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Schizophrenia, Psych Rehab, & Recovery: Things School Nurses Should Know

This guide provides school nurses with essential information on schizophrenia, including symptoms, theories, and recovery strategies.

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Schizophrenia, Psych Rehab, & Recovery: Things School Nurses Should Know

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  1. For the Union County School Nurses Association Tom Pyle, January 29, 2015 Schizophrenia, Psych Rehab, & Recovery: Things School Nurses Should Know

  2. What is Schizoprenia?(Torrey, 2006) Personal tragedy... Family calamity... An opportunity?...

  3. 295.30 • Positive symptoms • Negative symptoms • Cognitive symptoms

  4. Vincent van Gogh, Starry Night, 1889

  5. Marcel Duchamp, Nude Descending a Staircase, 1912

  6. Edward Munch, The Scream, 1895

  7. The Experience of Voices https://www.youtube.com/watch?v=yL9UJVtgPZY

  8. 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

  9. 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.

  10. 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.

  11. Who Provides PsyR? Consumer

  12. Where is PsyR? • Programs • Residences • Service support • PACT (Programs of Assertive Community Treatment) • Workplaces • Schools • Hospitals • Families • Self-help Centers

  13. 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

  14. PsyR“Jersey Strong” Expertise

  15. 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.

  16. Family Psychoeducation (Lucksted et al., 2012) • Individual family • Multifamily • Include consumer • Don’t include consumer • Length • Emphasis William McFarlane, M.D.

  17. Family Consultation (Schmidt & Monaghan, 2012) Intensive Family Support Services

  18. The National Organization Since 1975 Formerly IASPRS Formerly USPRA 8000 members

  19. The State Organization • 1000 members • 30 org members • Leading state chapter • Annual conference • Various trainings • Advocacy work

  20. Recovery Components Issues: “The System” Medicaid’s 3 Big Changes Family Needs; Provider’s Role Violence

  21. Recovery Process: 3 Components Psychiatric Rehabilitation Medical Medical RECOVERY Individual Empowerment time

  22. Recovery: Empowerment Component Individual Empowerment Psychotherapy Peer Groups & Services time

  23. Recovery: Medical Component Psychiatric Rehabilitation Hospitals Doctors Medical Medical RECOVERY Meds Individual Empowerment time

  24. 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

  25. 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

  26. The Common Misperception

  27. 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

  28. Affordable Care Act …bringing the biggest change in Medicaid since it began.

  29. NJ’s Comprehensive Waiver Getting it all together

  30. Enrollment & Shares, 2010(Centers for Medicare and Medicaid et al., 2012) ~ 60 mm

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