Rachael Hovermale DNP APRN Eastern Kentucky University Emerging Adults Moving outside family of origin Opportunities for growth and change Changes have potential for development of personal and emotional problems ID: 193609
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Slide1
Utilization of COPE in the College Population
Rachael Hovermale,
DNP, APRN
Eastern Kentucky University Slide2
Emerging Adults
Moving outside family of origin
Opportunities for growth and change
Changes have potential for development of personal and emotional problemsSlide3
Background
College is a potentially stressful and challenging transition
time
The pressure and freedom lead to co-morbid mental health
issuesOften the physiological age in which many serious mental health disorders emerge
Geller & Greenberg (2010);
Vanheusden
et al. (2008)Slide4
Attrition Rates
32% of students surveyed cited personal/family illness
24% personal or family conflicts
More likely to drop out in first yearNegative implications for leaving college without obtaining degreeSlide5
Young Adult Issues
Stress and depression
are on
the rise among college
students9.7% of college freshmen experienced depressive symptoms10.3% of college students reported serious suicidal thoughtsSlide6
Anxiety
One of the most common reasons students present to student health services
Pressure to succeed and excelSlide7
Depression
The prevalence of Major Depressive Disorder in college age youths is 8.7% which is higher than any other adult age-group. SAMSHA
2013
Depression in young adults is associated with an increased risk of
substance abuse, unemployment, early pregnancy, and educational underachievement. Suicide, the most serious risk of depression, is the 3rd leading cause of death in 14 – 24 year olds and the second leading cause of death among college students. Slide8
Underutilization of Treatment
Five
explanations for the underutilization
Generally healthy and do not seek care regularly
Diminished parental influence and responsibility Inability to recognize symptomsTreatment is historically aimed towards either children or older adultsStigma associated with mental health illness and treatment
Patel et al. (
2007
); Logan & King (2001);
Rickwood et al. (2005); Davis,
(2003); Wilson et al. (
2000); Newman et al.
(
1996) Slide9
Focus on Strength's
Because of their superb cognitive abilities, the
visit provides
a great opportunity for teaching about health/ mental health - common disorders/ contributing factors/etiology/ symptoms/ presentation and course of illness, and evidence based treatment – including
medicationsThey like to research topics on their own and engage in lively discussions about the pros & cons of treatment optionsSlide10
Cognitive Behavioral Therapy
Anxiety and depression respond very well to early intervention and treatment and findings indicate that early treatment significantly decreases the number and severity of recurrent depressive episodes, which have a reoccurrence rate of approximately 60% to 70%.
CBT is an effective first-line treatment for anxiety and depression as well as an effective adjunct to medication. Slide11
College Health Center
Young adults seek treatment for crisis (heavy course load,
homesick, romantic
break up). But also for
PTSD, GAD, mania, or psychosis. Sometimes at the insistence of othersSlide12
Evidence Based Practice
CBT clinically proven to be effective for decreasing anxiety and depressive symptoms
Will it work at Berea College?Slide13
Berea CollegeSlide14
Berea College StudentsSlide15
Campus Health ServicesSlide16
Counseling and Disability Services
3 Mental Health providers
In 2011-12 services for 364 students
86 met criteria for an anxiety disorder76 met criteria for a depressive disorderSlide17Slide18
Creating Opportunities for Personal
Empowerment
COPE Original
Copyright (1990)Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAANP, FAANPlease do not use or copy without permission Disclosure of Possible Conflicts of Interest
Rachael Hovermale has no financial relationships to disclose
Slide19
Creating Opportunity for Personal Empowerment (COPE)
Implement the COPE Young Adult program into the college setting
COPE (Melnyk, 2003)utilizes CBT (cognitive-behavioral therapy) to help promote and improve coping and stress management skills in order to:
Decrease symptoms of anxiety in young adults
Decrease symptoms of depression in young adultsSlide20
COPE
Process
7
Individualized
sessions1. Thinking, Feeling, and Behaving: What is the connection?2. Positive Thinking and Forming Healthy Thinking Habits
3. Coping with Stress
4. Problem Solving & Setting Goals.
5. Dealing with your Emotions in Healthy Ways through
Positive Thinking and Effective Communication 6. Coping with Stressful Situations
7. Pulling it all together for a Healthy
You
Homework assignmentsSlide21
COPE
Outcomes
Change
negative thoughts to
positiveDecrease symptoms of anxiety and depressionSlide22
Procedures
Student
identified by Counseling and Disability
Mental
Health ProvidersAge 18-24Student at Berea CollegeDiagnosis of either a Depressive and/or Anxiety Disorder
Written consent for participation Slide23
Procedures
Pre-intervention
BDI-II and STAI completed
Seven-session COPE Program for Young Adults initiated implemented
Post-intervention BDI-II, STAI, and COPE Program for Young Adults Evaluation completedSlide24
Beck Depression Inventory II
21-item instrument
Measures severity of depressive symptoms in prior two weeks
Cronbach’s
alpha for college students = .93 Cronbach’s alpha for this project:Pre-intervention = .94Post-intervention = .
97
Beck
, A.T., Steer, R.A., & Brown, G.K. (1996
).Slide25
State-Trait Anxiety Inventory
40-item instrument
Measures state and trait anxiety
Overall median alpha coefficients in normative samples:
State anxiety = .92Trait anxiety = .90
Speilberger
, (1983)Slide26
State-Trait Anxiety Inventory
Current Project Cronbach’s alpha reliability coefficients
:
State Anxiety Pre-intervention = .89
Post-intervention = .94Trait AnxietyPre-intervention = .75 Post-intervention = .95Slide27
Participant DescriptionN=10
Demographic
Variables
n
%
Gender
Male
Female
2
8
20
80
Race
Cau
casian
African American
8
2
80
20
Year in
College
Freshman
Sophomore
Junior
Senior
2
2
5
1
20
20
50
10
Diagnosis
Anxiety Disorder
Depressive
Disorder
4
6
40
60Slide28
Comparison of MeansSlide29
Paired t-test for BDI-II
Mean ± SD
t
df
pPre-intervention33.00 ± 14.645.93
9
.0001
Post-intervention11.30 ± 11.66Slide30
Paired t-test for State anxiety
Mean ± SD
t
df
pPre-intervention
60.40 ± 9.17
6.51
9.0001
Post-intervention41.70 ± 11.66Slide31
Paired t-test for Trait anxiety
Mean ± SD
t
df
pPre-intervention65.50 ± 5.89
6.33
9
.0001Post-intervention45.80 ± 11.63Slide32
COPE Program Evaluation
25-item open response instrument
Helpful and changed way of thinking
Worth time and effortSlide33
COPE Evaluation CommentsSlide34
COPE Program Evaluation
“
The COPE program has given me tools to use throughout the rest of my life. I am calmer and more confident and able to see things in a different
light. . .”Slide35
Discussion
Findings
support implementation of
COPE100
% of participants demonstrated improvementWell receivedHelped deal with individual issuesChanged negative thoughts to positive thoughtsSlide36
Limitations
Small sample
size
Lack of diversity in
participantsParticipants were already seeking mental health servicesSlide37
Implications for College Students
COPE intervention is an effective tool utilizing CBT framework : perception of trigger
increase positive thoughts
increase positive behaviors Easily adaptable into freshmen curriculum, making COPE intervention available to all incoming studentsProviding evidenced based programs early into the college setting both as prevention as well as early intervention is ideal. Slide38
S.B.I.R.T.
Screening
Brief
InterventionReferral TreatmentSlide39
Effective and Robust Treatment
COPE – A cognitive behavioral program for busy outpatient
practices
Brief visits - 30 minute medication management visits
7 Sessions in a developmentally appropriate manualShort course of therapyStructured sessions with homeworkUser friendly manual for cliniciansOutcomes measured - decreased anxiety and depressive symptoms with students receiving COPE in the College Health Center.Young adults found the program effective and acceptable Slide40
Conclusion
College is a major transition with unique and specific issues
T
ailored intervention is valuableCOPE program statistically and clinically significant in improving symptoms of anxiety and depression
All students reported changing the way they perceived and managed the triggers for anxiety and depressive symptomsSlide41
Questions?
Are we providing evidenced base care?
Are we offering more than just medications?
What are the barriers to care?Slide42
For further information about the COPE Program please contact:
Bernadette
Mazurek
Melnyk, PhD, CPNP/PMHNP, FAAN,FAANP
Associate Vice President for Health Promotion
University Chief Wellness Officer
Dean and Professor, College of Nursing
Professor of Pediatrics & Psychiatry, College of Medicine
The Ohio State University
Founder, COPE2Thrive
cope.melnyk@gmail.comSlide43
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (text revision) Washington, DC: Author
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory-2nd edition (BDI-II). Retrieved from
http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8018-370
Biji, R.V., & Ravelli, A. (2000). Psychiatric morbidity, service use, and need for care in the general population: Results of The Netherlands Mental Health Survey and Incidence Study. American Journal of Public Health,90, 602-607Davis, M. (2003). Addressing the needs of youth in transition to adulthood. Administration Policy Mental Health, 30, 495-509Geller, L.L., Greenberg, M. (2010). Managing the transition process from high school to college and beyond: Challenges for individuals, families, and society. Social Work in Mental Health,8, 92-116
Geller, L.L., Greenberg, M. (2010). Managing the transition process from high school to college and beyond: Challenges for individuals, families, and society. Social Work in Mental Health,8, 92-116.
Gerdes
, H., & Mallenckrodt, B. (1994). Social network development and functioning during a life transition. Journal of Counseling and Development, 72, 281-287.
Logan, D.E., & King, C.A. (2001). Parental facilitation of adolescent mental health service utilization: A conceptual and empirical review. Clinical Psychology, 8, 319-333.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(3), 226-236
Melnyk, B. (2003). COPE: Creating opportunities for personal empowerment. Instructor Manual
Melnyk, B.M., Jacobson, D.,
O’Haver
, J., Small, L., & Mays, M.Z. (2009). Improving the mental health, healthy lifestyle choices, and physical health of Hispanic adolescents: A randomized controlled pilot study. Journal of School Health,79(12), 575-584Slide44
References
National Center for Higher Education Management Systems (NCHEM) retrieved from http://www.nchems.org/
Patel, V.,
Flisher, A.J.,
Hetrick, S., & McGorry, P. (2007). Mental health of young people: A global public-health challenge. Lancet, 369, 1302-1313.Prancer, S .M., Pratt, M., Hunsberger, B., & Alisat
, S. (2004). Bridging troubled waters: Helping students make the transition from high school to university. Guidance & Counseling, 19(4), 184-190
Pryor, J.H., Eagan, K., Blake, L. P.,
Hurtado, S., Berdan, J., Case, M.C. (2012). The
american freshmen: National norms fall 2012. Cooperative Institutional Research Program at the Higher Education Research Institute at UCLA. Retrieved from:
http://www.heri.ucla.edu/monographs/TheAmericanFreshman2012.pdf
Rickwood
, D., Deane, F.P., Wilson, C.J., &
Ciarrochi
, J. (2005). Young people’s help-seeking for mental health problems. Australian E-Journal for the Advancement of Mental Health, 4 (3), 1-34. Retrieved from: http://www.acceptandchange.com/wp-content/uploads/2011/08/Rickwood_etal_Ciarrochi_AeJAMH_Young_Peoples_Help-seeking_for_Mental_Health_Problems_2005.pdf
Sax,L.J
. (1997). Health trends among college freshmen. Journal of American College Health, 45(6), 252-262. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/9164055
Speilberger
, C.D., (1985). Assessment of state and trait anxiety: Conceptual and methodological issues. The Southern Psychologist, 2(4), 6-16
Speilberger
, C.D., (1983). State-Trait Anxiety Inventory for Adults Manual. Consulting Psychologist Press, Inc. Mind Garden
Inc
Substance Abuse and Mental Health Services
Administration. 12
month prevalence of depression among all US adults by age.
http://
www.nimh.nih.gov/statistics/pdf/NSDUH-data-Depression_Prev_Adults-Age.pdf
Accessed 2014
WHO (2003) The world health report 2003-shaping the future. Retrieved from http://www.who.int/whr/2003/en/
Wilson, C., Raymond, N., Coverdale, J.,
Panapa
, F., &
Panapa
, A. (2000). How mental illness is portrayed in children’s television. The British Journal of Psychiatry, 176. 440-443. Retrieved from http://bjp.rcpsych.org/content/176/5/440.full
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, K., Mulder, C.L., van der
Ende
, J., van
Lenthe
, F.J.,
Mackenbach
, J.P., &
Verhulst
, F.C. (2008). Young adults face major barriers to seeking help from mental health services. Patient Education and Counseling, 73, 97-104.
Yu, J.W., Adams, S.H., Burns, J.,
Brindis
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