Student Name

NURS-4905

Capella University

Professor Name

Submission Date

Technology and Professional Standards

Technology is required to enhance current care practices and provide more opportunities to effectively treat adults diagnosed with major depressive disorder (MDD). Mentalist Specialist, PLLC in Mount Vernon, NY is a great case study of how technology can improve patient outcomes by offering a method of service delivery. By using Electronic Health Records (EHRs) with proven treatments/therapies, a recent study conducted by Berardifound suggests that the quality and consistency of evidence-based treatment strategies would benefit the treatment of depression and overall mental health care. By connecting these two components together, the provision of outpatient behavioral health services will help set the stage for continued success and improvements of sustainable, patient-centered outpatient healthcare service delivery.

Role in Process Change and Professional Standards

Registered nurses with a Bachelor of Science degree in nursing (BSN) have a priceless role to play in helping processes and systems improve in the healthcare environment. BSNs play a key role in helping patients with care and support; in competency assessment; in areas where patients may benefit from engaging with Cognitive Behavioural Therapy (CBT); and in an evidence-based approach. Clark., BSN’s can apply quality improvement processes that may be applied to help improve patient care processes and increase patient safety. These are the skills and abilities that enable BSNs to help bring about changes that have deeper and lasting impacts.

The overall responsibility of process change in the Mentalist Specialist PLLC is currently a combination of mostly observational operations for the practicum student. But there’s a lot of room to make a difference. Good opportunities for involvement in patient documentation, documentation of behavioural change, and involvement in interdisciplinary meetings related to patient care, which can all significantly influence patient care processes.

The New York State Nurse Practice Act clearly provides for nurses to advocate on behalf of patients and to engage in quality improvement, and the practicum student plays an important role in these transformations. Although the practicum student is currently limited in the ability to implement much change, if he/she were a fully licensed nurse, there are several roles he/she could take that would allow for formal leadership in the implementation of CBT referrals through the conducting of audits, development of standardised referral protocols, and education of the care team on positive/negative outcomes related to CBT referrals based on best practice.

Interprofessional Collaboration

Interprofessional working is the starting point for providing the right care in the right place for mental health issues in an outpatient behavioral health facility. Interprofessional collaboration at Mentalist Specialist PLLC is between psychiatrists, psychiatric nurse practitioners, therapists, psychologists, care coordinators, and nurses. He said that combined interdisciplinary work leads to high efficiency in processing referrals, continuity of care, and better mental health outcomes for people who have mental problems that are hard to diagnose. This may involve improving interprofessional working at the practicum site, which will facilitate regular and timely incorporation of CBT into intervention for adults with one or more episodes of major depression.

Government Agency Recommendations

There are several government agencies and government bodies that give recommendations which can directly correlate with the above narratives on the processes that The Mentalist Specialist PLLC uses when caring for individuals with mental illness like major depressive disorder (MDD). The Joint Commission outlines that all healthcare organizations (including The Mentalist Specialist PLLC) develop standardized care processes and evidence-based treatment pathways for treating mental health issues like MDD. The Centers for Medicare and Medicaid Services (CMS) regulations require that all mental health providers of outpatient mental health services give clients timely access to psychotherapy services as part of the overall management of MDD. These agency-developed guidelines all address the need for corrective action in the delayed referral to cognitive behavioral therapy (CBT) and for consistent and evidence-based treatment to be utilized at the practicum site.

Current Technology at the Practicum Site

Mentalist Specialist PLLC uses an Electronic Health Record system in its platform known as the Electronic Health Record (EHR). This helps providers record patients’ assessments, monitor psychiatric medication treatment progress, and maintain medication records. The ability to communicate with other providers and to continue care across disciplines in the outpatient setting is provided by the EHR platform. The current EHR platform lacks a computerized behavioral therapy (CBT) referral tracking tool, causing referrals for CBT for eligible adults with major depressive disorder (MDD) to be inconsistent and delayed. Thus, the technology constraints of the current EHR platform directly impact the quality and timeliness of evidence-based psychotherapy services delivered at this site.

Use of telehealth technology will help deliver psychiatric evaluation and medication management for adults at a distance. In addition, although telehealth has helped to increase access to psychiatric services, it has not been consistently used in delivering psychotherapy services at this site. Sandre found that the use of digitally delivered CBT (cognitive behavioral therapy) via telehealth demonstrated similar efficacy to providing in-person psychotherapy in an outpatient mental health setting, and thus supports their implementation in outpatient mental health resources. Lowering the obstacles to using telehealth for psychotherapy services could lead to greater access to timely comprehensive CBT services for patients. 

Technology Available and Recommended for the Practice Issue

The literature indicates that there are several promising technologies that could potentially help overcome the CBT referral delays encountered by Mentalist Specialist PLLC. There is significant evidence of digital CBT platforms and online-delivered CBT for adults with MDD reducing depressive symptoms. These digital CBT techniques, as stated by Gkintoni, will offer patients increased accessibility, uniformity, and personalisation of treatment options via teletherapy offerings and application-based software intended to help individuals with depressive disorder. While a number of those tools will be able to span both of these areas with psychotherapy, there are a few hurdles, such as individuals who don’t participate in psychotherapy and those who don’t have access to the Internet, that might make these innovations less widely adopted.

Integrated clinical decision support systems (CDSS) interfaced with the patients’ electronic health record (EHR) are another proposed approach to improving the accuracy and consistency of referrals to offer patients cognitive behavioural therapy (CBT). A CDSS can produce electronic reminders for the clinician informing them that the patient has documented symptoms that are severe enough for their referral. Clinicians using EHR-integrated decision support to guide the appropriate use of medications to treat outpatients with depression have noted that the percentage of outpatients receiving guideline-congruent treatment significantly increased post-implementation when Crouse did so. There will also be a need for some adaptation of the current EHR to fit for CDSS, to deliver training for clinicians, and ongoing technical assistance.

Potential Implementation Issues for New Technology

Before implementing the new technology at Mentalist Specialist PLLC, it is important to take

into account not just organizational considerations, but also practical considerations. Financial limitations, insufficient technical setup, and providers’ resistance to changing their workflow are two of the main issues that arise in adopting new technologies. Importantly, according to a study by Campion, there are three key areas necessary for successful technology implementation in mental health services: leadership support; Staff training/retraining; and engaging with all stakeholders (clients) to reduce adoption barriers.

Conclusion

The assessment completed by Mentalist Specialist PLLC revealed that individuals with Major Depressive Disorder would experience considerable advantage from targeted interventions that have been tailored to the individual’s needs; this aligns with both existing practices found among mental-health services, as well as recommendations set forth by the American Psychiatric Association and other professional entities within the mental-health field. Language barriers can be resolved by using incremental phased implementation models, establishing training programs for the staff, and accessing grants, all of which will aid in transitioning from traditional service delivery to technology-assisted delivery of mental health services.