| Module Code: NUR3037
||Module Title: EARLY INTERVENTION IN PSYCHOSIS
Module Provider: Health & Social Care
Short Name: NUR3037
Module Co-ordinator: BIRTWELL RW Mr (HSC)
Number of credits: 30
Number of ECTS credits: 15
|Two assessments will be submitted, as the module has a dual aim, of individual client work skill enhancement, and of service improvement. Each assessment will carry 50% of the marks.
1. A 2500 word care study, reflecting upon the process of collaboration between the student and a client and, if appropriate, family, towards a shared understanding of the client’s difficulties. The essay should demonstrate awareness of the psychological and social processes which can characterise early psychosis, as they apply to the client. As examples, these may include:
• loss, humiliation and entrapment
• traumatic reactions to life events or the experience of illness, including reactions to symptoms
• alienation from family, education and/or work, and friends
• shame and stigma
• the way the client and others around the client understand the illness and associated problems, and what the effect is of any discrepancies in these explanatory models.
It will not be enough merely to name such reactions, but rather to analyse the connections between the factors you identify, and use the literature to discuss the effect they have on the client, and on the client’s relationships with others, including services. Your own reflection on your engagement with the client will show how you attempted to form a collaborative working relationship based on a shared understanding of need.
2. A 2500 word project report of a contribution to the development of your own service. This will need to include:
• An analysis of an aspect of your service against published principles and values of early intervention. This should be a critical analysis, in the sense that the criteria or values chosen should not be accepted at face value, but the assumptions behind them analysed, and matched against the evidence, as part of the discussion. Thus the result of writing this section should be a critical appreciation of the present status of evidence supporting early intervention, enabling a more thoughtful analysis of your present service. As a guide this might be approximately 2/3 of the report.
• A plan, agreed with your manager and course leaders, to initiate a development in your service for young people at an early stage of psychosis, in the ways suggested by your analysis. This should include the way in which relevant stakeholders will be engaged and consulted about the formation of goals and action plan.
• Some examples of possible projects:
i. Establishment or evaluation of family psycho-education nights
ii. critical analysis of referrals and delays in care pathways
iii. use of medication and concordance with NICE guidelines
iv. methods in use in the team of working for medication concordance, or relapse prevention
• note that for people working currently in teams with limited contact with young people with early psychosis, a suitable project should be agreed with course leaders.
• Note also that it is possible for students to collaborate on a service project for the purpose of this assessment, but any submitted work must be the work of the individual student. In this case, the final 1/3 (i.e. the plan) of the report may be similar between students if the plan is for the same team or service, and the reason for this should be stated in the work. The first 2/3 of the assessment however, must identifiably be the work of the submitting student. It is important to be careful of this, as the dangers of inadvertent plagiarism are greatly increased where such collaboration has been used.
|The module aim is to equip early intervention workers with the attitudes, knowledge and skill to engage with clients with early psychosis and families to assist recovery, and contribute critically and thoughtfully to the continuing evolution of the early intervention method.
|Knowledge and understanding
Explored the nature of early psychosis, explanatory models (biomedical; cognitive; developmental; stress vulnerability & trauma) and associated models of treatment
Models and history of early intervention
Current UK policy frameworks
Debate the evidence underpinning early intervention, especially of the damage attributed to delay in treatment, and both the potential to avoid that damage, and the possible risks attached to earlier treatment.
Critically explore the concept of a “critical period” after onset of symptoms during which hard-to-repair damage may occur with ineffective help
Understand normal development, possible links with development of psychosis and implications for engagement
Critically understand approaches to, and evidence base behind, psychosocial care of people with psychosis, especially stress vulnerability, relapse prevention and medication concordance.
Understand prevalence of substance misuse and dangers of this in psychosis. Have a basic working knowledge of motivational interviewing and harm reduction approaches to managing this.
Have a working understanding of a range of opportunities engage with client’s social, educational and occupational lives to facilitate recovery
Have a working understanding of the pharmacology relevant to early psychosis, the rationale for low dose antipsychotic treatment, and the ability to explain this to and discuss it with, clients and family.
Understand the client’s behaviour, thoughts and feelings and relationships in the context of their development, previous experience and attachment patterns.
See the opportunities for care as existing as much with family, education, work and social settings, as with the client themselves.
Understand recovery as being about functioning in life settings, confidence and self esteem, as well as symptoms.
Engage clients collaboratively using a variety of approaches, settings, and practical and psychological help suited to the client’s perception of need.
Form an understanding of the client’s perception of their world, and work simultaneously with the client’s and services’ view of need.
Use collaborative assessment approaches to give a holistic understanding of young people’s personal needs in the context of family, work and education and friends.
Assess with the client the course of illness and help seeking, in the context of their general life experiences, using timelines or other reflective methods taking account of the client’s preferred way of working and adjustment to their illness.
Assess risk and work collaboratively with the client, family and teams involved to manage risk.
Engage family in assessment and plan of care, to leave family well informed within the boundaries of confidentiality, feeling supported and with a sense of partnership in the care process
Use formulation to engage the client and arrive at a shared understanding of connections between different aspects of the client’s life, and to negotiate a collaborative plan of care.
Apply the principles of early intervention to their own service for young people with early psychosis, and critique both service and principles from the analysis. See, and begin to translate into practice change, opportunities for development.
Academic presentation of critical thought.
|Models of understanding psychosis: medical, stress vulnerability, cognitive, trauma, developmental
Early intervention, history, models and concepts. Associated public policy.
Pharmacology relevant to early psychosis
The lived experience of people with early psychosis and their family:
Process of early psychosis, how illness develops and is experienced by the client and others.
Loss, humiliation and entrapment
Engagement of clients and family: understanding of engagement barriers and opportunities
Assessment approaches and tools. Use of timelines and other ways of assessing illness experience and DUP.
Interaction styles, including guided discovery
Psychosocial interventions: stress vulnerability approaches, medication concordance, relapse prevention, coping strategy enhancement, working with people who experience voices or distressing beliefs.
|Methods of Teaching/Learning
|Taught: 90 hours
Self directed learning: 210 hours
The module will comprise 15 taught days, one day per fortnight. Guided reading between most of the sessions, followed by seminar discussion during the sessions will enable a workshop approach to be used for many sessions, with less need for lectures for the delivery of basic material.
Some space will be devoted in the timetable for each course participant to present a formulation of one client, showing an understanding of the client in the context of external and internal dynamics, and providing a shared understanding as the basis for collaborative therapeutic work. This will link together the module and the student’s practice, and serve as formative work to assist in the summative assessment.
|Indicative reading (more reading will be indicated during lectures)
Most recommended in bold
Addington J, Francey S M., Morrison A P. (2005) Working with People at High Risk of Developing Psychosis: A Treatment Handbook. Wiley Blackwell.
Birchwood M J, Fowler D & Jackson C (eds) (2002) Early Intervention in Psychosis: A Guide to Concepts, Evidence and Interventions. John Wiley and Sons.
Compton MC & Broussard B (2010) The First Episode of Psychosis: A Guide for Patients and Their Families. New York, OUP
Edwards J and McGorry P D. (2002) Implementing Early Intervention in Psychosis Taylor & Francis Ltd. Nelson,H (2005) Cognitive-behavioural Therapy with Delusions and Hallucinations: A Practice Manual 2e: A Practice Manual. Nelson Thornes.
French P, Smith J, Shiers D, Reed M & Rayne M (Eds) (2010) Promoting Recovery in Early Psychosis: A Practice Manual. Chichester, Wiley Blackwell
Gleeson J And McGorry P (Eds) (2004) Psychological Interventions in Early Psychosis, A Treatment Handbook. Wiley, Chichester
Jackson HJ & McGorry PJ (eds) (2009) The Recognition and Management of Early Psychosis: A Preventive Approach (2nd Ed) Cambridge University Press
Larkin W & Morrison A (Eds) (2006) Trauma and Psychosis. New directions for theory and therapy. Routledge, London
Repper J. & Perkins R. (2003) Social Inclusion and Recovery. A Model for Mental Health Practice. Edinburgh, Bailliere Tindall.
Rollnick S, Miller W & Butler C (2008) Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing) New York, Guilford Press
|29TH JULY 2010