Tuesday, June 17, 2008

Best Practices and Resources for Psychopharmacotherapy: Interview with Kia J. Bentley, Ph.D.

[Episode 41] Today’s podcast is the second of three interviews with Kia J. Bentley on psychopharmacotherapy. Kia J. Bentley is Professor of social work at Virginia Commonwealth University in Richmond Virginia and has published extensively in the area of psychopharmacotherapy (see references below). Psychopharmacotherapy refers to the treatment of psychiatric disorders with the use of medication. But, as Kia pointed out in our interview, psychopharmacotherapy is not just about giving people medication and calling it a day. It is an approach to treatment that acknowledges the strengths and limitations of medications.

In today’s podcast, Kia talks about best practices for referring clients for psychiatric medications, resources for social workers interested in learning more about psychopharmacotherapy and how social workers can think critically about psychopharmacotherapy for both adults and children. In the first interview, Kia and I talked about key concepts and the role that social workers can play in psychopharmacotherapy. In the third interview, Kia talks about a recent qualitative research study she did to explore the meaning that medication had for residents in a psychiatric facility.

Download MP3 [21:08]

Six Best Practices for Referring Clients for Psychiatric Medication (Bentley, Walsh, & Farmer, 2005):
  1. Establishing and maintaining collaborative relationships with prescribers;
  2. Sharing up-to-date information about psychiatric medications with clientsand families;
  3. Helping clients and families understand and manage the meaning of medication;
  4. Preparing clients and families for the actual medication evaluation and anticipating issues that might emerge;
  5. Following up on the results of the referral;
  6. Managing legal and ethical concerns.
Today's interview was recorded using the "voice-over-internet" program Skype. This is because Kia was in Richmond, VA and I was in Pittsburgh, PA. There are some pops and hisses, but not enough to detract from the quality of the interview. If you have questions or comments for Kia or me, please leave your comments below and we'll get back to you.

About Kia J. Bentley, Ph.D.

Dr. Bentley is a tenured Professor and Director of the Ph.D. Program at the Social Work at Virginia Commonwealth University where she has taught since 1989. She publishes, presents and teaches social work practice in mental health, especially serving people with severe mental illness and is involved in several community-based research projects. One research project concerns the meaning of and impact of taking psychiatric medication, in partnership with Gateway Homes, a residential treatment facility for adults with serious mental illness. You can hear more about that project in our third interview. Another in collaboration with colleague Sarah Kye Price, is a study of decision-making about psychiatric medication among pregnant and postpartum women.

She is the former chair of Central State Hospital’s Human Rights Committee, a state psychiatric facility in Petersburg, Virginia, the former Chair of the Virginia Mental Health Planning Council, and served six years on the Board of Virginia’s chapter of the advocacy organization the National Alliance on Mental Illness (NAMI). She has been active with the Council on Social Work Education for many years, currently serving as consulting editor of the Journal of Social Work Education and was one of last year’s winners of the “Reviewer of the Year Award.” She is an active and enthusiastic site visit chair and accreditation consultant. In the past she has served on their Commission on the Role & Status of Women for 6 years and their Commission on Accreditation for three.




Jonathan Singer: Hello and welcome! You’ve found the social work podcast. My name is Jonathan Singer and I’ll be your host as we explore all things social work.

Today’s podcast is the first of three interviews with Kia Bentley on Psychopharmacotherapy. Kia Bentley is Professor of social work at Virginia Commonwealth University in Richmond, Virginia and has published extensively in the area of psychopharmacotherapy. Now Psychopharmacotherapy is a big, long word that refers to the treatment of psychiatric disorders with the use of medication. But, as Kia pointed out in our interview, psychopharmacotherapy is not just about giving people medication and calling it a day. It is an approach to treatment that acknowledges the strengths and limitations of medications.

In our interview, we talked about why social workers should be familiar with psychopharmacotherapy, legal and ethical limitations of social workers discussing medications with clients, some challenges social workers might have with agency policy around medications, and the role of social workers on a treatment team. Now as I mentioned this is the first of three interviews. The next interview focuses on best practices for referring clients for psychiatric medications, resources for social workers interested in learning more about psychopharmacotherapy and how social workers can think critically about psychopharmacotherapy for adults and children. In the third interview, Kia talks about a recent, unpublished, qualitative research study she did to explore the meaning that medication had for residents in a psychiatric facility.

All three interviews were recorded using Skype. This is because Kia was in Richmond, VA and I was in Pittsburgh, PA. During the interviews I noticed some pops and hisses, presumably because the network was congested or there were bottlenecks with the bandwidth, I’m not really sure what that means. But regardless, the problems were not enough to detract from the interviews. If you have questions or comments for Kia or me about this topic, or any topic on the podcast, please go to the social work podcast website at www.socialworkpodcast.com. And now, onto the interview with Kia Bentley and psychopharmacotherapy.

Jonathan Singer: You identified six dimensions that constitute best practices for referring clients for psychiatric medications, and this was in an article that you wrote a couple of years ago. [Yes] I was wondering if you could talk about what those best practices are?

Kia Bentley: Well first of all I really did like that article that came out in best practices in mental health because I think that, well a couple of things, the reason why the article got written was because in our national survey of social workers, of practicing social workers, we had just under a 1,000. The second most frequent thing that social workers did was make referrals to physicians around medication, to do a medication assessment.  The first most frequent thing by the way was discussing feelings about medication.  So, but anyway, so because social workers in the real world out there are making referrals, and I looked to the literature saying “okay, well, what’s a good referral”. You know, what constitutes great social work practice with respect to referring, and you know basically there’s very little out there and so we did. We created, generated six ideas, kind of based on the literature, not much empirical research, but we felt like we could put out these six ideas.  And the first one talks about establishing and maintaining collaborative relationships with prescribers, so difficult this day and age with that notion of, you know, in the article talks about referral highways for example is, that you build a network of prescribers that you can work with no matter if you are in a public setting or a private setting, or whatever, you develop sort of a network of people that you trust and also you’re also letting them know about the services that either you provide or your agency provides in terms of working with people.  So that was one of the things, how hard it is to maintain those lasting collaborations.  Also to be a great prescriber, I mean referrer, you need to be able to share information about psychiatric medications, and that I talk, in that part of the article, about the heart of social work practice is problem solving, and so sharing information, helping people look at the pros and cons of medications, I mean that just ought to be practically second nature.  And then I do talk about helping clients manage the meaning of medication, I mean and this is what my more recent research has been about, is, you know, taking psychiatric medications is not a benign thing, I think someone said that in the center of my sort of meaning of, meaning results, was that taking medication… well, I have to find this because it’s so good Jonathan, so I may have to just look for a second where my little thing is.  Okay, taking medication insights meaning, influences identity, and impacts life, and so if that’s true, then social workers training puts us in a perfect position to help people manage that.  What does it mean when someone tells you that perhaps you should consider having a medication evaluation, what does that mean to you, what kind of an impact does that have on you? And then if you actually get to a prescriber and they decide that in conjunction with you that maybe you should receive a prescription and try it, what does that mean to you, what kind of impact does that have on you?  Do you feel relief, do you feel fear, what do you feel?  And social workers should be helping people manage those things.

In addition, social workers should be preparing, literally emotionally preparing, and informationally, practically preparing clients for referrals, you know, what can they expect when they go to see their prescriber, whether it’s their OBGYN, a general practitioner, a nurse practitioner, a psychiatrist, whoever it might be. What can you expect, and again how are you going to deal with that?  And then I do make the argument, we make the argument, that a great referral should be not steering, the term steering, which means sort of writing a name on a piece of a paper and throwing a phone number at somebody, but a great referral really is following up and finding out the results of that attempted connection.  And if we can discuss, I think the literature calls that cementing the connection.

And then again, if there are legal or ethical concerns around decision making and coercion, or you know sometimes actually social workers have in our survey showed that they were particularly concerned around social justice issues for example, like they had clients that needed medication and we know that there are some ones that are effective in populations, 70-75% effective, that we can’t get access to, the public mental health system has waiting lists. And so, what do you do when you have to sort of tolerate waiting lists? Or another less frequent one is - what do you do when you’re not completely sure about the quality of psychopharmacological intervention being given out? That you have doubts about it. Those would be some other kind of ethical concerns that might come up.  So, but the argument basically was, let’s define excellent social work practice. Let’s go ahead and expand that definition to mean being an excellent referrer.

Jonathan Singer:  I think everything that you just talked about it makes so much sense and listening to you talk about it, it’s sort of surprising that nobody has talked about it before, or [Yeah] nobody has published it in sort of one place before.  And I’ll go ahead and put up the link, to the, I’ll put the reference on the Social Work Podcast website, [Okay] and a link to the article because it definitely sounds like something that social workers should have access to.  I was wondering what other resources are available for social workers who are interested in improving their knowledge about psychopharmacotherapy or medications in general?

Kia Bentley: Oh that’s a good question.  Well, a couple of different sort of categories, I’ll say one is I’ll just say books targeted to us, and so that would be psychopharmacology texts that are written for non-medical providers.  So obviously, you know, my own book with Joe Walsh is one of those books, that you know basically half of the book is a primer of psychopharmacology and the other half talks about social work roles.  But Brooks, Cole, and Thompson also publish other books like Psychotherapist resource on psychiatric medication by Buewlo, Herbert, and Buewlo, and there’s another one by Ingersoll and Rak called Psychopharmacology for the helping professions, and so there are some books written for us, in our own field as well, there is June Goleski has written one that comes about pretty regular.  So that’s one way of going.  I really like, and when I teach courses on social work and psychopharmacology, psychiatric medication reference guides that are written for nurses because they’re usually written in an approachable language and not overly sort of sophisticated in their terminology, so I like those.  Then the other thing to look for is mainly review articles, so you know the American Psychiatric Association puts out review guidelines and those kinds of big articles that are summarizing the literature are good, and I subscribe to a listerserv, Medscape Psychiatry, and so once a week I think I get updates and opportunities to read up to date articles on what’s going on.  But clearly those are all, you know, going to have a certain sort of I’ll say bias towards being pro-medication and suggesting that, you know, this is what people should be doing, so you have to kind of recognize that.  Another, two other places, I mentioned the personal account books, so books written by people who have struggled with emotional problems or mental illnesses that have written about their experiences, I think that’s a really good place for people who want to know more about medications and also be more compassionate, be more compassionate social workers.  And so I think to stay immersed in the experience of clients who take medications, one of the ways you can do that is to read personal account books.  And then the final place would be to, you know there are some well known I’ll call them trade books, so they’re written for the public but, but if, you know, I’m looking at one right now called Straight Talk about Psychiatric Medication for Kids by Timothy Wilens, W-I, I hope I am pronouncing that right, W-I-L-E-N-S and it’s in it’s like kazillionth edition and it’s just a very, very approachable guide written by a, he’s a MD, but it’s for, you know, parents and kids, and so it’s kind of, I would describe it as trustworthy and approachable.

Jonathan Singer: So, you’re really recommending a wide variety of academic and non-academic resources. Clearly the academic resources make sense for folks in a professional program, but could you say a little more about why social workers should read these personal accounts?

Kia Bentley: Well, I, the personal accounts is really to keep the social worker immersed in that life lived experience of clients, and so it’s not that you’re reading a personal account book to find out sort of the effectiveness rates of Clozaril, or Celexa, you know, obviously you’re not trying to garner that kind of information from a personal account book, but you are trying to gain insight and empathy into their experience of people who have struggled with the kinds of disorders treated by these medications so that you can be a better social worker, so that you can be more humble, and more appreciative.  In addition to being that kind of social worker, what I’m implying to you about the consumer of information is my argument that we need, which I think that everyone who writes about this in our field would agree, is that social workers, as I said, need to keep a critical perspective about medications.  We need to understand the sociopolitical context in which medications are prescribed, the power of drug companies to define what treatment looks like, the fact that prescribing medications you know has perpetuated sort of a medical dominance, and sometimes to the detriment of psychosocial interventions, so and we need to not, as I said before, you know, I’m not suggesting that we become cheerleaders for the use of medications, a great, a critical perspective means understanding that if the effectiveness rates published is 70%, that means that 30% of folks aren’t being helped in a way that’s being considered clinically significant and so let’s not forget about those kinds of folks. And we can’t forget about the men and women of good will who, in our field like David Cohen, who has called attention to some of the biases in research, we can’t turn our heads to that.  But my argument is that we can’t turn our heads to the tens of thousands of people who have been helped and in fact my own study at, that I just talked about, that I completed, you know many, many, many of the clients basically described medications as a life changing, godsend, and that they were deeply grateful for having medications that were useful, in spite of these incredible histories of struggling to sort of get to a place where they were helpful, with long histories of hospitalizations, and terrible side effects, and things like that.  So, we have to understand that people are on a journey and medications can sometimes help them along that journey and sometimes, you know, it’s not such a pretty story, and I think that if we go, social workers go in with that perspective, that critical perspective, that typical, understanding the sociopolitical context, staying immersed in the experience of clients, then we’ll be better social workers.

Jonathan Singer: You’ve convinced me.  [Laughing] No, but seriously, I really like how you’re advocating a critical perspective on mediation because I think social work sometimes aligns itself with a perspective that the medical model and therefore medications are just bad and that in order to be true social workers we can’t acknowledge the good in medications.  But you’re saying you know what, there are a lot of different people out there and they have a lot of different experiences and it’s not up to us to say what is best for clients sight on-scene and so to keep an open mind to medications as a possibility.

Kia Bentley: Jon, I don’t know if you’ll use this or not, but I certainly remember when I was a brand new MSW student back in 1978 and I remember distinctly having an anti-medication kind of view, and I really do now believe that it was really tied up with my frustration about the lack of acknowledgement of the power of psychosocial interventions.  And so, somehow I sort of took it out on this other treatment option, which was quote “more medical”, certainly more biological, and I now think I’ve grown up and said you know what I need to practice some professional humility, other professions and other kinds of interventions offer something to our clients and I should know about it, and not just to any client but to many clients.  So, I think that giving up that sort of anti-medication view involves professional humility.  Now having said that, I do collaborate and I’m very familiar with people in our own field who really have stressed the, and have argued that recurrent clinical research around drugs is reaped or racked with bias and that too often clients are given medication with other options.  And you know you have to look at the grain of truth in that, for example with kids, I just did this article with Katherine Collins at Maryland, our book chapter actually on kids, and the conclusion around kids is are kids over medicated? Yes. Are kids under-medicated? Yes. They both are true.  Some kids are out there taking, being prescribed medications as a shortcut and without adequate assessment, without adequate exposure to all the options, particularly the psychosocial and behavioral interventions, so yes that’s true.  Is it true that there are kids out there that have real behavioral and emotional needs that medication can help with, and yet they don’t have access to it or that, you know, yes that is true as well and so that’s quite the dilemma.

Jonathan Singer: It is a dilemma; it’s interesting that you answered both of those questions “yes”.  What publication is that coming out in or what book is that coming out in?

Kia Bentley: That came out in Cynthia Franklin, and Harris, and Paula Allen-Meares’s book the School Services Sourcebook in 2006.  So, it’s just a book chapter on psychopharmacology treatment with kids and adolescents, and basically we argued in that, that wow, social workers that work with kids and medication think of what they need to understand Jonathan, I mean they need to understand the controversies about use with kids because parents and kids are going to come to them with questions about rumors they’ve heard, and worries about physical and psychological development, worries about what this will mean for, the meaning, an identity of their adolescent kid or their other kid, which Jerry Flourish in our own field has written about.  What about backlash against medication in schools, will this mean, is there sort of an anti-medication bias that’s going on now that will prevent kids that need help? What about off label use, what about the use of research with kids? And so, we tried to, in that article just make the argument again, that social workers knowledge isn’t just about the name of the drug, it’s really about the sort of social context that medication prescribing is happening right now.

Jonathan Singer: It sounds like there’s certainly room for a podcast on psychopharm and kids.

Kia Bentley: [Laughing] There might be.

Jonathan Singer: Among other things, okay.

Kia Bentley: Yes.
Jonathan Singer: Well, this is has been fascinating. I really enjoy this and appreciated you providing all of your insight and wisdom on this topic and I suspect that our listeners will be similarly appreciative.

Kia Bentley: Well thanks.

End interview

Please join us for part three of this podcast when Kia talks about a recent qualitative research study she did to explore the meaning that medication had for residents in a psychiatric facility.

[Outro music] I’m Jonathan Singer and thanks for being with me today for another episode of the social work podcast. If you missed and episode or have suggestions for future episodes please visit socialworkpodcasts.com. If you would like to support the podcast please visit our online store at cafepress.com/swpodcasts. To all the social workers out there, keep up the good work. We’ll see you next time at the social work podcast.

References and Resources

During the podcast, Kia mentioned that she receives a weekly email about psychopharmacotherapy from Medscape. To learn more about Medscape: Psychiatry and Mental Health, visit http://www.medscape.com/psychiatry. To register for free access to articles and newletters on Medscape, visit https://profreg.medscape.com/px/registration.do?cid=med

APA (6th ed) citation for this podcast:

Singer, J. B. (Host). (2008, June 17). Best practices and resources for psychopharmacotherapy: Interview with Kia J. Bentley, Ph.D. [Episode 41]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2008/06/best-practices-and-resources-for.html

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