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Utilization of COPE in the College Population
Utilization of COPE in the College Population

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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 Download Presentation

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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 disorderSlide17
Slide18

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

Youth risk behavior surveillance: National college health risk behavior survey. (1997) Surveillance Summaries,46, 1-54

Vanheusden

, 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

, C.D., & Irwin, C.E. (2008). Use of mental health counseling as adolescents become young adults. Journal of Adolescent Health, 43, 268- 276

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