EVIDENCE-BASED REHABILITATION INTERVENTIONS FOR ADOLESCENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS – FROM LITERATURE REVIEW TO PRACTICE Kiki Metsäranta,

EVIDENCE-BASED REHABILITATION INTERVENTIONS FORADOLESCENTS WITH

SCHIZOPHRENIA SPECTRUMDISORDERS –

FROM LITERATURE REVIEW TO PRACTICE

Kiki Metsäranta, RN, Nurse Manager

Anna Laine, RN, BHSc

Breaking barriers, The Nordic Conference of Mental Health Nursing

11 – 13 September 2013

10.04.23 [email protected]

SHORT FACTS OF HUS

BACKGROUND

• Adolescent Psychiatry Rehabilitation Unit is under development – from in-patient to out-patient– out patient rehabilitation services have been centralized– for adolescents with psychotic disorders and/or neuropsychiatric problems– impaired functionality

• Need for – evidence-based care methods to improve adolescent psychiatric

rehabilitation– safe and effective treatments


MAIN FOCUS ON DEVELOPING WORK

• We decided to focus on Schizophrenia – one of the most severe mental disorder appearing typically in the late

adolescence or early adulthood. – a chronic disorder – impairing patients social and cognitive functioning– expensive diseases economically and humanely


THE AIMS

1. To do literature review for evidence-based interventions for adolescents with schizophrenia spectrum disorders

2. To find out how this knowledge can be tailored for daily practice in adolescent psychiatric rehabilitation unit


LITERATURE REVIEW

• An electronic search February 2013– CINAHL, Pubmed and PsycINFO

• inclusion criteria– English language– adolescent population – intervention included– diagnosis of schizophrenia spectrum

disorders– empirical research– studies published after the January 1st

2000.10.04.23 [email protected]

RESULTS

• 1032 initially identified abstracts• 166 articles were retrieved • 12 articles were included based to

inclusion criteria.


TARGET GROUP OF INTERVENTION

• 5 individual • 3 integrative – family, patient• 2 in-patient (individual)• 1 family• 1 group intervention


INTERVENTION

• Cognitive rehabilitation therapy (CRT)• Computer- assisted, CARC (based on

CRT)• Cognitive behavioral therapy (CBT)• EPP (Early Psychosis Program)• Intensive community management• Family focused intervention• Telepsychiatry• In- patient treatment – restrain,

holding, seclusion, time-out

INTERVENTION - COGNITIVE


• CRT– training programme– cognitive differentation, attention, memory and social perception– may have a positive effect on cognition and cognitive flexibility

• CBT– focused on the present– time- limited– problem- solving oriented– patients learn specific skills

INTERVENTION - COGNITIVE

• EPP (Calgary Early Psychosis Program)– case management, psychiatric management and medication,

strategies, cognitive-behavior therapy, group therapy and family interventions

INTERVENTION – CASE STUDIES


• Intensive community management – the family's determination to avoid

hospitalization– work of the families concerned– intensive community resources – ready availability of inpatient beds

• Telepsychiatry– interactive sessions by teleconferencing

• Family-focused intervention – community based– family-centered– self-management– group sessions

INTERVENTION- IN-PATIENT


• In - patient treatment – restrain, holding, seclusion, time-out

– high risk group of restrain during inpatient treatment

WHAT WILL CHANGE?


CHOOSING AND IMPLEMENTING NEW INTERVENTIONS

• Cognitive remediation treatment – CRT

• Cognitive behavioral therapy – CBT– Social Cognition and Interaction Training (SCIT)– Acceptance and commintment therapy (ACT)

• Importance of medical treatment – monitoring and motivating• Preventing and minimize risks of relapses and substance abuse

AND THAT WAS NOT ALL /BONUS MATERIAL /

WHAT ELSE?

ENABLERS OF THE DEVELOPMENT PROJECT

• Need for evidence based rehabilitation

• Manager involvement and support

• Importance to improve rehabilitation

• Easy to use

CHALLENGES• Clear implementation plan is needed

– Training– Follow-up– Feedback– Administration´s support

• Resource – Time, support

• Barriers must be verify– Weak collaboration between different professional level– Resistance

WHAT WE HAVE LEARNED

Support from administration is important

Nurses´ professional indentity have increased

We can make improvement if we want it

KIITOS

ÞAKKA ÞÉR

TACK

THANK YOU


EVIDENCE-BASED REHABILITATION INTERVENTIONS FOR ADOLESCENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS – FROM LITERATURE REVIEW TO PRACTICE Kiki Metsäranta,

Documents

inpatient treatment

group intervention

commintment therapy

cognitivebehavior therapy

group therapy

short facts of hus slide

target group of intervention

family interventions