Daily Monitoring of Progress and the Mediators of Change in Mental - PowerPoint PPT Presentation

Daily Monitoring of Progress and the Mediators of Change in Mental Health Geoff Hooke Director of Information Technology, Perth Clinic Adj. Associate Professor, Psychological Science, UWA, Perth @geoffrhooke geoffh@perthclinic.com.au

Presentation Plan  What is Old news.  What is New!  Why monitor patient progress  Monitoring at Perth Clinic – Improving Patient Outcomes – New in Mental Health!  Method of giving feedback, live system – New!  Trajectories of expected outcome, automated – New!  If “off track” how about mediators/process? – Very New!  Self harm prediction project – Very Very new!

Setting the Scene • 100 bed Inpatient Private Mental Health hospital – Western Australia • Inpatient, day-patient, outpatient and outreach services – ~ 60 day patients per day 5

What is Old! End of treatment, follow up Graphs 6

OLD NEWS! Av erage DASS Depression For Patients With Affectiv e Disorders (1998-2003) 22 Severe Depression 20 18 DASS Depression 16 14 12 10 Normal Range 8 6 Pre-CBT Pos t-CBT 6W k F/U 3M F/U 12M F/U

Recovered Improved Deterioration (Newnham, Harwood, & Page, 2007)

Illustrative Patient Inpatient Stay Daypatient Rx Admission Discharge Pre-CBT Post-CBT Follow Up Acute Treatment Groups Cognitive-Behavioural Treatment HoNOS HoNOS HoNOS HoNOS HoNOS DASS DASS DASS DASS DASS MH-14 MH-14 MH-14 MH-14 MH-14 RSES QOL QOL RSES RSES LCB POC Audit LCB LCB CBT-POC (RAS) Daily Symptom Monitoring

A System was Developed – with Point of Care Access

Provided Access Throughout the Hospital Live, real time connectivity- MX component, clinical component Viewed in Nurses station – Patient location – group attendance or not Patient progress available in number and graph Suicide thinking item choice - visible

Nursing – Daily Monitoring

CBT Closed Group Patient Graph 13

Feedback Feedback can be • given at the point of care or in printed form

Mobile Access 

Now IPad in every Inpatient Bedroom = 100 Ipads.

Inpatients & Day patients: Improved outcomes (F(1,649) = 6.29, p = .01) Vitality: (F(1,639) = 5.53, p = .02) Role Emotion: Newnham, E.A., Hooke, G.R., & Page, A.C. (2010) (F(1,635) = 4.11, p = .04) Journal of Affective Disorders

Therapist iPad View – Daily Schedule

VERY NEW!!

Patient had minimal change, some correlation with better outcome and greater practice.

CBT Skills “Use”, asked Daily Over the last day, I used the skills from the CBT course when I needed them.. Figure 2: Mean and standard error ratings for the Use of CBT skills item for each clinical significance group

CBT Skills “Effective”, asked Daily Over the last day, the CBT skills I used were effective… Figure 3: Mean and standard error ratings for the Effectiveness of CBT item for each clinical significance condition.

Use of CBT Skills - For average use, symptoms at day 1 remained a significant predictor, however the variance in symptoms at day 10 explained increased to 32%. So Use is a partial mediator. Figure 5: Figure depicting mediation model with path coefficients for Average Use of CBT skills Use Use a = -.08* b = -.34* * Symptoms day 1 Symptoms day 10 b = -.34* * Symptoms day 1 Symptoms day 10 c’ = .50* * c’ = .50* *

VERY VERY NEW!! Dual Approach (All data plus 7 extra questions)  1. Predicting Self harm (binary alert) in Inpatients, intervening, reducing. - UWA Maths Dept, YLM. Daily measures + Self harm data (Riskman)  2. Providing a treatment option for those identified of suicidal thinking that utilizes Interpersonal Therapy. (Thwarted belonging and perceived burdensomeness)

VERY VERY NEW!! Self Harm Prediction – Joint Project with UWA Mathematics Dept

In Summary  Small organization  Our strength is agility and customization, using in house developers  Multi-disciplinary team, I.T., therapy, nursing, Mx  Have to be innovative, can’t wait for others to develop concepts, so we have to develop our own  Thereby we can accommodate patient and staff requests quickly  In house research team, linked to UWA Psychology and Mathematics Depts, Ph.D. students involved, 11 have completed.  So far 42 publications

The End  Geoff Hooke  https://www.researchgate.net/profile/Geoffrey_Hooke  Email: Geoffh@perthclinic.com.au  Twitter: @geoffrhooke