Psychotherapy and Psychogeriatrics by MikeJenny

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									 Psychotherapy and
  Psychogeriatrics

     Bradley E. Karlin, Ph.D.
Director, Psychotherapy Programs

          April 26, 2008
Psychotherapy
    Evidence-Based Psychotherapy
            Dissemination
National initiatives to train MH staff in the
delivery of EBPs for:
  PTSD

      Cognitive Processing Therapy
      Prolonged Exposure Therapy
   Depression
      Cognitive Behavioral Therapy
      Acceptance and Commitment Therapy
   Serious Mental Illness
      Social Skills Training
            Training Model
In-person workshop
   Didactic
   Experiential


Ongoing regular consultation to build
mastery and facilitate implementation

Train-the-trainer component
 Training Workshop Timelines
Initiative   Initial Workshop
  CPT        July 2007
  PE         November 2007
  SST        April 2008
  CBT/ACT    June 2008
         Implementation
Top down + bottom up approach to promote
adoption and sustainability

CPRS templates under development

Roster

Local champions
    Uniform MH Services Package:
    Evidence-Based Psychotherapy

Access and capacity for:
   CPT or PE for PTSD
   CBT/ACT or IPT for depression/anxiety
   SST for SMI
   Other provisions (e.g., Family Psychoeducation,
    Motivational Enhancement, EB psychosocial
    treatments in RRTPs)
   Evidence-based somatic treatments for mental
    and substance disorders

Mental Health Metrics Evidence-Based
Treatments Work Group
                Related Goals
Increase delivery of psychotherapy in VA
   Develop metrics to monitor psychotherapy delivery

Promote bibliotherapy
   Bibliotherapy resource guide

Supplemental EBP training
   e.g., CBT for insomnia

Group therapy training

Suicide prevention
Psychogeriatrics
“Geriatric Mental Health Care Crisis”

Older adults receive MH treatment at very low rates
(Karlin, Duffy, & Gleaves, in press; Karlin & Norris, 2006; Wei et al., 2006)

Older adults unlikely to receive specialty MH
treatment
(Crabb & Hunsley, 2006)

Prevalence of MH problems in older adults expected
to increase over the coming decades
(Gfroerer, Penne, Pemberton, & Folsom, 2003)
          Mental Health Outpatient Unique Patients by Age Groups

350,000

300,000

250,000
                                                                               1990
200,000                                                                        1995
150,000                                                                        1998
                                                                               2000
100,000
                                                                               2001
 50,000                                                                        2002

     0                                                                         2003
           <25   25-34   35-44   45-54   55-64   65-74   75-84   85-94   95+
Home Based Primary Care Mental
       Health Initiative
MH provider funded for each HBPC team (130)
   FT, integral member of HBPC team
   Psychologist on almost all teams

General responsibilities of HBPC MH Provider
   Cognitive and psychological assessment
   Time-limited psychotherapy/psychosocial and
    behavioral medicine services
   Behavior management/caregiver interventions
   Team-focused activities
              Implementation
~70 HBPC MH Providers on board

Opportunities for limited contributions to other geriatrics
settings, after determined 100% commitment not needed

Support/mentorship from MH

VA HBPC MH Provider e-mail group

National conference May 13-16, 2008

HBPC MH Coordinator position being developed

Close collaboration with GEC
Nursing Home Mental Health Initiative

  MH providers in community living centers
  (CLCs), as part of special initiative
      Promote delivery of psychosocial services for
      behavior management

      Facilitate NH culture transformation

  National conference August 2008
        Other Developments
Psychologist part of Palliative Care Consult
Team (part-time)
   new directive
Uniform MH Services Package:
       Older Veterans
Integration of MH services in:
   HBPC
   Community Living Centers
   Palliative Care Consult Teams
   SCI
   Blind Rehab

Capacity for:
   Cognitive screening
   Capacity assessment
   Education and support for family caregivers
         Additional Activities
MH Education Debt Reduction Program
   Significant majority of awards to psychologists


Monitoring of staffing and hiring
          1400
                 1600
                        1800
                               2000
                                      2200
                                             2400
                                                    2600
 FY
     9
 FY 5
     9
 FY 6
     9
 FY 7
     9
 FY 8
     9
 FY 9
     0
 FY 0
     01
 FY
     0
 FY 2
     0
 FY 3
     0
 FY 4
     0
 FY 5
     0
                                                                        FY95-March 08




 FY 6
O 07
  ct
N 07
 ov
D 07
 ec
Ja 07
  n
Fe 08
  b
                                                           VA Psychologists GS11-GS15 by Fiscal Year,




M 08
  ar
     08
       Additional Activities
Development of VA Mental Health Design Guide

Standardization of MH stop code reporting for
MH programs

								
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