Electronic Screening: A Case Study Summary

At the San Diego VAMC, we proudly offer two Store and Forward Telehealth (SFT) programs. The first SFT program offers an eye screening exam (Tele-retinal) to a diabetic Veteran at a local VA clinic. These images are then reviewed by an Eye Specialist, who determines if the Veteran needs a face to face eye clinic appointment. The second SFT program takes pictures of the Veteran's skin lesions, which are then uploaded to the electronic medical record so that a Dermatologist can best determine how to treat the lesion. Telehealth appointments save Veterans an extra office visit and create a 'one-stop shop health care'.

On 7/30/2015, client walk in the social service office and CM completed Bi-Weekly ILP Review. In the meeting client appears she appeared her stated age and in good physical health. She was satisfactorily groomed & dressed. She constantly throb her forehead, she most of time space out and her affect is flat.

Mr. Saunders is a 60 year old male who presented to the ED via LEO under petition by his niece, Rachelle, for allegedly putting a gun into his mouth, him putting a gun in another individuals mouth called "legs", and increasing alcohol consumption. At the time of the assessment Mr. Saunders is calm and cooperative. He denies suicidal ideation, homicidal ideation, and symptoms of psychosis. Mr. Saunders reports he has been depressed for several months and has been binge drinking alcohol. He reports relational issues with his wife has been the primary stressor contributing to his distress. He express feelings of hopelessness, worthlessness, irritability, and isolation. He does admit to informing a friend, William, he see no reason to leave if he can not be with his wife. Patient does not appear to be exhibiting signs of agitation,

S has quite a strong baseline of strengths. Firstly, Mrs. S is a very kind man, never lashing out during interviews, always receptive of health provider interventions even when he might not agree. In addition, he has completed his high school diploma. Mr. S is also good at maintaining and looking after his room at the booth, as evidenced by the recounts of the case manager’s room visit. In addition, Mr. S always attends his medical appointments, and IM injection appointments, and has good insight on their importance. The patient is also has insight to find help from the institute or ER if warning signs, or symptoms creep up. Mr. S is also responsible enough to call if he cannot make an appointment. In addition, he has good personal hygiene during his visits. Mr. S also has a number of deficits he has to combat. First of the deficits, include his ¬¬lack of social support; like previously mentioned about his parents, half-sister or half-brother. This can put Mr. S at risk for redevelopment of avolition and negative symptoms that have previously hindered his success, and will become deficits. Another deficit is his inability to manage his own finances and money, as he gets his welfare allowance every week from his case manager, and social worker, who also manages his finances. A third deficit might be his inability to get food. The final deficit, would be his situation with the Booth Center, as he might find himself to be homeless. Mr. S’ only resources are the case manager, the writer, social worker, and the FEPP

The direct clinical practice offers a solid structure to construct the standards of expert care, consultation, collaboration, evidence-based care, leadership as well as ethical decision-making. Direct client contact assist J.F. to effectively direct as well as refer direct patient care as needed. She evaluates patterns in individuals diagnostic data as well as appropriate interventions, recommended medications, obtaining additional diagnostic testing and/or supplying education. J.F. has establishes a healing partnership with all her clients. Her patients are open to her about their feelings as well as existing stressors. She admits to closely monitoring as well as proactively paying attention to them while analyzing their psychological wellness. An APRN such as J.F. communicates and interact with with her client| in order to be in tune with the patient’s psychosocial requirements. To achieve this, J.F. carries out a comprehensive|an extensive psychosocial history and physical. The demands of her patients assist J.F. to individualize treatments and review the effectiveness of care given to the patient. As a result, the relationship and direct patient treatment J.F. has effectively established a mutual understanding with her patients. The patients seem to value her awareness, respect her as a professional and accept her advice without hesitation.

The patient moved from Troy, New York a few months ago after getting married. She is living in Barrington and working in Northwood. They moved because her husband's job. The patient would like to talk about depression. She tells me that she has had anxiety her whole life. She was never evaluated by a physician for this, as her parents reportedly did not believe in any medication. She says that she struggled with her anxiety throughout her teen years and went to counseling in college, but never saw a physician at that time. She is no longer in counseling. In addition to feeling anxious, she feels depressed. She says

The client’s primary care physician is Dr. Damian Covington. The client does not currently have a psychiatrist.

MENTAL UPDATE: Client was recently diagnosed by the on-site psychiatrist with Axis 1: Minimal cognitive impairment; 331.83 (primary) rule out and Anxiety about health -300.09 vs. illness anxiety d/o vs. pt seeking secondary gain. No referral or medication was prescribed.

D-Met with the patient upon request. Upon meeting with the patient, the patient appeared upset and addressed her frustration in this writer's office. According to the patient, she's upset with her PCP forcing the patient to admit herself to the psych. ward to get on medication. Failure to do so, her PCP will complete the medication protection for her electricity. The patient owes over $3000 and with the protection, her light company cannot turn off her lights. Please note, the patient was pacing back and forth and getting emotional. This writer consolet he patient and validated her feelings. According to the patient, she reports that CMHA informed her that she in order to get into their clinic, an evaluation is needed whereas the evaluation can be completed at a hospital; however, the patient is worried about being admitted. Please note, the patient denies any suicidal or homocidal ideation when questioned.

Patient presented to the ED via EMS after a attempted suicide by driving his car into a tree. Patient reports braking up with his girlfriend a month ago and experiencing depressive symptoms. He reports that his girlfriend and him had a 7 year relationship, which he shared a with a 6 year old daughter from the relationship. Patient expresses that in the past he has been verbal aggressive towards her and she has recently moved into er mothers home. The patient reports since her leaving he has been having suicidal thought. He reports that he never attempted suicide, however has had a history of depression and a verbally abusive father. The patient express a poor appetite, sleep, and loss in usual pleasure, which is praying for change in his relationship.

Psychiatric- patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services, she refused for now.

Mr. Moore is a 24 year old male who presented to the ED with reports of experiencing depressive symptoms, vague suicidal ideation without a plan, and recent episodes of anxiety. At the time of the assessment Mr. Moore denies current suicidal ideation, homicidal ideation, and symptoms of psychosis. He reported to suicidal ideation would come and go, however never had a plan . Mr. Moore appears calm, cooperative and in good spirits during assessment. He reports a history of anxiety, depression, and emotional trauma by father at the age of 8 years old. Mr. Moore expressed he started noticing increase anxiety when he had to speak in large groups, present in school, driving, and engaging in social actives. He states, "Over the past 16 years my father has been out my live, when I was younger he would hit me if he felt I said anything out of line." Mr. Moore reports recent relationship issues and separation with his fiance. He reports due to him not engaging in many social actives his fiance has left him. He reports for many year going to Randolph Counseling Center for his anxiety. He reports positive results from services. Mr. Moore mention coming to the hospital last Thursday for his anxiety and bring prescribed a 30day supply of Ativan, which he reports has helped him become more stable when engaging in actives,like driving his mother's car. He reports depressive comes and goes depending on the mood he is in. He describes symptoms on occasion as feelings of

Within the team I work, the main intervention that is used is a screening tool. The tool encourages both the professional and the service user to develop a therapeutic relationship by encouraging two-way communication. It is a need - led assessment where not only the service user and professional is involved, but also enables family, carer and outside agency input. The initial data collected using this tool identifies who will be involved in the process and assists in looking at the statutory needs of the service user. We are then able to look at previous social issues, including accommodation and finances which may highlight potential issues now or in the future.

There hope is to diagnosis and treat the illness at hand. This article questions the validity of diagnosing each patient. If the doctors or the nurses’ diagnosis is wrong then, the treatment will also be wrong. This can create complications for all parties at hand. Most often there is protocol that most doctors have to follow when diagnosing a patient “However, it should not be forgotten that they are all using same diagnostic manual, and probability of diagnosing a person is in depression with same instructions.”(). Now this makes a person question whether the validity is of the doctor or the protocol. If it is the protocol than that is something that needs to be evaluated. At the time the DSM system was in use for diagnosing a patient. At the time of this experiment Rosenhan used the DSM-II statistical evaluation. Years later this statistical data was look over, “According to Mattison, Cantwell, Russell, Will (1979) general inter-rater reliability of DSM-II was about %57 and %54 for axis I in DSM-III. In DSM III, which is published twelve years later after first version of DSM II, reliability scores of psychosis, conduct disorder, hyperactivity, and mental retardation was slightly higher than general reliability scores; however, as it is accepted today with the circumstance of logical base, reliability under 0.7-0.8 is found questionable and possibility of error is

Phil came into the clinic because his wife had requested him to receive some professional help. While he was at the clinic, the meeting did not last long. He was there for about an hour and I was able to determine some psychological disorders that Phil may be suffering from. Phil was asked to come back in for follow-up sessions which he will be asked more questions and complete assessments that are the appropriate diagnosis of Phil.