cognitive rehabilitation - dsh.ca.gov · dr. williams, dr. mathiesen, dr. mosich, dr. britt, ......
TRANSCRIPT
Cognitive Rehabilitation
Building Blocks for Treatment
Leaders and Contributors
• Cognitive Rehabilitation Work Group:
Dr. Stahl, Dr. Cummings, Dr. Meyer, Dr. Dardashti, Dr. Evans, Dr. Velasquez, Dr. Rose
• Consulting Neuropsychologists at DSH Hospitals:
Dr. Williams, Dr. Mathiesen, Dr. Mosich, Dr. Britt, and Dr. Nitch, and other DSH neuropsychologists
• Consultant:
Dr. Harvey
Why should we care about
improving cognition?
Cognitive deficits are core features of serious mental illness
Predictive of functional outcome
(Palmer, 1997) and (Kurtz, 2007)
Why should we
care about
cognition?
Studies within DSH
Studies outside of
DSH
Impact of aggression
can be devastating for
patients and staff (Reinharth et al., 2014; Rose et al., 2017, Bader and Evans, 2015)
Bader, S. & Evans, S. (2015) Predictors of severe and repeated aggression in a
maximum security forensic hospital. International Journal of Forensic Mental
Health, 14, 110 – 119.
Table 2
Standardized Function Coefficients and Structure Weights_______________________
Standardized Structure
Coefficients Weights
____________________________________________________________ ________
Sporadic Employment 0.47 0.28
Diagnosis of Mood Disorder 0.31 0.33
Diagnosis of Psychopathy 0.27 0.26
Diagnosis of Personality Disorder 0.47 0.49
Psych Hospital as Juvenile 0.34 0.28
Diagnosis of Dementia or MR 0.25 0.26
History of Suicide Attempts 0.50 0.48
Variable Ratio
Employment Problems 10/11
History of Suicide Attempt 10/11
Cognitive Impairment 9/11
Psych Hospitalization as Juvenile 6/11
Diagnosis of Personality Disorder 5/11
Mood Disorder Diagnosis 0/11
Psychopathy No Information
Chronic Aggressors Project I
Chronic Aggressors
II
Most chronically aggressive patients in
our system
77% of them had cognitive deficits
Cognitive deficits was able to predict
group membership between
chronically aggressive and matched
controls
Cognitive
Rehabilitation
Cognitive Remediation
Social Cognition
Treatments
Attention
Memory
Language
Visual Spatial
Executive Functioning
Cognitive Skills
Cognition is Core
to Treatment
Safety
Treatment
Responsibility
Cognitive
Rehabilitation
Cognitive Remediation
Social Cognition
Treatment
DSH Cognitive
Rehabilitation
Programs
RISE (Dr. Williams)
FREE (Dr. Britt)
Brain Fitness (Dr. Mathiesen and
Mosich)
Reach (Dr. Mathiesen and Mosich)
How are we working
on this problem?
Work groups of
talented clinicians
Implementation Plan
Sustainability
Core Components of
the Plan
Assessment
Treatment
Leadership
Research
Assessment
Individualizing
treatment
Necessary to complete
research
Cognition, Functional
Abilities, Aggression,
Psychiatric Symptoms
Treatment
Individualized
Applied
Use technology
Leadership
Development
Sustainability
Organizational
Support
Research
Priority
Communication
Feedback loop
Research Measures
BAC APP/RBANS
BPRS
UPSA
DSH Aggression Stats
AIHQ
Next Steps
Finalizing
implementation plan
Pilot program
Expansion
The End
