1. EVIDENCE-BASED REHABILITATION INTERVENTIONS FOR ADOLESCENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS – FROM LITERATURE REVIEW TO PRACTICE Kiki Metsäranta, RN, Nurse Manager Anna Laine, RN, BHSc Breaking barriers, The Nordic Conference of Mental Health Nursing 11 – 13 September 2013

2. 29.5.2014kiki.metsaranta@hus.fi SHORT FACTS OF HUS

3. BACKGROUND Adolescent Psychiatry Rehabilitation Unit is under development –from in-patient to out-patient –out patient rehabilitation services have been centralized –for adolescents with psychotic disorders and/or neuropsychiatric problems –impaired functionality Need for –evidence-based care methods to improve adolescent psychiatric rehabilitation –safe and effective treatments 29.5.2014kiki.metsaranta@hus.fi

4. MAIN FOCUS ON DEVELOPING WORK We decided to focus on Schizophrenia –one of the most severe mental disorder appearing typically in the late adolescence or early adulthood. –a chronic disorder –impairing patients social and cognitive functioning –expensive diseases economically and humanely 29.5.2014kiki.metsaranta@hus.fi

5. THE AIMS 1.To do literature review for evidence- based interventions for adolescents with schizophrenia spectrum disorders 2.To find out how this knowledge can be tailored for daily practice in adolescent psychiatric rehabilitation unit 29.5.2014kiki.metsaranta@hus.fi

6. LITERATURE REVIEW An electronic search February 2013 –CINAHL, Pubmed and PsycINFO inclusion criteria –English language –adolescent population –intervention included –diagnosis of schizophrenia spectrum disorders –empirical research –studies published after the January 1st 2000. 29.5.2014kiki.metsaranta@hus.fi

7. RESULTS 1032 initially identified abstracts 166 articles were retrieved 12 articles were included based to inclusion criteria. 29.5.2014kiki.metsaranta@hus.fi

8. TARGET GROUP OF INTERVENTION 5 individual 3 integrative – family, patient 2 in-patient (individual) 1 family 1 group intervention 29.5.2014kiki.metsaranta@hus.fi INTERVENTION Cognitive rehabilitation therapy (CRT) Computer- assisted, CARC (based on CRT) Cognitive behavioral therapy (CBT) EPP (Early Psychosis Program) Intensive community management Family focused intervention Telepsychiatry In- patient treatment – restrain, holding, seclusion, time-out

9. INTERVENTION - COGNITIVE 29.5.2014 kiki.metsaranta@hus.fi CRT –training programme –cognitive differentation, attention, memory and social perception –may have a positive effect on cognition and cognitive flexibility CBT –focused on the present –time- limited –problem- solving oriented –patients learn specific skills

10. INTERVENTION - COGNITIVE EPP (Calgary Early Psychosis Program) –case management, psychiatric management and medication, strategies, cognitive-behavior therapy, group therapy and family interventions

11. INTERVENTION – CASE STUDIES 29.5.2014 kiki.metsaranta@hus.fi Intensive community management –the family's determination to avoid hospitalization –work of the families concerned –intensive community resources –ready availability of inpatient beds Telepsychiatry –interactive sessions by teleconferencing Family-focused intervention –community based –family-centered –self-management –group sessions

12. INTERVENTION- IN-PATIENT 29.5.2014 kiki.metsaranta@hus.fi In - patient treatment – restrain, holding, seclusion, time-out –high risk group of restrain during inpatient treatment

13. WHAT WILL CHANGE? 29.5.2014 kiki.metsaranta@hus.fi

14. CHOOSING AND IMPLEMENTING NEW INTERVENTIONS Cognitive remediation treatment – CRT Cognitive behavioral therapy – CBT –Social Cognition and Interaction Training (SCIT) –Acceptance and commintment therapy (ACT)

15. Importance of medical treatment – monitoring and motivating Preventing and minimize risks of relapses and substance abuse AND THAT WAS NOT ALL / BONUS MATERIAL / WHAT ELSE?

16. ENABLERS OF THE DEVELOPMENT PROJECT Need for evidence based rehabilitation Manager involvement and support Importance to improve rehabilitation Easy to use

17. CHALLENGES Clear implementation plan is needed –Training –Follow-up –Feedback –Administration´s support Resource –Time, support Barriers must be verify –Weak collaboration between different professional level –Resistance

18. WHAT WE HAVE LEARNED Support from administration is important Nurses´ professional indentity have increased We can make improvement if we want it

19. KIITOS ÞAKKA ÞÉR TACK THANK YOU 29.5.2014 kiki.metsaranta@hus.fi