Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Substance-Related Disorders--psychology"
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Assessing Motivation and Readiness for Treatment for Substance Use DisordersBackground: Patients who complete inpatient treatment and receive appropriate aftercare such as follow-up doctor appointments and referral to outpatient therapy, have better sobriety rates and health outcomes. Patients who chose to leave a substance abuse treatment center against medical advice experienced worse health outcomes and re-admissions compared to those who were successfully discharged after thirty-day in-patient program completion. Patients who were discharged against medical advice were seven times more likely to be admitted or readmitted within fifteen days. Local Problem: Over the last three years a substance abuse treatment center experienced a significant increase of patients leaving treatment against medical advice. The against medical advice discharge rate at this facility increased almost ten percent over this timeframe. A designated team complete a quality improvement project, using a self-reporting assessment tool to determine if readiness for treatment improved retention rates. Interventions The purpose of this quality improvement project was to assess the circumstances, motivation and readiness for treatment of newly admitted substance use disorder patients at a Mid Atlantic substance abuse treatment center. The Circumstances, Motivation Readiness (CMR) scale was used for these purposes. Results: The majority of the patients scored in the moderately high to high for the CMR subscales and total scale, indicating lower risk of leaving against medical advice. Yet, there was no significant difference between the total scores of those who remained in treatment for the full 30-day requirement or left AMA. However, there were positive correlations between LOS and the readiness subscale (p= 0.047) and total scores (p= 0.0346). There was no significant difference scores for either gender, ethnicity or drug of choice. Conclusion The CMR scale presented a feasible mechanism to identify substance use disorder patients’ readiness for treatment and risk for dropping out. The CMR scale may be of greater use in assessing risk for AMA discharges by counselors during initial intake into the facility by focusing on the individual statements to specifically identify characteristics that would place patients at higher risk for AMA.
Implementing Posttraumatic Stress Disorder Screening at an Adult Substance Use Disorder ClinicProblem & Purpose: Posttraumatic stress disorder (PTSD) is a prevalent co-occurring disorder among substance use disorder patients. Often, urban substance use disorder clinics do not screen for PTSD, and patients are not referred to available mental health services unless in crisis. When PTSD is left undetected and unaddressed, it adversely affects patients' symptoms severity and treatment outcomes. The purpose of this quality improvement project was to identify adult substance use disorder patients with probable PTSD using the Primary care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PC-PTSD-5), and evaluate the effectiveness of the screening to trigger referral for additional mental health assessment. Methods: The project occurred over 12 weeks and included all qualified substance use disorder patients, 18 years, and older in an urban, outpatient substance use disorder clinic. Screening was implemented by a team of champions trained in the administration and scoring of the Primary care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PC-PTSD-5). Education regarding PTSD symptoms was required for all screened patients. Data were analyzed using descriptive statistics of the sample and a Chi-square test to determine the association between referral and PC-PTSD-5 score. Weekly progress of screening, referral, and education was tracked using a run chart. Results: Of the 116 eligible patients, 62 were screened for PTSD. Thirty-five screened patients received a referral for further assessments. A chi-square test of independence was performed to examine the relation between PC-PTSD-5 score and referral. The relation between these variables was significant, X2 (2, N = 62) = 11.2, p = .0037. Patients with a higher PC-PTSD-5 score were more likely than those with a lower score to receive a referral for further mental health assessment. Conclusions: The PC-PTSD-5 screening tool was successful at increasing mental health services awareness and utilization by substance use disorder patients through the score-based referral process. PTSD screening and score-based mental health referrals were recommended to become standard practice. Digitalization and integration of the screening tool in the electronic health record are instrumental in ensuring sustainability and compliance.