Through the Creating Opportunities for Personal Empowerment (COPE) program, children and adolescents can receive cognitive behavioral therapy (CBT) even if they do not have access to a mental health care provider.
The 7-session, manualized program allows an instructor such as a teacher or primary care doctor to use evidence-based techniques to help young people struggling with depression, anxiety, or stress. It was developed by researcher Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, who has worked as a nurse, pediatric nurse practitioner, and psychiatric mental health nurse practitioner.
In this Q&A, in conjunction with National Nurse Practitioner Week 2020, Dr. Melnyk describes the founding and future of the program, the outcomes and implementation of it, and barriers still faced by children and adolescents who are in need of mental health treatment.
Q: Can you describe how and why the COPE program was started?
A: I lost my mom when I was 15 years of age. She wasn't having any issues outside of headaches. She sneezed, and stroked out right in front of me. You can imagine, I suffered with terrible post-traumatic stress disorder, depression, anxiety. Where I grew up in southwestern rural Pennsylvania, there was no help for me at all. There was no counseling.
I was taken to my family physician after about 4 months of not eating, sleeping, doing well in school. That provider did what so many do today, got out his prescription pad, wrote a script for Valium, said, "Give Bern one of these every night. She'll sleep and be just fine." Bottom line is, there was no help for me; no counseling.
Flash forward to 2020. Most recent figures before the pandemic showed that about 1 in 5 children and teens have a mental health problem, yet less than about 30 percent get any treatment. Those mental health issues are skyrocketing even more now. One of the latest studies has shown among 18 to 24‑year‑olds, 25 percent have thought of suicide since the pandemic struck.
That whole traumatic event triggered a passion in me to become a nurse, a pediatric nurse practitioner, a psychiatric mental health nurse practitioner, and go on to get my PhD so I could develop and test cognitive behavior therapy‑based interventions to improve mental health outcomes in children, teens, and young adults.
After I became a psychiatric nurse practitioner, I started to become specialized in cognitive behavior therapy and say to myself, "What happens if I could manualize cognitive behavioral therapy so that other people besides psychiatric providers could actually deliver it to children, teens, and college students? We could help so many more than are getting help today." That's how it came to be.
Q: What outcomes have you seen from the COPE program?
A: I've got over 20 years of testing, developing, and refining this program through 17 studies. In every single population, the COPE program has been delivered, we see the same outcomes: drops in stress, anxiety, depression, suicidal thinking, and an improvement in healthy lifestyle behaviors, and even academic performance.
Q: In what settings is COPE being used and how widely used it is?
I'm blessed because not many researchers can say what they spent their whole life developing and testing through research is being used in the real world to improve outcomes. COPE is being used now in 49 states, 5 countries, primary care settings, community health settings, mental health settings, schools, and universities.
Q: How has the delivery of the program changed during the pandemic?
A: It's being used more now, to be honest with you. Some of the practitioners that deliver it in primary care settings have even gone to virtual delivery of COPE because of the pandemic.
I also want to share that providers are getting reimbursed to deliver COPE in primary care settings. That's huge. So oftentimes, providers have a hard time taking something else on unless they can get reimbursed for it. Nurse practitioners, social workers, psychologists, I haven't had one person call me to say they submitted this for reimbursement, and it got rejected. It is getting covered, these 7 COPE sessions.
Q: What do you see as the biggest barriers to children and adolescents getting appropriate treatment for depression and anxiety?
A: One, screening is not being done in every practice, like primary care practice, throughout the country. Stigma is still an issue, even in 2020. And, not enough mental health providers. We still have a severe shortage of mental health providers in so many counties throughout the nation.
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