program credits and time to graduation
• Desire to maintain depth of content

Decision

• Provide distinct adult and child courses and shift timing in the program
• 2 faculty members who are primarily child-focused in practice

Step 2: Faculty Collaboration

Cultivate a shared philosophy on learning and teaching goals

• Scaffolding course content
• Standardization of learning activities
• Focus on core diagnoses and treatment modalities

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 4

Step 3: Scaffolding Course Content

• Reduce overlapping content
• Introduce CBT in the adult course then apply and adapt content to child-specific

disorders

• Expand learning from adult courses to child
• Psychopharmacology with application to adults (4 credits)
• Build on the adult foundation in child

psychopharmacology (2 credits)

Step 4: Standardize Learning Activities

Comprehensive learning adaptable to clinical settings

• Psychiatric assessment
• Biopsychosocial formulation
• Case supervision
• Treatment plans

Step 5: Focus on Core Diagnoses and Treatment

Create depth

• Identify most common adult diagnoses to teach
• Child course adds specific knowledge on common disorder
• In addition address commonly occurring child-specific

disorders

• Y model of therapy

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 5

Step 5: Focus on Core Diagnoses: Learning Provided To Other NP Specialties

• Develop courses for FNP and PNP that focus on mental health within their

scope of practice

• Provide lectures to Acute Care NP and others
• Maintain PMHNP courses for PMHNP students
• Maximize scaffolding
• Ensure full scope of PMHNP practice learning

Step 6: Provide Exceptional Clinical Placements: Reviewing the Numbers

MN has 680 hours:

• 25% must be adult
• 25% must be child/adolescent
• 50% student may choose age focus: child/adolescent/adult/gero/mix
• With approval of faculty to make sure true lifespan is met,

(fill weak areas first)

Step 6: Provide Exceptional Clinical Placements: Create Opportunities

• Build site and preceptor relationships
• Role of the agency liaison
• Maintain relationships with graduates
• Supervision groups
• Meet weekly
• 4-6 students
• Assigned to child and/or adult/lifespan faculty as needed per placement

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 6

Step 6: Provide Exceptional Clinical Placements: Structure

• Long term placements working with youth reserved for students specializing in

child/adolescent

• Placements with most opportunity for independent practice with preceptor
• versight
• Focus on community need
• Community Mental Health
• Rural
• Crisis

To meet Oregon’s call for more child providers:

• Faculty encouragement, 2 faculty with primarily child focus in practice
• Moved up child assessment and psychopharmacology

10 20 30 40 50 2010 2011 2012 2013 2014 2015 2016 % of total graduates Year of graduation

Child focused Graduates

APNA 30th Annual Conference Session 4012: October 22, 2016 Walde 7

Future Steps

• MN program focuses on high need

populations and settings

• DNP subspecialization opportunities
• Age groups
• Therapies
• Disorders
• Settings

References

• Anderson, L.E., Chen, M.L., Perrin, J.M., & Van Cleave, J. (2015). Outpatient visits and medication

prescribing for U.S. children with mental health conditions. Pediatrics, 136(5), 1178-85.

• Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children:

Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548-1555.

• Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime

prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey

• Replication. Archives of General Psychiatry, 62(6), 593-602.
• Oregon Health Authority. (2016). Youth suicide intervention and prevention plan, 2016-2020. Salem, OR:

Oregon Health Authority.

• Wang, P.S., Berglund, P., Olfson, M., Pincus, H.A., Wells, K.B., & Kessler, R.C. (2005). Failure and delay in

initial treatment contact after first onset of mental disorders in The National Comorbidity Survey Replication. Archives of General Psychiatry, 62(5), 603-13.

• Images from openclipart.org

Questions