Integrated Approach to Treating Depression

Treating Depression From an Integrated Approach A Collaborative Approach to Care May 4, 2019 * Tex-CHIP Training Series

Psychological Assessment of Depression (and contributing factors) Thomas Graf, PhD

Understanding Provider Roles in Treating Depression (when to consult or refer) 1. Does patient need inpatient treatment or can he be seen as outpatient? 2. Do you have the training, current emotional resources and current availability to see this patient with his or her level of problems? Are you going practice within your scope of training and knowledge? Do you need consultation with this one? or to refer all together? 3. PCP: rule out medical problem, like endocrine (hypothyroidism), neurological(tumor), systemic illness (cancer) 4. Psychologists: If persisting learning problems are a factor, psychologist can evaluate for cognitive factors: Borderline and Mild Intellectual Disability, or for specific learning disabilities versus ADHD -these factors often go undetected.

When to Consult (continued) 5. Personality disorders specialists: if PD suspected, who in community works with personality disorder/traits (and depression), for ex DBT 6. Addiction specialist in case of alcohol, drug problems 7. Family treatment: in case of severe mental illness, violence, poverty, recent suicides,lack of control by or participation of family 8. Psychiatry: medication treatment of depression and for treatment of bipolar and schizoaffective or other severe mental illness 9. Cultural acceptance: are you considered an acceptable healer for this person from her or his culture? Can they educate you on this or are the barriers to high?

Considerations when Interacting with Clients look for an emotional connection through demonstrating empathy with their despair and feelings obtain informed consent about limitations of confidentiality establish therapeutic alliance by eliciting and defining what patient would see as improvement and treatment goal that you can help with evaluate level of depression, and factors that make life easier and harder for the person, and being able to stay at home with support or go to more secure place presence of family conflict and support and acceptance have knowledge and follow an assessment/intervention plan that works with depressed/suicidal patient like CAMS (Collaborative Assessment and Management of Suicidality) or similar proven approaches. Determine need for consultation and referral

Our Treatment Plan Healthcare Domain: Psychological Assessment Provider: Psychologist Goals: Interventions: Objective: Decrease in symptoms as indicated by client report of: (a) sleeps through the night 5/7 nights (b) able to concentrate in school 6/7 classes (c) feels enough energetic 5/7 days (d) socializes with family and friends daily a) determine level of depression and needed level of treatment and referrals a) Refer and consult as indicated b) help rekindle interests, identify strengths the patient can build on, engage in physical activity, a natural antidepressant b) engage in activities that are worthwhile and generate accomplishments and improved mood c)Help identify, tolerate and accept negative emotional experiences c) Mourn and accept losses

Measuring Outcomes/Success pre and post: Beck Depression Inventory 2nd Edition Children s Depression Scale 2nd Edition Columbia Suicide Severity Rating Scale or number of depression symptoms reported

Communication Needed from Counselors find out who sees what kinds of problems in the community for you to refer to. Call individual psychologist if you are not sure if they will see this kind of person and within what time frame