Using DSM-5 in Case Formulation

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Using DSM-5 in Case Formulation

Gary G. Gintner, Ph.D., LPC

Louisiana State University

gintner@lsu.edu

 

 

Case Formulation

• Case formulation is a core clinical skill that links assessment information and treatment planning

• It is a hypothesis about the mechanisms that cause and maintain the problem

• It answers the question, “Why is this person, having this type of problem, now?”

 

 

 

DSM-5 Informed Case Formulation Process

Assessment •DSM-5 Enhancements

•DSM-5 Organization

•DSM-5 Background information

Case Formulation

• DSM-5 Criteria Sets

•DSM-5 Background Information

Treatment Planning

•Best practice guidelines are often tied to a diagnosis

• DSM-5 measures to monitor progress

 

 

Fundamental Changes in DSM-5

Dimensional Approach

• The conundrum with categories

• Dimensional concepts:

• Spectrum Disorders

• Severity ratings

• Dimensional assessment tools

Lifespan Perspective

• Lifespan perspective is infused throughout the manual

• More attention to developmental differences in presentation

New Organization

 

• Data-informed reorganization

• Proximity reflects similarity

 

 

DSM-5’s Single Axis System

• There is one diagnostic axis on which all of the following can be coded:

– All mental disorders (formerly on Axis I and II)

– Other Conditions that May be the Focus of Treatment (V-codes; formerly Axis I)

– Medical disorders (formerly Axis III)

 

 

 

 

 

 

 

DSM-5 Tools and Enhancements

• Clinical rating scales

• WHODAS 2.0

• Cultural Formulation Interview

 

 

Clinical Rating Scales

• Rationale for adding: – Measurement-informed care – Dimensional assessment of severity – Assessment of broad range of symptoms – Adjunct to clinical evaluation

• Types – Cross-Cutting Symptom Measures – Disorder-Specific Severity Measures – Disability Measures (WHODAS 2.0) – Personality Inventories – Early Development and Home Background Form

 

 

 

Link to Online Assessment Measures

• Assessment measures can be freely used by clinicians for use with clients

• They can be downloaded at:

http://www.psychiatry.org/practice/dsm/ dsm5/online-assessment-measures

or

www.dsm5.org DSM-5 Online Measures.docx

 

 

 

 

 

 

Cross-Cutting Symptom Measures

• Assesses symptoms across the major domains of psychopathology

• Two types:

– Level 1

– Level 2

• Versions

– Adult self-report

– Parent/guardian-rated version (for children 6-17)

– Youth self-report (11-17)

 

 

 

 

Level 1 Cross-Cutting Symptom Measure

• Description: Adult version measures 13 domains of symptoms DSM-5 level1 assessment.pdf

• Rate each item: – How much or how often “you have you been

bothered by…in the past two weeks.” – 5-point rating scale from 4 (severe, nearly everyday)

to 0 (none or not at all)

• Scoring: Rating of 2 or higher (Mild, several days) should be followed up by further clinical assessment. On items for suicidal ideation, psychosis and substance use, a rating of 1 (Slight) or higher should be used.

 

 

 

Level 2 Assessment Measure

• Description: A brief rating scale for a particular symptom (e.g., anxiety, depression, substance use)

• Indications: When a Level 1 item is rated above the cut-off

• Can be readministered periodically to plot change

• Scoring instructions are available at the site

• DSM-5 Online Measures.docx

 

 

 

 

Disorder-Specific Rating Scales

• Description: Disorder-specific rating scales that correspond to the diagnostic criteria

• Indications: Used to confirm a diagnostic impression, assess severity, and monitor progress

• Versions: Adult, Youth and Clinician rated

• DSM-5 Online Measures.docx

 

 

WHODAS 2.0

• Description: A 36-item measure that assesses disability in adults 18 years and older

• Rating: “How much difficulty have you had doing the following activities in the past 30 days.” Rated 1 (None) to 5 (Extreme or cannot do)

• Scoring: Calculate average score for each domain and overall

• Versions: Adult and proxy-administered • DSM-5 whodas2selfadministered.pdf

 

 

Domains on the WHODAS 2.0

1. Understanding and communicating

2. Getting around

3. Self-care

4. Getting along with people

5. Life activities

6. Participation in society DSM-5 whodas2selfadministered.pdf

 

 

 

Cultural Formulation Interview (CFI)

• Description: A 16-item semistructured interview to assess the impact of culture on key aspects of the clinical presentation and treatment plan

• Indications: Use as part of the initial assessment with any client but is especially indicated when there are significant differences in “cultural, religious or socioeconomic backgrounds of the clinician and the individual”(p. 751).

 

 

 

CFI Domains

• Cultural definition of the problem

• Causes of the problem, stressors and available supports

• Coping efforts and past help-seeking

• Current help-seeking and the clinician- client relationship DSM-5 Cultural Formulation Interview.pdf

 

 

 

Clinical Applications of DSM-5 Enhancements

• During initial assessment: – Administer Level 1 Cross-Cutting Symptom

Measure – Complete intake including social history, mental

status, and diagnostic assessment – Administer Level 2 measures as needed – WHODAS 2.0 can be administered as indicated – Use aspects of the CFI interview throughout

• Follow-up sessions – Administer disorder-specific measures – Re-administer periodically to assess progress

 

 

DSM-5 and Case Formulation

• Biopsychosocial model in case formulation

• The Five P’s of Case Formulations

• Doing a case formulation using DSM-5

 

 

Biopsychosocial Model in Case Formulation

Case Formulation

Biological Factors

Psychological Factors

Sociocultural

Factors

 

 

The Five P’s of Case Formulation (Macneil et al., 2012)

• Presenting problem – What is the client’s problem list? – What are DSM diagnoses?

• Predisposing factors – Over the person’s lifetime, what factors contributed to the development

of the problem? – Think biopsychosocial

• Precipitants – Why now? – What are triggers or events that exacerbated the problem?

• Perpetuating factors – What factors are likely to maintain the problem? – Are there issues that the problem will worsen, if not addressed

• Protective/positive factors – What are client strengths that can be drawn upon? – Are there any social supports or community resources ?

 

 

 

The Five P’s in DSM-5 • Diagnostic criteria

– Disorder-specific criteria set (Presenting Problem) – Subtypes and specifiers (Presenting Problem)

• Explanatory text information – Diagnostic features (Presenting Problem) – Associated features (Presenting Problem) – Prevalence (Presenting Problem) – Development and course (Predisposing, Perpetuating and

Protective Factors) – Risk and prognostic factors (Predisposing, Perpetuating

Protective Factors) – Culture-related diagnostic issues (5 P’s) – Gender-related diagnostic issues (5 P’s) – Suicide risk (Presenting Problem) – Functional consequences (Perpetuating Factors) – Differential diagnosis (Presenting Problem) – Comorbidity (Presenting Problem and Perpetuating Factors)

 

 

Case of Helen

Helen was fired from her job one month ago because she started making numerous mistakes and had trouble concentrating. About three months ago she started feeling “down“ after a break-up with a man she had been dating for a few months. She has trouble falling asleep and has noticed a significant decline in her appetite. She feels like a failure and believes that no one will want to hire her again.

 

 

Helen Continued

She has thoughts of committing suicide but admits, “I could never do it.” The only thing that seems to help is when she participates in a bible-reading group every Tuesday night. She explains, “During that time I’m more like my old self and at least that night I can sleep.” She also reports that her mood improves when she visits her friends. However, she reports such low energy throughout the day that she is unable to schedule a job interview.

 

 

Helen Continued

She had a similar episode about two years ago after she was laid off from her former job. She reports that it took four months before she began feeling “normal” again and positive about herself.

Her history indicates that her mother had severe depression and was hospitalized on several occasions when Helen was young. She describes her as “negative” and often absent in her youth. However, Helen always did well in school and had an active social life. Her work history has been very consistent up to her lay off.

 

 

 

 

Diagnostic Work-Up • DSM-5 measures:

– Level 1(positive for depression, sleep problems and avoiding certain events)

– PHQ-9, Score = 20 (Severe) – WHODAS 2.0

• General Disability Score = 85 (2.36; Mild) • Subscale: Life activities = 14 (3.5; Moderate) • Subscale: Participation in Society = 28 ( 3.5;

Moderate) • Differential diagnosis: What are the possibilities? • Diagnostic Impression: 296.33 Major Depressive Disorder, recurrent, severe severity V62.29 Other Problems related to employment

 

 

 

Case Formulation • Why is she so depressed?

– Predisposing factors?

– Precipitating factors?

– Perpetuating factors?

– Positive or protective factors?

• How does the diagnosis and case formulation inform your treatment plan?

 

 

Guide to Case Formulation

1. State the problem or diagnostic impression.

2. State the precipitant

3. Describe critical predisposing factors

4. Include a statement about perpetuating or maintaining factors

5. Highlight protective and positive qualities

 

 

Write a Case Formulation

Helen presents with……(1) which appears to be precipitated by…..(2). Factors that seem to have predisposed her to depression include….(3). The current problem is maintained by….(4). However, her protective and positive factors include….(5).

 

 

From Formulation to Treatment

• How does the formulation inform the treatment plan? – Best practices for this disorder?

– Which types of interventions will address the predisposing, precipitating and perpetuating factors?

– How do you ensure that diversity factors are considered?

– How do you tailor treatments so that they are more strength-based?

 

 

Final Thoughts…

• Begin using DSM-5 enhancements

• DSM-5 can help you identify the five P’s

• Case formulation is a skill and has been tied to better outcome

 

 

 

 

References American Psychiatric Association. (2014). Online assessment measures. Retrieved from

http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures.

American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental

disorders (5th ed.). Washington DC: American Psychiatric Association.

American Psychiatric Association. (2010). Practice guidelines for the treatment of major

depressive disorder, third edition [Supplement]. American Journal of Psychiatry. 167(10).

doi:10.1176/appi.books.9780890423387.654001

Craighead, W. E., Miklowitz, D. J, & Craighead, L. W. (2013). Psychopathology: History, diagnosis,

and empirical Foundations. Hoboken, NJ: Wiley.

Frank, R. I., & Davidson, J. (2014). The transdiagnostic road map to case formulation and

treatment planning. Oakland, CA: New Harbinger Publications.

Gintner, G. G. (In press). DSM-5 conceptual changes: Innovations, limitations and clinical

implications. The Professional Counselor.

Gintner, G. G. (2008). Treatment planning guidelines for children and adolescents. In R.R. Erk

(Eds.), Counseling treatments for children and adolescents with DSM-IV-TR mental disorders

(pp.344-380). Upper Saddle River, NJ: Prentice Hall Publishing.

Macneil, C. A., Hasty, K., K, Conus, P., & Berk, M. (2012). Is diagnosis enough to guide treatment

interventions in mental health? Using case formulation in clinical practice. BMC Medicine,

10, 111. doi:10.1186/1741-7015-10-111

In this assignment, you are required to evaluate Patient Experience Measurement Program in Saudi Arabia. 

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In this assignment, you are required to evaluate Patient Experience Measurement Program in Saudi Arabia. 

– you are required to apply the program evaluation processes in analyzing this program.

Note*: CDC’s Framework for Program Evaluation in Public Health has six connected steps that can be used as a starting point to tailor an evaluation for a particular public health effort at a particular point in time. It also has a set of standards that can be used to assess the overall quality of evaluation activities.

Step: 

1. Engage Stakeholders: Engage stakeholders, including those involved in program operations; those served or affected by the program; and primary users of the evaluation.

2. Describe the Program: Describe the program, including the need, expected effects, activities, resources, stage, context, and logic model.

3. Focus on the Evaluation Design: Focus on the evaluation design to assess the issues of greatest concern to stakeholders while using time and resources as efficiently as possible. Consider the purpose, users, uses, questions, methods, and agreements.

4. Gather Credible Evidence: Gather credible evidence to strengthen evaluation judgments and the recommendations that follow. These aspects of evidence gathering typically affect perceptions of credibility: indicators, sources, quality, quantity, and logistics.

5. Justify Conclusions: Justify conclusions by linking them to the evidence gathered and judging them against agreed-upon values or standards set by the stakeholders. Justify conclusions on the basis of evidence using these five elements: standards, analysis/synthesis, interpretation, judgment, and recommendations.

6. Ensure the Use and Share Lessons Learned: with these steps: design, preparation, feedback, follow-up, and dissemination. For additional details, see Ensuring Use and Sharing Lessons Learned as well as a checklist of items to consider when developing evaluation reports.

–Standards:

Utility standards ensure that an evaluation will serve the information needs of intended users.

Feasibility standards ensure that an evaluation will be realistic, prudent, diplomatic, and frugal.

Propriety standards ensure that an evaluation will be conducted legally, ethically, and with due regard for the welfare of those involved in the evaluation, as well as those affected by its results.

Accuracy standards ensure that an evaluation will reveal and convey technically adequate information about the features that determine the worth or merit of the program being evaluated.

– you are required to apply various feasible program Evaluation tools and techniques to analyze and interpret the contingency.

– you are required to interpret and discuss comprehensively the findings (ACTUAL) as compared with the theoretical information (literature).

In the Asian culture, there is often a belief that terminally ill patients should not be informed about their prognosis.

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In the Asian culture, there is often a belief that terminally ill patients should not be informed about their prognosis. Would you respect the cultural practice and not inform a patient about the prognosis? Is there a way for health care providers to balance the patient’s right to know with respect for the cultural practices and beliefs of the family? Is not fully disclosing information to the patient an ethical breach?

CLINICAL PRACTICE

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1 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

CASE EXAMPLE

Jill, a 32-year-old Afghanistan War Veteran This case example explains how Jill’s therapist used a cognitive worksheet as a starting point for engaging in Socratic dialogue.

This is a case example for the treatment of PTSD using Cognitive Behavioral Therapy. Cognitive Behavioral Therapy is strongly recommended by the APA Clinical Practice Guideline for the Treatment of PTSD.

Jill, a 32-year-old Afghanistan war veteran, had been experiencing PTSD symptoms for over 5 years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED) while driving a combat supply truck. Over the years, Jill became increasingly depressed and began using alcohol on a daily basis to help assuage her PTSD symptoms. She had difficulties in her employment, missing many days of work, and she reported feeling disconnected and numb around her husband and children. In addition to a range of other PTSD symptoms, Jill had a recurring nightmare of the event in which she was the leader of a convoy and her lead truck broke down. She waved the second truck forward, the truck that hit the IED, while she and her fellow service members on the first truck worked feverishly to repair it. Consistent with the traumatic event, her nightmare included images of her and the service members on the first truck smiling and waving at those on the second truck, and the service members on the second truck making fun of the broken truck and their efforts to fix it — “Look at that piece of junk truck — good luck getting that clunker fixed.”

After a thorough assessment of her PTSD and comorbid symptoms, psychoeducation about PTSD symptoms, and a rationale for using trauma focused cognitive interventions, Jill received 10 sessions of cognitive therapy for PTSD. She was first assigned cognitive worksheets to begin self-monitoring events, her thoughts about these events, and consequent feelings. These worksheets were used to sensitize Jill to the types of cognitions that she was having about current day events and to appraisals that she had about the explosion. For example, one of the thoughts she recorded related to the explosion was, “I should have had them wait and not had them go on.” She recorded her related feeling to be guilt. Jill’s therapist used this worksheet as a starting point for engaging in Socratic dialogue, as shown in the following example:

Therapist: Jill, do you mind if I ask you a few questions about this thought that you noticed, “I should have had them wait and not had them go on?”

Client: Sure.

Therapist: Can you tell me what the protocol tells you to do in a situation in which a truck breaks down during a convoy?

Client: You want to get the truck repaired as soon as possible, because the point of a convoy is to keep the trucks moving so that you aren’t sitting ducks.

Therapist: The truck that broke down was the lead truck that you were on. What is the protocol in that case?

 

 

2 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

Client: The protocol says to wave the other trucks through and keep them moving so that you don’t have multiple trucks just sitting there together more vulnerable.

Therapist: Okay. That’s helpful for me to understand. In light of the protocol you just described and the reasons for it, why do you think you should have had the second truck wait and not had them go on?

Client: If I hadn’t have waved them through and told them to carry on, this wouldn’t have happened. It is my fault that they died. (Begins to cry)

Therapist: (Pause) It is certainly sad that they died. (Pause) However, I want us to think through the idea that you should have had them wait and not had them go on, and consequently that it was your fault. (Pause) If you think back about what you knew at the time — not what you know now 5 years after the outcome — did you see anything that looked like a possible explosive device when you were scanning the road as the original lead truck?

Client: No. Prior to the truck breaking down, there was nothing that we noticed. It was an area of Iraq that could be dangerous, but there hadn’t been much insurgent activity in the days and weeks prior to it happening.

Therapist: Okay. So, prior to the explosion, you hadn’t seen anything suspicious.

Client: No.

Therapist: When the second truck took over as the lead truck, what was their responsibility and what was your responsibility at that point?

Client: The next truck that Mike and my other friends were on essentially became the lead truck, and I was responsible for trying to get my truck moving again so that we weren’t in danger.

Therapist: Okay. In that scenario then, would it be Mike and the others’ jobs to be scanning the environment ahead for potential dangers?

Client: Yes, but I should have been able to see and warn them.

Therapist: Before we determine that, how far ahead of you were Mike and the others when the explosion occurred?

Client: Oh (pause), probably 200 yards?

Therapist: 200 yards—that’s two football fields’ worth of distance, right?

Client: Right.

Therapist: You’ll have to educate me. Are there explosive devices that you wouldn’t be able to detect 200 yards ahead?

Client: Absolutely.

Therapist: How about explosive devices that you might not see 10 yards ahead?

Client: Sure. If they are really good, you wouldn’t see them at all.

 

 

3 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

Therapist: So, in light of the facts that you didn’t see anything at the time when you waved them through at 200 yards behind and that they obviously didn’t see anything 10 yards ahead before they hit the explosion, and that protocol would call for you preventing another danger of being sitting ducks, help me understand why you wouldn’t have waved them through at that time? Again, based on what you knew at the time?

Client: (Quietly) I hadn’t thought about the fact that Mike and the others obviously didn’t see the device at 10 yards, as you say, or they would have probably done something else. (Pause) Also, when you say that we were trying to prevent another danger at the time of being “sitting ducks,” it makes me feel better about waving them through.

Therapist: Can you describe the type of emotion you have when you say, “It makes me feel better?”

Client: I guess I feel less guilty.

Therapist: That makes sense to me. As we go back and more accurately see the reality of what was really going on at the time of this explosion, it is important to notice that it makes you feel better emotionally. (Pause) In fact, I was wondering if you had ever considered that, in this situation, you actually did exactly what you were supposed to do and that something worse could have happened had you chosen to make them wait?

Client: No. I haven’t thought about that.

Therapist: Obviously this was an area that insurgents were active in if they were planting explosives. Is it possible that it could have gone down worse had you chosen not to follow protocol and send them through?

Client: Hmmm. I hadn’t thought about that either.

Therapist: That’s okay. Many people don’t think through what could have happened if they had chosen an alternative course of action at the time or they assume that there would have only been positive outcomes if they had done something different. I call it “happily ever after” thinking — assuming that a different action would have resulted in a positive outcome. (Pause) When you think, “I did a good job following protocol in a stressful situation that may have prevented more harm from happening,” how does that make you feel?

Client: It definitely makes me feel less guilty.

Therapist: I’m wondering if there is any pride that you might feel?

Client: Hmmm…I don’t know if I can go that far.

Therapist: What do you mean?

Client: It seems wrong to feel pride when my friends died.

Therapist: Is it possible to feel both pride and sadness in this situation? (Pause) Do you think Mike would hold it against you for feeling pride, as well as sadness for his and others’ losses?

Client: Mike wouldn’t hold it against me. In fact, he’d probably reassure me that I did a good job.

Therapist: (Pause) That seems really important for you to remember. It may be helpful to remind yourself of what you have discovered today, because you have some habits in thinking about this event in a particular way. We are also going to be doing some practice assignments [Challenging Questions Worksheets] that will help to walk you through your thoughts about what happened during this event, help you to remember what you knew at the time, and remind you how different thoughts can result in different feelings about what happened.

 

 

4 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

Client: I actually feel a bit better after this conversation.

Another thought that Jill described in relation to the traumatic event was, “I should have seen the explosion was going to happen to prevent my friends from dying.” Her related feelings were guilt and self-directed anger. The therapist used this thought to introduce the cognitive intervention of “challenging thoughts” and provided a worksheet for practice. The therapist first provided education about the different types of thinking errors, including habitual thinking, all-or-none thinking, taking things out of context, overestimating probabilities, and emotional reasoning, as well as discussing other important factors, such as gathering evidence for and against the thought, evaluating the source of the information, and focusing on irrelevant factors.

More specifically, Jill noted that she experienced 100 percent intensity of guilt and 75 percent intensity of anger at herself in relation to the thought “I should have seen the explosive device to prevent my friends from dying.” She posed several challenging questions, including the notion that improvised explosive devices are meant to be concealed, that she is the source of the information (because others don’t blame her), and that her feelings are not based on facts (i.e., she feels guilt and therefore must be guilty). She came up with the alternative thought, “The best explosive devices aren’t seen and Mike (driver of the second truck) was a good soldier. If he saw something he would stopped or tried to evade it,” which she rated as 90 percent confidence in believing. She consequently believed her original thought 10 percent, and re-rated her emotions as only 10 percent guilt and 5 percent anger at self.

REPRINTED WITH PERMISSION

Treating PTSD with cognitive-behavioral therapies: Interventions that work This case example is reprinted with permission from: Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive- behavioral therapies: Interventions that work. Washington, DC: American Psychological Association

What is your vision for the future of nursing?

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What is your vision for the future of nursing? How does your vision fit with the recommendations in the IOM report? What two action steps do you plan to take to promote this vision?

Review the case study and answer the following questions.

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Review the case study and answer the following questions.

Case Study: Jimmy, ten years old, was admitted to the pediatric intensive care unit after a fall from the second-story townhome were sustained a fractured left femur and mild head injury. Currently, Jimmy is two days post open reduction internal fixation of the left femur. Orders were updated to transfer Jimmy out of Intensive Care Unit (ICU) after being cleared by the neurologist. He has a long leg cast, indwelling foley catheter and will require neuro checks every two hours.

  • What are two priority nursing diagnoses for this child?
  • What are the priority nursing interventions for this patient after being transferred from the ICU?
  • What are the risks of foley catheter placement?
  • Does the patient still require an indwelling foley catheter? Provide a rationale to support your answer.

At least 120 words in total. Thank you

Assignment: Final Paper: Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem

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Assignment: Final Paper: Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem

Throughout this course, you have been applying an epidemiological approach to analyze a population health problem. In previous weeks, you have developed distinct sections of your paper; it is now time to finalize and submit a cohesive, polished version of work. This paper serves as your Major Assessment for this course and must be uploaded by Day 3of this week.

To prepare:

· Finish incorporating any feedback from the submitted sections of your paper.

To complete:

Write a 12- to 15-page paper that includes the following:

Section 1: The Problem

· A brief outline of the environment you selected (i.e., home, workplace, school)

· A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)

· Research question/hypothesis

Section 2: Research Methods

· The epidemiologic study design you would use to assess and address your population health problem

· Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)

· Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)

Section 3: The Intervention

· An outline of an intervention you would implement to address the population health problem with your selected population based on the results of the study in Section 2 (Note: If you selected a descriptive study design, you are still required to outline an intervention that might be developed based on future research.)

· A review of the literature that supports this intervention

Section 4: The Impact

· An explanation of the health outcome you would be seeking and the social impact of solving this issue

Section 5: Evaluation

· An evaluation plan based upon the health outcome that you have chosen and your anticipated results

Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in- text citations and reference list are correct.

By Day 3

Submit your Major Assessment paper.

Factors That Impact Population Health

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Discussion 2: Factors That Impact Population Health

In this Discussion, you bring together the concepts that have been presented throughout this course by analyzing a current population health topic from an epidemiological approach. Consider the cultural, ethical, regulatory, and legal factors that may influence your selected topic.

To prepare:

· Review the case study, presented on page 288 of your course text, Population Health: Creating a Culture of Wellness. Consider the cultural, ethical, and legal factors presented in the case study and how they influence the Michigan Primary Care Transformation Project.

· With these thoughts in mind, select a current public health initiative that has been discussed in the popular press or available at the CDC website or your state’s health department website.

· Consider this initiative through the lens of an epidemiologist, and identify what you think are the three most important issues related to culture, ethics, regulatory, or legal aspects of the public health initiative.

· Consider how current health care legislation might impact your selected public health initiative. Conduct additional research as necessary.

By Day 4

Post a cohesive response that addresses the following:

· Provide a summary of your selected public health initiative, and include a reference to the article (and URL to the article, if possible).

· Analyze the cultural, ethical, regulatory, and legal factors that influence your specified population health topic.

· Evaluate how current health care legislation may positively or negatively impact your selected public health initiative.

Write 1.5 page and cite at least 3 sources

 

Chronic Disease Management: Mortality and Morbidity

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Week 10: Chronic Disease Management: Mortality and Morbidity

The management of chronic disease poses a significant health care challenge in the United States and elsewhere. By the year 2030, chronic disease will cost the world over 47 trillion dollars annually (Bloom, et al, 2011; Jaslow, 2011). As noted in Week 6, many of the factors that contribute to chronic illness—such as poor diet, lack of activity, drug and alcohol use, and smoking—are lifestyle choices. Consider, for instance, diabetes: the significant increase in prevalence from 1980 to 2007 is explainable almost entirely by lifestyle choices. Most adults report having the condition long term, and the direct and indirect costs associated with it are substantial (Nash, Reifsnyder, Fabius, and Pracilio, 2011).

As a nurse leader, what opportunities do you see for reducing morbidity and mortality—and, ultimately, for diminishing the tremendous personal and societal costs—related to chronic disease?

You have explored many of the facets of epidemiology throughout this course; this week, you will examine the study of chronic disease. You will investigate models and frameworks for managing chronic disease, as well as how the challenges of managing chronic disease inhibit the delivery of quality health care.

Learning Objectives

Students will:

· Analyze a chronic disease model and its relationship to a chronic disease

· Evaluate current challenges in delivering effective quality health care as it relates to chronic disease management

 

Learning Resources

Required Readings

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Structure, systems, and stakeholders. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
In Chapter 4 the current structure of the United States health system and the influence on population health is discussed. Stakeholders are identified, and the relationships between the structure, system and stakeholders is  explored.

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Coordinated care delivery models. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

Chapter 12 examines the influence of accountable care organizations and ambulatory care organizations on the current health care delivery system. Examples of successful organizations are explored.

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Developing the workforce to enhance population health. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

In Chapter 7 the authors address the social determinants driving population health. The strategies needed to develop a workforce that will be able to support current population health strategies is discussed.

Dossey, B. M., Rosa, W. E., & Beck, D.-M. (2019). Nursing and the sustainable development goals: From Nightingale to now. AJN American Journal of Nursing, 119(5), 44–49. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NAJ.0000557912.35398.8f

Easley, C., Petersen, R., & Holmes, M. (2010). The health and economic burden of chronic diseases in North Carolina. North Carolina Medical Journal, 71(1), 92-95.

This short reading presents an analysis of the economic effects of selected chronic diseases resulting in increased hospitalization, with a focus on behaviors that may be changed to prevent these diseases.

Kim, T. W., Saitz, R., Cheng, D. M., Winter, M. R., Witas, J., & Samet, J. H. (2011). Initiation and engagement in chronic disease management care for substance dependence. Drug & Alcohol Dependence, 115(1-2), 80-86.

This article presents a study on treating substance abuse as a chronic disease. The authors discuss challenges to treatment options and propose methods for more appropriately managing treatment for substance dependence as a chronic illness.

Tenforde, M., Jain, A., & Hickner, J. (2011). The value of personal health records for chronic disease management: What do we know? Family Medicine, 43(5), 351–354.

This reading examines evidence related to the value of electronic personal health records (PHRs), noting that additional research is needed to evaluate this for chronic disease management.

United Nations. (2011, September 19). Non-communicable diseases deemed development challenge of ‘epidemic proportions’ in political declaration adopted during landmark general assembly summit. Retrieved from http://www.un.org/News/Press/docs/2011/ga11138.doc.htm

 

The United Nations met in September 2011 to collaborate on global plans to address the control and prevention of chronic diseases. This report from the general assembly notes the high cost of not managing chronic disease worldwide.

 

Yale School of Public Health. (2012). Chronic disease epidemiology. Retrieved from http://publichealth.yale.edu/cde/index.aspx

 

Yale School of Public Health sponsors this site. Explore the information presented on addressing chronic disease through epidemiology.

 

Florida Department of Health. (n.d.). Bureause of epidemiology: Surveillance and investigation guidance. Retrieved March 5, 2012, from http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/surveillance-and-investigation-guidance/index.html

 

This Florida-based agency monitors chronic disease conditions in Florida’s population using a variety of population-based surveillance systems.

 

World Health Organization. (2012). Chronic diseases and health promotion: Integrated chronic disease prevention and control. Retrieved from http://www.who.int/chp/about/integrated_cd/en/

The World Health Organization monitors chronic diseases worldwide. This website provides an overview of their programs, monitoring efforts, and activities they engage in to reduce the incidence of chronic disease globally.

 

 

Discussion: Addressing Chronic Disease

According to the Population Health course text, “Roughly 40 million Americans are still uninsured and 112 million Americans (almost half of the U.S. population, 45%) suffer from at least one chronic condition in the United States, an estimated 125 million persons have at least one chronic condition, and half of these persons have multiple chronic conditions” (Nash, Skoufalos, Fabius, and Oglesby,  2021, p. 5 ).

This week’s Learning Resources examine numerous health problems that result in a need for ongoing care. As you have explored this week, many costs are associated with chronic disease—both in terms of lives lost and socioeconomic burden. What can be done to help reduce chronic disease at the population level?

For this Discussion, you will take an in-depth look at chronic disease, and you will evaluate ways to address this issue through the application of chronic disease models and frameworks. In addition, you will consider the impact of the challenges of managing chronic disease on quality of care delivery.

To prepare:

· Review the application of chronic disease models as a method for managing chronic diseases at the population level.

· Consider characteristics of chronic disease models and how to apply them as presented in the Learning Resources.

· Consult The Chronic Care Model (Figure 1–1 (p. 9) in Population Health: Creating a Culture of Wellness, and consider examples of determinants and outcomes of population health with chronic diseases in a specific subpopulation. Then, select one chronic disease on which to focus for this Discussion.

· Ask yourself, “What are the challenges of managing this chronic disease? How do these challenges limit the ability to deliver effective quality care?” Conduct additional research using the Walden Library and credible websites as necessary.

By Day 3

Post a cohesive scholarly response that addresses the following:

· Identify your selected chronic disease.

· Describe the application of a chronic disease model to address this disease at the population level. Include your rationale for selecting this particular model.

· Discuss one or more current challenges related to the management of the chronic disease, and explain how these challenges limit the ability to deliver effective quality care.

1.5 pages in APA and cite at least 3 sources

 

Assignment: Major Assessment 7: Using an Epidemiological Approach to Critically Analyze a Population Health Problem

Continue improving upon your paper, paying careful consideration to the feedback you have received on the drafts you have submitted in previous weeks. Your Final Paper will be due by Day 3 of next week.

 

Week in Review

This week, you analyzed a chronic disease model and its relationship to a chronic disease and evaluated current challenges in delivering effective quality health care related to chronic disease management.

In the final week, you will consider emergency preparedness and disaster management strategies and how these strategies are used to cope with disasters.

To go to the next week:

Week 11

More sources

https://www.who.int/home/cms-decommissioning

https://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/index.html

https://journals.lww.com/ajnonline/Fulltext/2019/05000/Nursing_and_the_Sustainable_Development_Goals_.27.aspx

Week 11: Practical Application of Epidemiological Interventions in Settings and Populations

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Week 11: Practical Application of Epidemiological Interventions in Settings and Populations

Most people can recall where they were and what they were doing on the morning of September 11, 2001, when terrorists flew two airplanes into the Twin Towers. One week after that attack, anthrax was sent through the U.S. Postal Service to news media offices and politicians. In addition to these human-made emergencies, notable natural disasters have also occurred: the tsunami in Japan, a large earthquake in Haiti, tornadoes throughout the central United States, wildfires in California and Texas, flooding in the Northeast, etc. Out of all these disasters, many heroic stories unfolded as cities quickly responded to the needs of the citizens. For example, the New York Visiting Nurses Association had over 1,400 patients in the lower Manhattan area affected by the September 11th terrorist attacks. Within 3 days, they had tracked down each of their patients either in shelters or in the homes of family members.

In this final week of the course, you will consider emergency preparedness and disaster management strategies, and you will evaluate how these strategies are used to cope with disasters. In doing so, you will look through the lens of the epidemiologist and consider interventions for settings and populations. Additionally, you will be asked to synthesize your learning as you explore a case study on ethics and population health. You will also consider the effect of health care reform on a selected population health issue.

Learning Objectives

Students will:

· Analyze epidemiological considerations resulting from natural or human-made disasters

· Apply an epidemiological methods in a community-based or clinical setting to effectively address a population’s needs

· Analyze the impact of culture, ethics, regulatory, and legal issues on population health

· Evaluate the effects of health care reform as it relates to a selected population health initiative

 

Learning Resources

Required Readings

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). On the path to health equity. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

Chapter 3  addresses non-biomedical influences on health that impact health equity. This chapter is explored in four sections: (a) meaning of health equity, (b) issues of racism and discrimination, (c) cultural competency, and (d) achieving health equity. The authors ask the reader to consider how current efforts to the address social determinants of health may be applied to your workplace.

Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H.  (2021). Policy and advocacy. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.

Chapter 13  discusses the role that public policy and advocacy play  in promoting and adapting public health initiatives and policies. Key players at the national level are identified. A common form of advocacy, lobbying is introduced. A vignette describing a successful coalition was described.

Levin, A. B., Bernier, M. L., Riggs, B. J., Zero, S. D., Johnson, E. D., Brant, K. N., Dwyer, J. G., Potter, C. J., Pustavoitau, A., Lentz, T. A., Jr, Warren, E. H., Milstone, A. M., & Schwartz, J. M. (2020). Transforming a PICU into an adult ICU during the Coronavirus disease 2019 pandemic: Meeting multiple needs. Critical Care Explorations, 2(9), e0201. https://doi-org/10.1097/CCE.0000000000000201

Sprung, C. L., Cohen, R., & Adini, B. (2010). Chapter 1. Introduction. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Medicine, 36(Supplement 1). S4-10

This reading describes the efforts put forth as a result of a task force established by the European Society of Intensive Care Medicine in December 2007. The chapter examines the purpose and development of standard operating procedures (SOPs) to better address population needs during an infectious disease breakout or disaster.

Richards, G. A., & Sprung, C. L. (2010). Chapter 9. Educational process. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Medicine, 36(Supplement 1), S70–S79.

As noted in this chapter, planning and education are imperative to adequately prepare intensive care units (ICUs) and hospitals for an influenza pandemic or mass disaster. The authors provide standard operating procedures (SOPs) and recommendations.

Veenema, T. G., Deruggiero, K., Losinski, S., & Barnett, D. (2017). Hospital administration and nursing leadership in disasters. Nursing Administration Quarterly, 41(2), 151-163. doi: 10.1097/NAQ.0000000000000224.

Wu, X., Zheng, S., Huang, J., Zheng, Z., Xu, M., & Zhou, Y. (2020). Contingency nursing management in designated hospitals during COVID-19 outbreak. Annals of Global Health, 86(1), 70. https://doi-org.ezp.waldenulibrary.org/10.5334/aogh.2918

Federal Emergency Management Agency. (2011). Retrieved from http://www.fema.gov/

Explore the Federal Emergency Management Agency website, whose mission is to “support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.”

 

Required Media

Laureate Education (Producer). (2012). Epidemiology and population health: Population health issues, part 1 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 6 minutes.

In part 1 of this week’s media, the presenters discuss how epidemiology can be utilized to improve population health.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Laureate Education (Producer). (2012). Epidemiology and population health: Population health issues, part 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

In part 2, Dr. Hull discusses lessons learned from global efforts to eradicate polio.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

The following document provides credit for Laureate-produced media within this course: Credits (PDF)

More Sources

https://www.fema.gov

https://doaj.org/article/3fee75604bff4bf59cb1005ce49a0ef1?

https://pubmed.ncbi.nlm.nih.gov/32984831/

Discussion 1: Applied Epidemiology

On September 11, 2001, terrorist attacks created a grave disaster that included the destruction of the World Trade Center in New York. The day after 9/11, epidemiologists were asked to assess the environment around Ground Zero for potential hazards that might put those engaged in rescue and recovery at risk of harm. Beside the dust, what toxins might be in the air? Was the air quality safe or should rescue workers wear canister respirators or particle masks? What other protections might be necessary in the days following the disaster?

In this Discussion, you will look at the impact of a disaster through the lens of an epidemiologist, addressing such questions as, “What epidemiological considerations arise in the wake of a disaster? And, what makes disaster planning or emergency preparedness effective in terms of mitigating or preventing negative aftereffects?”

To prepare:

· Identify a disaster that led to a population health issue. Consider this disaster through the lens of an epidemiologist, using the information presented in the Learning Resources to examine the epidemiological considerations resulting from the disaster. Conduct additional research as necessary using the Walden Library and credible websites.

· Ask yourself, “What factors made the community’s and/or nation’s response effective or ineffective? What aspects of disaster planning or emergency preparedness did the community have in place that helped it cope with the disaster and resulting population health issue?”

By Day 3

Post a cohesive scholarly response that addresses the following:

· Identify the disaster and resulting population health issue.

· Describe the epidemiological considerations resulting from this disaster. Support your response with specific examples and evidence from the literature.

· Discuss the factors that made the community’s and/or nation’s response effective or ineffective.

Write 1.5 page and cite at least 3 sources