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

▶
daily monitoring of progress and the mediators of change
SMART_READER_LITE
LIVE PREVIEW

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

Jan 16, 2023 183 likes •560 views

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

slide-1
SLIDE 1

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

slide-2
SLIDE 2
slide-3
SLIDE 3

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!
slide-4
SLIDE 4
slide-5
SLIDE 5

5

  • 100 bed Inpatient Private Mental Health hospital –

Western Australia

  • Inpatient, day-patient, outpatient and outreach

services – ~ 60 day patients per day

Setting the Scene

slide-6
SLIDE 6

6

What is Old! End of treatment, follow up Graphs

slide-7
SLIDE 7

6 8 10 12 14 16 18 20 22

Av erage DASS Depression For Patients With Affectiv e Disorders (1998-2003)

Normal Range Severe Depression

12M F/U 3M F/U 6W k F/U Pos t-CBT Pre-CBT

DASS Depression

OLD NEWS!

slide-8
SLIDE 8

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

slide-9
SLIDE 9

Illustrative Patient

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

slide-10
SLIDE 10

A System was Developed – with Point of Care Access

slide-11
SLIDE 11

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

slide-12
SLIDE 12

Nursing – Daily Monitoring

slide-13
SLIDE 13

13

CBT Closed Group Patient Graph

slide-14
SLIDE 14
slide-15
SLIDE 15

Feedback

  • Feedback can be

given at the point of care or in printed form

slide-16
SLIDE 16

Mobile Access

slide-17
SLIDE 17

Now IPad in every Inpatient Bedroom = 100 Ipads.

slide-18
SLIDE 18

Newnham, E.A., Hooke, G.R., & Page, A.C. (2010) Journal of Affective Disorders

Inpatients & Day patients: Improved outcomes (F(1,649) = 6.29, p = .01) Vitality: (F(1,639) = 5.53, p = .02) Role Emotion: (F(1,635) = 4.11, p = .04)

slide-19
SLIDE 19

Therapist iPad View – Daily Schedule

slide-20
SLIDE 20

VERY NEW!!

slide-21
SLIDE 21
slide-22
SLIDE 22
slide-23
SLIDE 23
slide-24
SLIDE 24

Patient had minimal change, some correlation with better

  • utcome and greater

practice.

slide-25
SLIDE 25

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

slide-26
SLIDE 26

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.

slide-27
SLIDE 27

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.

Use Symptoms day 1 Symptoms day 10 a = -.08* b = -.34* * c’ = .50* * Figure 5: Figure depicting mediation model with path coefficients for Average Use of CBT skills Use Symptoms day 1 Symptoms day 10 c’ = .50* * b = -.34* *

slide-28
SLIDE 28

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)

slide-29
SLIDE 29

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

slide-30
SLIDE 30

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
slide-31
SLIDE 31

The End

  • Geoff Hooke
  • https://www.researchgate.net/profile/Geoffrey_Hooke
  • Email: Geoffh@perthclinic.com.au
  • Twitter: @geoffrhooke
slide-32
SLIDE 32
slide-33
SLIDE 33
slide-34
SLIDE 34
slide-35
SLIDE 35
slide-36
SLIDE 36