Population Summary

Population Summary

Agency Information

1. Within the walls of Bon Secours Southside Regional Medical Center, there are a variety of populations served with a variety of illnesses.
2. It (SRMC) is a community hospital within the city of Petersburg, Virginia that serves the tri-cities and local nearby counties. Within this medical hospital, there is a behavioral health unit with 30 beds (Branzelle, M, June 13, 2020).
3. It is an acute care unit for adult mental health patients. This means that it is a unit which manages the patient for a short-term hospital stay. Some of the patients may need a continuation of care which can include follow up with a provider, treatment at an out-patient program, or at a long-term rehab stay (Branzelle, M, June 13, 2020).
4. While at Bon Secours SRMC, patients receive treatment which enables them to work on goals to manage the exacerbation of their symptoms that has triggered the need for a hospitalization (Branzelle, M, June 13, 2020).
5. Treatment components include group therapy, individual sessions, and medication management (Branzelle, M, June 13, 2020).
6. When a patient arrives, it is usually because they are having a crisis in their mental health that prevents them from being safe at home. On admission, a treatment plan is created which will determine the needs of the patient and goals that the Interdisciplinary team would like to see the patient accomplish.
7. Within the behavioral health unit, patients are admitted from the local community, transferred to the facility from various locations within the state, are soldiers from nearby bases, and some are from out of state and had a mental health emergency during their travel (Branzelle, M, June 13, 2020).
8. The majority of the patients are acute patients and are brought into the emergency room. Some of the patients are brought in by the police or a family member while in other cases, a patient may voluntarily check themselves in. There are some referrals to the unit from their medical or mental health providers (Branzelle, M, June 13, 2020).
9. In some cases, a patient has been transferred from a medical unit with the hospital because of an overdose and needs treatment for an onset bout of depression related to their current mental health status. Some are admitted due to having the desire to stop using substances and need to be observed and stabilized during the detoxing stage (Branzelle, M, June 13, 2020).
10. Along with substance abuse, Bon Secours Southside Regional Medical Center also serves patients with a diagnosis of depression, bipolar disorder, schizoaffective, schizophrenia, post-traumatic stress disorder, generalized anxiety disorder, and borderline personality disorder. Overall, the recreation therapists serve a wide variety of patients within the mental health setting (Branzelle, M, June 13, 2020).

Basic Functional Agency Requirements

In order for a patient to be able to receive treatment groups in the hospital unit, there are multiple basic functional agency requirements that the patient has to have met.

The four main requirements are:

1. The individual must be in-patient status.
2. The patient must be assigned a room in the behavioral health unit
3. The patient must be able to tolerate being in a group setting.
4. The patient must demonstrate appropriate and safe behaviors.

1. Every patient that is admitted is assessed by a recreation therapist. Not only does this help the patient build rapport with the RT, it also gives the RT insight as to what is going on within the patient’s current status. It is required by the governing body of JCAHO as well as other state requirements that the assessment be completed within 72 hours of admission (Branzelle, M, June 13, 2020).
2. Secondly, based on the assessment, the RT will determine goals for group therapy. It is the goal of treatment that the patient will gain tools and strategies to assist in managing their current mental health crisis and tools that can assist in managing future stressors or conditions to decrease future hospitalizations.
3. Within the treatment model, there are many different types of groups that a recreational therapist plans ranging from psycho-educational groups, leisure skills groups, and leisure activity groups that are led by the RT (Branzelle, M, June 13, 2020).
4. Lastly, it is important to be aware of the patient’s status upon arrival. In some cases, the hospital might need to obtain a TDO (Temporary Detention Order) if the patient is not wanting to stay at the facility. In that case, a TDO takes place on the unit and District 19 is called. District 19 is the community service board that comes in and does an evaluation on the patient to determine if it is safe for the patient to leave or not. If they issue a TDO, a hearing takes place and the judge will determine if the patient is committed, released, or if the patient voluntarily agrees to stay on the unit (Branzelle, M, June 13, 2020).
5. In conclusion, there are many factors that are considered while assessing the patient’s appropriateness for treatment, treatment goals, and functionality. These factors also impact the patient and their willingness to participate in treatment.

The primary disability groups served by the agency are depression, bipolar disorder, schizoaffective, substance abuse, and post-traumatic stress disorder.

            Depression

• According to the American Psychiatric Association, depression is a common and serious medical illness that negatively affects how you feel, the way you think, and how you act (American Psychiatric Association, n.d.).
• It causes feelings of sadness and a loss of interest in activities
• In regards to the domains, physically the person has a loss of energy (American Psychiatric Association, n.d.).
• Cognitively, the person has difficulty thinking and concentrating (American Psychiatric Association, n.d.).
• Emotionally, the person shows feelings of sadness and maybe thoughts of suicide.
• Socially, the person becomes withdrawn from their friends and spends more time alone.
• In regards to the strengths, an individual’s strengths are assessed through the RT assessment and the patient is encouraged to identify their own personal strengths that have helped them thus far. The assessment will also ask the patient what their limitations are and what they feel is holding them back from success or completion of personal goals (Branzelle, M, June 13, 2020).
• Some areas of functional improvements rely heavily on Cognitive Behavioral Therapy as well as self-esteem classes. A recreation therapist might also lead coping skills groups in order to help the patient learn to love themselves again (Branzelle, M, June 13, 2020).
• By the end of the program, a common goal for the patient might be that they are more stable and are no longer demonstrating those symptoms associated with depression.

Bipolar Disorder

• The second most common disability that is treated at the agency is bipolar disorder.
• According to the Mayo Clinic, bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania) and lows (depression) (Mayo Clinic, January 31, 2018).
• Physically, bipolar disorder causes the individual to be full of energy when they are having a manic episode (Mayo Clinic, January 31, 2018).
• Cognitively, the person’s judgement is fogged and it is hard for them to think clearly (Mayo Clinic, January 31, 2018).
• Emotionally, the person’s mood swings fluctuate so much that they can feel extreme hopelessness one second and then feel euphoria later on (Mayo Clinic, January 31, 2018).
• Socially, the person’s mood swings can take a toll on their family and friends as they might lash out at those closest to them.
• When it comes to strengths, an individual’s strengths are assessed through the RT assessment and the patient is encouraged to identify their own personal strengths (Branzelle, M, June 13, 2020).
• Some functional improvements are it is very important for the patient to not be experiencing manic episodes and are more stabilized on their medications (Branzelle, M, June 13, 2020).
• At the end of the hospitalization stay, the patient is stable and is no longer demonstrating symptoms associated with bipolar disorder.

Schizoaffective Disorder

• The third most treated disability at the hospital is schizoaffective disorder.
• It is a chronic mental health condition characterized primarily by symptoms of schizophrenia such as hallucinations or delusions as well as symptoms of a mood disorder such as mania and depression (National Alliance on Mental Health, n.d.).
• According to each domain, schizoaffective disorder affects each one differently.
• Physically, the person expresses manic behavior such as risky behavior (National Alliance on Mental Health, n.d.).
• Cognitively, the person has disorganized thinking and may switch rapidly from one topic to another (National Alliance on Mental Health, n.d.).
• Emotionally, the person may have a depressed mood and feelings of emptiness.
• Lastly, one of the biggest cognitive effects of schizoaffective disorder is hallucinations which is seeing or hearing things that aren’t there and having delusions which are false beliefs that are held regardless of contradictory evidence (National Alliance on Mental Health, n.d.).
• A patient’s strengths are gathered during the RT assessment portion of their treatment. The main functional improvements a person will want to achieve is to no longer demonstrate the symptoms stated above and become stable on their medications (Branzelle, M, June 13, 2020).

Substance Abuse Disorders

• The fourth population that the hospital serves is individuals with substance abuse disorders.
• It is a disease that affects a person’s brain and behavior and leads to the inability to control the use of legal or illegal drugs or medication (Mayo Clinic, October 26, 2017).
• Substances such as alcohol, marijuana, and nicotine are also considered drugs. It is common to see patients admitted due to the use of alcohol, marijuana, crack, cocaine, methamphetamines, heroin, and use of legally prescribed pain medications (Branzelle, M, June 13, 2020).
• Physically, a person will spend money on the drug even though they can’t afford it.
• Cognitively, a person will experience the idea that they need the drug in order to be okay.
• Emotionally, a person may act out in order to get the drugs that they need (Mayo Clinic, October 26, 2017).
• Socially, a person may spend time with the wrong crowd in order to get drugs and not spend time with their loved ones who truly care about their wellbeing.
• A strength a person with a substance abuse disorder may have is the ability to act “normal” and be resourceful in times of need (Branzelle, M, June 13, 2o20).
• Lastly, some of the functional improvements a person may have after therapy is their want to maintain sobriety after therapy and not relying on drugs anymore (Branzelle, M, June 13, 2020).

Post-Traumatic Stress Disorder

• The fifth and final population that the hospital serves is individuals with post-traumatic stress disorder.
• It is a mental health condition that is caused by a terrifying event by either experiencing it first hand or by witnessing it. Trauma impacts many in a variety of ways and is identified as post-traumatic stress disorder (Mayo Clinic, June 6, 2018).
• Some patients that also suffer from PTSD are current soldiers and veterans (Branzelle, M, June 13, 2020).
• Physically, a patient may be easily frightened and may have trouble sleeping (Mayo Clinic, July 6, 2018).
• Cognitively, the patient may avoid thinking about the event (Mayo Clinic, July 6, 2018).
• Emotionally, the patient may feel numb to everything around them.
• Socially, the patient may have difficulty maintaining close friendships.
• In this case, it can be difficult for the patient to notice their strengths especially if they are unable to see themselves (Branzelle, M, June 13, 2020).
• It is important for the RT to set small goals to help the patient become more confident about their growth. By the end of the hospitalization, some of the functional improvements a patient should have is the ability to cope with the traumatic experience while still maintaining a positive lifestyle (Branzelle, M, June 13, 2020).

References

Branzelle, M. (2020, June 13). Personal Interview

Bipolar disorder. (2018, January 31). Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

Depression. (n.d.). Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression

Drug addiction (substance use disorder). (2017, October 26). Retrieved from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112

Post-traumatic stress disorder (PTSD). (2018, July 6). Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

Schizoaffective Disorder. (n.d.). Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizoaffective-Disorder#:~:text=Schizoaffective%20disorder%20is%20a%20chronic,such%20as%20mania%20and%20depression.

Criteria for Success:  Rubric-