Department of Psychiatry and Human Behavior Posters

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  Empowering Resident Autonomy, Competence, and Relatedness Through Opt-Out Visits

  Emily Lisco, MD; Alexandra Hughes, LCSW; and Meghan O’Meara, PhD, LPC

  Background

  • House staff officers are more likely to experience burnout than their age-matched peers in the general population.³
  • ACGME Common Program requirements emphasize the importance of well-being in residency programs, including the opportunity to attend healthcare appointments during working hours.¹
  • Opt-out programs have been used to increase help-seeking behavior and provide low-barrier access to mental health care and other supports.^{2, 4-5}
  • Self-determination theory proposes that individuals’ well-being can be enhanced if the core psychological needs of autonomy, competence, and relatedness are met.⁶
  • The lack of perceived autonomy, competence, and connection felt by residents can lead to new or worsening depression, anxiety, and burnout among house staff.
  • Thomas Jefferson University Hospital (TJUH) is a multi-state not-for-profit academic medical system affiliated with the Sidney Kimmel Medical College.
  • The Emotional Health and Wellness Program for House Staff (EHWP) provides long-term counseling, medication management, and outreach services.
  • The EHWP opt-out visit structure was modeled on the framework of creating a safety plan. Residents reflected on their personal signs of burnout, coping skills, supports, and indications for seeking professional help.
  • AY21: 76 visits were scheduled. 61% (46/76) opted in. Of those, 24% (11/46) scheduled a therapy intake.
  • AY22: 369 visits were scheduled. 32% (118/369) opted in. Of those, 34% (40/118) scheduled a therapy intake.
  • This data shows that residents who attend opt-out visits often choose to schedule intake appointments, illustrating an increase in help-seeking behavior.
  • Anonymous survey comments indicated that residents appreciate the autonomy to be able to choose to take dedicated time to reflect on their well-being and be connected to available support that they did not always know existed.
  • Offering opt-out visits meets ACGME requirements and are a low-cost, meaningful addition to residents’ medical training.

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  Enhance Resident Physician Well-being: How and Why to Implement Opt-Out Wellness Check-Ins

  Emily Lisco, MD; Alexandra Pierlott, LCSW; and Meghan O’Meara, LPC

  Abstract

  • The stress of transitioning to residency can lead to new or worsening depression, anxiety, and burnout among house staff.¹
  • Lowering barriers to accessing mental health services and emphasizing preventative mental health care can improve the mental well-being of residents.
  • Opt-out programs have been used to target resident physicians and medical students, to increase help-seeking and provide low-barrier access to mental health care and other supports.^2-5
  • Thomas Jefferson University Hospital (TJUH) is a multi-state not-for profit academic medical system that trains approximately 2,100 house staff/year.
  • Opt-out visits began at TJUH as a pilot in 2021 with 2 residency programs. In 2022, the program expanded to include 9 residencies.
  • AY21: 76 visits were scheduled. 61% (46/76) opted in. Of those, 24% (11/46) scheduled an intake.
  • AY22: 369 visits were scheduled. 32% (118/369) opted in. Of those, 34% (40/118) scheduled an intake.
  • This data shows that residents who attend opt-out visits often choose to schedule intake appointments, illustrating increased help-seeking behavior.
  • This low-cost intervention can be implemented by all institutions to demonstrate that hospital and program leadership value well-being.

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  Symptom Relief and Quality of Life in Autistic Children Using Medical Cannabis: A Secondary Analysis

  Wendy J. Ross, MD, FAAP; Jennie Ryan; Madalene Zale; and Alexander Fossi, MPH

  Objectives

  • This study aimed to examine the experiences of parents and caregivers of autistic children who used medical cannabis (MMJ) for the treatment of core symptoms or co-occurring conditions
  • Considered priorities and outcomes of medical cannabis use, including: 1) Quality of life (QoL) effects; 2) Symptoms of interest; 3) Symptoms of co-occurring conditions

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  Effects of Using Different Death Rate Metrics on the Analysis of Drug-Overdose Death Rates and Socioeconomical Factors

  William R. Duan and Dennis J. Hand

  Age-adjusted death rate (AADR) and raw death rate (RDD) used in drugoverdose studies typically involves death-record data and populationsurvey data. Difference can exist between the two data sources, leading to the so-called dual data-source error. Proportionate mortality avoids the error; however, no studies have been done comparing the conclusions drawn using the different metrics. The objective of this study is to evaluate the differences and merits of using different death-rate metrics in overdose analysis.

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  Patterns in Change of Opioid Overdose Death Rate with the Day of the Week and Their Implications

  William R. Duan and Dennis J. Hand

  The objective of this study was to investigate the dependencies of opioid overdose death rates on the day of the week and understand the implications of the dependencies Understanding and presenting the dependencies is useful for first responders and for health care system resource planning It can provide additional insights in the opioid epidemic and should be considered in prevention efforts

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  Using the System of Care Approach to Distinguish School Refusal from School Truancy

  Connie Chang, MD and Aneela Khan, MD

  Learning Objectives

  To recognize the importance of taking a system of care approach to determine whether the symptoms of school avoidance are due to mental illness

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  Determining a Clinical Role for Digital Apps for Mental Health

  Hephsibah Loeb, MD and Ann Chandy, MD

  In 2017, the FDA approved the first app for treatment of alcohol, cocaine, marijuana and stimulant use disorders. In a preceding randomized controlled trial, mobile software Therapeutic Education System (TES) was found to reduce dropout from treatment and to increase patients’ rates of abstinence from substance abuse. Another study showed that PRIME-D, a mobile-based treatment for depression, positively affected symptoms of depression and disability. Many individuals seek out self-help apps for psychiatric complaints, although, in general, little evidence exists for evaluation of the most accessible mobile apps for self-help. What are the strengths and weaknesses of digital apps for treatment of mental illness? How should a mental health clinician assess the role and efficacy of mobile apps within a patient’s treatment? Results of TES trial include lower dropout rate and greater abstinence rate from non-opioid substance abuse. Through use of PRIME-D, individuals were found to have improvement in self-reported depression and self-reported disability. Both TES and PRIME-D trials involved a clinician or coach alongside the mobile intervention. Patients in the PRIME-D study who had greater interaction with masters' level mental health coaches were more likely to have greater improvement in mood symptoms. The high level of retention in study was also thought to be related to human support from mental health coaches. Self-help apps for mental health can increase access to care, without barriers such as clinician availability or clinic hours. Lower cost and convenience could increase adherence. Psychoeducational information can be accurately provided, without risk of faulty administration by staff. The potential for a mobile app-based approach to treatment can reduce stigma and thus increase the likelihood of a patient seeking to address mental illness. Significant drawbacks of self-help apps for mental health include the concerns about privacy of data shared on apps. Apps can provide information that is inappropriate, incorrect or that may be misinterpreted by individual users. Apps may not be suitable for emergency situations and may not be easy to use by patients who have serious mental illness. Developed by the American Psychiatric Association, the APA App Evaluation model provides a means for clinicians to evaluate apps for mental health. The model employs a five-tiered system for assessing background information, privacy and security, clinical evidence, ease of use, and potential to share data with the clinical team. In conclusion, evidence from two interventions shows that mobile apps can improve outcomes in patients with non-opioid substance use disorder and depression. Digital apps for mental health can allow increased access to mental health resources; however, also have significant drawbacks related to privacy, the risk of misinformation, and inadequacy in an emergency.