It’s Not Just Murphy’s Law: A Case Study of Problematic Records Transmission

Quality behavioral health care depends on a multitude of factors, from the strength of the therapeutic alliance to the use of evidence-based treatments. However, one factor that can easily be overlooked is the coordination of care between providers via the transmission of client records. Overall, the transmission of client records has lagged significantly behind other technological improvements in healthcare for decades. Unfortunately, this has led to a number of barriers that can delay or outright prevent vital client information from being shared amongst clinicians. This paper examines a specific case of record transmission and explores the difficulties encountered in the timely sharing of information. The case study involved a university training clinic requesting records for a client with a complex presentation and involved requesting records from three separate facilities. However, the requested records were delayed significantly due to a variety of factors, including outmoded transmission technologies, differences in how each facility handled records requests, and the need to use facility specific record request forms. The case study illustrates a number of weaknesses in the current system of records management and transmission. Solutions to these problems are of paramount importance for efficient, safe, and timely care.

Feasibility and Effectiveness of an Integrated Cognitive Behavioral Treatment to Address Psychological Distress in a Stroke Self-Management Program

This is a case-study of a Hispanic man who had an ischemic stroke and was participating in a stroke self-management (SSM) program. He was identified as having comorbid symptoms of anxiety and depression that were not addressed by the SSM program and was subsequently enrolled in the Enhance Psychological Coping after Stroke (EPiC) program. EPiC is a telephone-based cognitive-behavioral treatment integrating mental and stroke-related behavioral health principles that is delivered concurrent to the SSM program. Over the course of six sessions, the participant learned psychological symptom and behavioral monitoring, thought stopping, cognitive restructuring, deep breathing, calming thoughts, social support, and problem-solving skills aimed at overcoming barriers to engagement in behaviors taught in the SSM program. Client-centered psychological distress and behavioral health treatment goals were integrated into each session. The client demonstrated reduced anxiety symptoms and improved stroke SSM behaviors at 6, 12, and 18 weeks after the initiation of treatment. He also improved in disability, social role limitations, quality of life, and stroke self-efficacy at 18 weeks following the initiation of treatment. This case study demonstrates that incorporating an integrated cognitive behavioral treatment to an SSM program can be beneficial for decreasing psychological symptom barriers to SSM, which may reduce the risk of stroke recurrence.

Case Study: A Transactional Analysis Model for a Single Mother and Her Adult Child With Bipolar Disorder

This case study describes a transactional analysis model based on the strain of a single mother with an adult son suffering from bipolar I disorder. The study examines interaction patterns within the clinical setting; the therapeutic view examines contextual factors that affect this mother and her adult son through assessment and recovery with transactional analysis therapy. The 16-session therapeutic experience of a client and his mother is presented. The subjects in the case study were administered the Sixteen Personality Factor Questionnaire (16PF) assessment tool during the second and 16th sessions. There was a significant change from pretest to posttest stens scores regarding increased scores in emotional stability from 2 (extremely low) to 4 (average), rule consciousness from 1 (extremely low) to 3 (moderately low), openness to change from 6 (average) to 8 (moderately high), and self-control from 1 (extremely low) to 4 (average). Decreased scores included apprehension from 9 (extremely high) to 7 (average) and tension from 6 (average) to 3 (moderately low). Behavioral changes after a 1-month follow-up included taking the bus to sign up for a college class, taking his medication as prescribed, getting a part-time job in the kitchen at the Veteran Administration Medical Center, and developing a budget to manage his disability check.