Learning Outcomes Programs: Results Curriculum and Clinical - - PDF document

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 1

ENHANCING CHILD AND ADOLESCENT CONTENT & CLINICAL TRAINING IN ADVANCED PRACTICE PSYCHIATRIC NURSING PROGRAMS:

A JOINT WORKSHOP FROM THE APNA CHILD/ ADOLESCENT COUNCIL AND THE APNA GRADUATE EDUCATION COUNCIL

■ Present Presenters: rs: Session #4022

■ Jason Earle PhD, RN, PMHNP-BC ■ Erin Ellington, DNP, RN, PMHNP-BC ■ Pam Lusk, DNP, RN, PMHNP-BC, FAANP

■ The presenters, Jason Earle, Erin Ellington, Pam Lusk have no financial conflicts of interest to disclose

Learning Outcomes

■ Discuss the basic knowledge, skills, and attitudes needed by the PMHNP to provide evidence based psychiatric mental health care to children and adolescents. ■ Identify various child/adolescent teaching strategies and clinical training opportunities that can be employed in PMHNP programs ■ Create a forum where teaching strategies for child/adolescent content and PMHNP learning

• pportunities can be shared.

National Organization of Nurse Practitioner Faculties (NONPF): 2016 Survey of PMH NP Programs

(Vanderhoef & Delaney, in press)

■ Current state of PMH NP graduate education ■ Particular focus on two challenges: – Alignment with APRN Consensus Model (lifespan curriculum) – Suggested transition of APRN education to the Doctor of Nursing Practice (DNP) NONPF 2016 Survey of PMH NP Programs: Results – Program Descriptors

(Vanderhoef & Delaney, in press)

■ 118 program directors – 75 responded (64% response rate) ■ Lifespan curriculum – all but 1 program (transitioning) ■ Total student enrollment: 2,802 ■ Average number of PMH NP graduates/program – 12 (1-50) ■ MSN PMH NP post-graduation position: 96% clinical ■ DNP post-graduation position: 46% clinical (remainder applying for dual roles – practice- academic or practice-administration)

NONPF 2016 Survey of PMH NP Programs: Results – Curriculum and Clinical Practicum

(Vanderhoef & Delaney, in press)

Re Regulato tory Re Requirement: Classroom curricula and clinical practica across the lifespan ■ Difficulty finding child placements and preceptors ■ 2 programs have closed; 1 new program being developed Re Regulato tory Re Requirement: Education in 2 psychotherapy modalities (individual, family, group) ■ 10 programs offer separate theory of psychotherapy course ■ 38 programs offer separate family therapy course ■ Psychotherapy content frequently integrated into other courses ■ 53 programs require psychotherapy clinical practicum hours (similar to 2008 finding: 50%)

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 2

Re References

Vanderhoef, D. M. & Delaney, K. R. (in press). National Organization of Nurse Practitioner Faculties: 2016 Survey

• f Psychiatric Mental Health Nurse Practitioner Programs.

Journal of the American Psychiatric Nurses Association.

Rush University College of Nursing

JA JASON EA EARLE PHD PHD, PMHNP PMHNP‐BC BC JA JASON_ N_EARL RLE@RUS E@RUSH.EDU

Ov Over erview of

• f Rus

Rush’s Psy Psych DNP DNP Popula pulation/R ion/Role Cogna Cognates es and and Pra Practica ca Curriculum Curriculum

DNP Clinical Practica

• Neuropathophysiology: A

Lifespan Approach

• Psychopharmacology
• Major Psychopathological

Disorders

• Psychiatric Assessment Across

the Lifespan

• Evidence‐Based Treatment
• Group Therapy and Complex Care

Mor More In In‐Dep Depth Teaching hing on

• n the

the Com Common

• n Psy

Psychiatric Di Disor sorder ers DNP Clinical Practica

• Neuropathophysiology: A Lifespan

Approach

• Psychopharmacology
• Major Psychopathological Disorders
• Psychiatric Assessment Across the

Lifespan

• Evidence‐Based Treatment
• Group Therapy and Complex Care

(Pediatric ADHD, Anxiety, Depressive, and Disruptive Behavior Disorders) (Integration into Clinical Practice)

Neuropathophysiology

Pediatric Anxiety Neurocircuity Emotion Generation Circuit Emotion Regulation Circuit

Progr

• gressiv

ssively ly De Deepening epening Kn Knowledge Thr Through a Sequ Sequence of

• f Cour

Courses ses

Psychopharmacology

Pediatric Anxiety Molecular/Cellular Processes Neurotransmitters Receptors Signaling the Nucleus Evidence‐Based Treatment Pediatric Anxiety and Development Dan Siegel’s Interpersonal Neurobiology Perspective Mind Brain Relationships

University of Missouri-Kansas City

Erin Ellington, DNP, RN, PMHNP-BC

PMHNP Track Coordinator ellingtone@umkc.edu

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 3

UMKC PMHNP Program

• 53 credit hours
• 660+ psychiatric clinical hours
• Full‐time, part‐time, post‐MSN
• Seamless entry to DNP if desired
• 4 core psychiatric courses (16 hrs)

– Didactic & clinical – Full lifespan

Child and Adolescent Content

• Reading
• Case studies
• Discussion board
• Exam questions
• Lectures
• Clinical training
• Therapy & medication management

Enhancing Child and Adolescent Content

• Grant

– HRSA Behavioral Health Workforce Education and Training for Professionals – Develop and expand the substance abuse and mental health workforce who will focus on children, adolescents, and transitional‐age youth – Emphasis is on prevention and clinical intervention

This work supported by grant G02HP27985 from the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration

Enhancing Child and Adolescent Content

• Pediatric Behavioral Health Integration
• Adolescent SBIRT
• Cognitive Behavioral Therapy
• Clinical Training Sites

Pediatric Behavioral Health Integration

• Didactic

– Pediatric primary care – Advantages/disadvantages – Collaborative Care vs Integrated Care – SAMHSA Levels of Integration and Competencies

• http://www.integration.samhsa.gov/
• Case examples
• Clinical training

Adolescent SBIRT

http://www.nattc.org/regional‐centers/content.aspx?rc=midamerica&content=STCUSTOM5

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 4

Adolescent SBIRT Cognitive Behavioral Therapy

• Workshop: 8‐hour training session with an Beck trainer

– Lecture, video, roleplays, Q&A

• CBT basics: cognitive model, cognitive case

conceptualization, session structure, treatment

• Emphasis: depression and anxiety disorders

– Cognitive restructuring, exposure exercises for anxiety, and behavioral activation for depression

• Population: adolescent, transitional age, young adult
• Considerations: brief CBT services & E/M add‐on

Cognitive Behavioral Therapy

• 1‐hr initial assessment on a transitional age

standardized patient

• Complete the Beck Cognitive Case Writeup

– (Beck, 2011)

• Overwhelmingly positive student feedback

– Increased understanding of and confidence in their ability to provide CBT – Some interest in post‐graduation training in CBT – Students were better‐equipped to participate more effectively in their psychotherapy preceptorships

Clinical Training Site

• Local Kansas City sites

– Inpatient – Outpatient – Residential – Primary care

• Distance sites

– Student‐led search; faculty‐assisted recruitment

Future Plans

• Enhanced pediatric psychopharmacology

modules

• Pediatric telepsychiatry didactic and

experiential training

• Educational integration with PNP students
• Expand CBT for younger children, play therapy,

and family therapy

• Child/adolescent content for Adult PMHNP

References

• Beck, J. (2011). Cognitive therapy: Basics and beyond. New York, NY:

Guilford Press.

• Heath B, Wise Romero P, and Reynolds K. (2013, March). A Standard

Framework for Levels of Integrated Healthcare. Washington, D.C.: SAMHSA‐HRSA Center for Integrated Health Solutions.

• Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014).

Core Competencies for Integrated Behavioral Health and Primary

• Care. Washington, DC: SAMHSA ‐ HRSA Center for Integrated Health

Solutions.

• Mid‐America ATTC. (n.d.) Screening, Brief Intervention and Referral to

Treatment (SBIRT) Resources. Retrieved from http://www.nattc.org/regional‐centers/content.aspx?rc= midamerica&content=STCUSTOM5

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 5

Facult aculty Deliv Delivered Clin Clinic ical trai aini ning ng in in Psy Psychotherapy fo for PM PMHNP st students:

CB CBT fo for Child Children an and Ado Adolescents

ON ONLINE, IN IN CLA CLASS & HYBR HYBRID PR PROGRAMS

PAM LUSK, DNP, PMHNP‐BC, FAANP PROFESSOR, COORDINATOR PMHNP PROGRAM EASTERN KENTUCKY UNIVERSITY

Objectiv Objectives: es:

Discuss the need for PMHNP students to have clinical training in psychotherapy modalities, including the opportunity to develop psychotherapy skills through direct supervised experiences as core content in PMHNP programs. Identify the basic competencies (knowledge, skills, and attitudes) in psychotherapy (cognitive behavioral therapy and group psychotherapy) that are the basis for clinical training of PMHNP students Describe strategies for delivery of clinical training in psychotherapy in PMHNP programs, including online, in class, or hybrid delivery. Identify teaching resources and student evaluation tools / outcome measures for clinical training in psychotherapy in PMHNP programs.

GAP GAP

To be eligible to sit for the ANCC board certification exam, PMHNP students are required to have clinical training (didactic and experiential) in 2 forms of

• psychotherapy. Graduate faculty are challenged to make psychotherapy training

and clinical skill practice available for all their specialty students. Brick & Mortar students: Lack of preceptor therapists Training Institutes Online Students: Diverse geographical areas

ANA Scope of Practice (2014)

Standard 5F. Psychotherapy

The Psychiatric‐Mental Health Advanced Practice Registered Nurse conducts individual, couples, group and family psychotherapy using evidence‐based psychotherapeutic frameworks and nurse‐patient therapeutic relationships.

ANCC

PMHNP Board Certification Exam eligibility requirements:

• Physical assessment, pathophysiology, pharmacology

Content in:

• Health promotion and/or maintenance
• Differential diagnosis and disease management, including the use and

prescription of pharmacologic and nonpharmacologic interventions

AND clinical training in at least two psychotherapeutic treatment modalities. Graduate Programs for Advanced Practice Nurses ‐Our Our Fo Fourth “P “P”

Physical Assessment Pharmacology Pathophysiology

PSYCHOTHERAPY

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 6

Compe Competencies encies fo for Psy Psychotherapists

Generic Therapeutic Competencies ‐

“The competencies needed to relate to people and to carry out any

form of psychological intervention.”

Roth, A. & Piling, S. (2008). Using an evidence‐based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety

• disorders. Behavioral and Cognitive Psychotherapy. 36, 129‐147.

Basic Basic Ther Therapeu eutic tic Comp Competenci encies es

Knowledge and understanding of mental health problems Knowledge of, and ability to operate within professional and ethical guidelines Knowledge of a model of therapy, and the ability to understand and employ the model to practice Ability to engage client Ability to foster and maintain a good therapeutic alliance, and grasp the client’s perspective and “world view” Ability to deal with emotional content of sessions Ability to manage endings Ability to undertake generic assessment (relative history and identifying suitability for intervention) Ability to make use of supervision

Teachi hing ng St Strategy:

To share a successful strategy for providing PMHNP students clinical training in two modalities of psychotherapy in a format delivered to a totally

• nline cohort, a traditional campus based cohort,

and students in a hybrid program with week long on campus immersions.

CB CBT wi with th Child Children & Ado Adolesce cents Gr Group Ther Therapy

An 8 week clinical training module has been developed and delivered that provides knowledge and skill practice for PMHNP students in psychotherapy. The module is competency based ‐ teaches psychotherapy knowledge, skills, and attitudes while providing experience in group psychotherapy and cognitive behavioral psychotherapy with children and adolescents. Data: PMHNP student post clinical training evaluations have been collected and are being analyzed from groups of PMHNP students representing the 6 cohorts.

• Online

COPE Training and online group experience – 7 weeks

• Hybrid

In Person COPE Training and online group experience – 7 weeks

• In Class COPE Training and “brick and mortar” COPE groups with

faculty, face to face Eastern Kentucky University, St. Francis University, University of Arizona University of California, San Francisco, Vanderbilt University

3 Types of Graduate Programs

Presentation of the model we have used to teach psychotherapy with 5 different graduate cohorts – one distance – online presentation only, one in‐ class, in a large city University, and one hybrid program, with in person workshop “immersion” and online group sessions. Competency‐based teaching materials, and student/ training workshop evaluation tools.

• ONLINE
• BRICK & MORTAR
• HYBRID

Basics and Beyond : Primary Text

Beck, J. (2011). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press

APNA 30th Annual Conference Session 4022: October 22, 2016 Lusk 7

7 Sessions: Group Delivery The Clinical Training :

A clinical training experience has been developed and delivered by PMHNP faculty to students in an Online PMHNP program, a traditional

• n Campus University based PMHNP program, and a hybrid online

program with on campus summer immersions. The students received a content based workshop on Cognitive Behavior Therapy (CBT) basics and adaptation of CBT for children and adolescents. The didactic workshop was followed by weekly small group sessions (for 7 weeks) that allowed the students to lead and experience being a member of a therapy group as they learned the process of CBT. We used a CBT 7 session manual for adolescents in the weekly sessions. Student outcomes were measured, and data analyzed for common

• themes. Students in the group sessions,(face‐to‐face and online,

reported that they learned how to do CBT, group process, stages of group psychotherapy and also how CBT is developmentally presented to adolescents and children

The process:

Faculty Role Basics of CBT: Supervised Practice Student Feedback Evaluation Tool: anonymous after 7 sessions of COPE practice Beck CTRS –Cognitive Therapy Rating Scale

Thematic analysis revealed greater understanding of CBT through the simplicity and

• rganization of the COPE sessions. Students also benefited from their peer

interaction and felt safe practicing this new skill in a group atmosphere.

Future directions:

This module can be delivered easily in any PMHNP program and will provide the students with clinical training (active skill development with faculty supervision – as well as didactic/ knowledge) in Group psychotherapy, Cognitive Behavioral Psychotherapy and evidence based psychotherapy for children and adolescents. Re Refere rences:

American Psychiatric Nurses Association. (2014). Psychiatric‐Mental Health Nursing: Scopes and Standards of Practice (2nd Ed. Silver Springs, MD; Nursebooks .org. Beck, J. (2011). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press. Lusk, P. & Melnyk, B.M. (2011). The brief cognitive‐behavioral COPE intervention for depressed adolescents: Outcomes and feasibility of delivery in 30 minute outpatient visits. Journal of the American Psychiatric Nurses Association. 17(3), 226‐236. Lusk, P. & Melnyk, B.M.(2011). COPE for the treatment of depressed adolescents: Lessons learned from implementing an evidence‐based practice change. Journal of the American Psychiatric Nurses

• Association. 17(4), 297‐309.

Melnyk, B. (2013). COPE (Creating Opportunities for Personal Empowerment) for Teens: A 7‐Session Cognitive Behavioral Skills Building Program (3rd edition). Columbus: COPE2Thrive Roth, A. & Piling, S. (2008). Using an evidence‐based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety

• disorders. Behavioral and Cognitive Psychotherapy. 36, 129‐147.

Wheeler, K. (Ed.) (2014). Psychotherapy for the advanced practice psychiatric nurse. New York, NY: Springer.