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This guide provides school nurses with essential information on schizophrenia, including symptoms, theories, and recovery strategies.
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For the Union County School Nurses Association Tom Pyle, January 29, 2015 Schizophrenia, Psych Rehab, & Recovery: Things School Nurses Should Know
What is Schizoprenia?(Torrey, 2006) Personal tragedy... Family calamity... An opportunity?...
295.30 • Positive symptoms • Negative symptoms • Cognitive symptoms
The Experience of Voices https://www.youtube.com/watch?v=yL9UJVtgPZY
Components of “Lived” Experience • Insufficient meds • Overzealous police • Adverse publicity • Foiled interventions • Botched discharges • Abrupt Treatment • State Hospitalization • Differing diagnoses • Exposure to violence • HIPAA barriers
Theories about schizoprenia(torrey, 2006) • Genetic • Neurochemical • Neurotransmitters? (Dopamine, glutamate, 100+ others…) • Neuropeptides (Endorphines…) • Developmental • Infectious • Nutritional • Endocrinal • Stress • Trauma E. Fuller Torrey, M.D.
What is Psychiatric Rehabilitation? Psychiatric Rehabilitation... helps those with psychiatric disabilities... get emotional, social and intellectual skills and supports... to live, love, learn and work... as and where and how they wish... as independently of professional supports as possible... thus to engage, pursue and achieve recovery... as they determine it for themselves.
Who Provides PsyR? Consumer
Where is PsyR? • Programs • Residences • Service support • PACT (Programs of Assertive Community Treatment) • Workplaces • Schools • Hospitals • Families • Self-help Centers
PsyR Evidence-Based Practices(Pratt, Gill, Barrett, & Roberts, 2007) • Illness Management and Recovery • Integrated Dual Disorder Treatment • Assertive Community Treatment • Family Psychoeducation • Supported Employment • Supported Education • Supported Housing • Other “promising” practices Psychiatric Rehabilitation Recovery
Family Education (Lefley, 2009, p. 41) • Premise: diathesis-stress model • Medications • Compliance • Expectancy of change • Stress identification and control • Family issues • Loved one issues • Joint planning Joyce Burland, Ph.D.
Family Psychoeducation (Lucksted et al., 2012) • Individual family • Multifamily • Include consumer • Don’t include consumer • Length • Emphasis William McFarlane, M.D.
Family Consultation (Schmidt & Monaghan, 2012) Intensive Family Support Services
The National Organization Since 1975 Formerly IASPRS Formerly USPRA 8000 members
The State Organization • 1000 members • 30 org members • Leading state chapter • Annual conference • Various trainings • Advocacy work
Recovery Components Issues: “The System” Medicaid’s 3 Big Changes Family Needs; Provider’s Role Violence
Recovery Process: 3 Components Psychiatric Rehabilitation Medical Medical RECOVERY Individual Empowerment time
Recovery: Empowerment Component Individual Empowerment Psychotherapy Peer Groups & Services time
Recovery: Medical Component Psychiatric Rehabilitation Hospitals Doctors Medical Medical RECOVERY Meds Individual Empowerment time
Recovery: Rehabilitation Component Psychiatric Rehabilitation Illness Management & Recovery Supported Housing Supported Education Medical Medical RECOVERY Supported Employment Assertive Community Treatment Family Psychoeducation Individual Empowerment time
The Whole Recovery System Psychiatric Rehabilitation Illness Management & Recovery Supported Housing Hospitals Supported Education Doctors Medical Medical RECOVERY Supported Employment Meds Assertive Community Treatment Family Psychoeducation Individual Empowerment Psychotherapy Peer Groups & Services time
NJ Medicaid’s 3 Big Changes • Reform • “Innovations” • Accountable Care Orgs (ACOs) • “Benchmark” plans • Expansion • 25% increase • Managed care • Behavioral Health Admin Service Org (ASO) • Grant Fee For Service Case Capitated
Affordable Care Act …bringing the biggest change in Medicaid since it began.
NJ’s Comprehensive Waiver Getting it all together
Enrollment & Shares, 2010(Centers for Medicare and Medicaid et al., 2012) ~ 60 mm