Dr. O. J. Sahler is the George Washington Goler Professor in Pediatrics, and Professor of Psychiatry, Medical Humanities & Bioethics and Oncology at University of Rochester School of Medicine & Dentistry. She is a member of the Divisions of Adolescent Medicine, Pediatric Hematology/Oncology and Pediatric Palliative Care. She is the director of Pediatric Psychosocial Oncology Services and Research and Director of the Childhood Cancer Long-term Survivors Program.
Dr. Sahler has been the principal investigator on multi-institutional Foundation- and NIH- funded grants and contracts for more than 30 years, many focused on the development, implementation, and dissemination of the Bright IDEAS Problem-Solving Skills Training intervention. She has published three books and more than 150 peer-reviewed articles, book chapters, and computer-based cases, and presented nationally and internationally on children’s understanding of illness and death, adaptation to chronic or life-threatening illness, adjustment to psychological distress using cognitive-behavioral and integrative medicine approaches, and on medical education.
Questions & Answers
Problem-solving skills training (PSST) is a generic approach to using problem solving to reduce stress and anxiety about actions to be taken or decisions to be made. It provides a structured approach to weighing risks and benefits of various options and then prompts a critical appraisal of the success of the decision/action option chosen. The specific name of the intervention, Bright IDEAS, is an acronym for the actual steps of the problem-solving process (Bright = optimism that the problem can be solved---an essential element for successfully using the approach; I=Identify the problem, D=determine your options, E=Evaluate your options and choose the best. A=Act, S=See if it worked).
The process is independent of the particular issue being addressed. In this regard, there are NO restrictions on the situations in which Bright IDEAS can be applied. Similarly, there are no restrictions on who can use the process as long as they are old enough to understand the steps, especially the concept of alternatives (probably can be used independently at age 8 and above; can be used with assistance beginning at age 5).
For convenience and uniformity of experiences, our study population has been mothers of children newly diagnosed with cancer. In actuality, we could have recruited fathers, grandparents, or the patients themselves. We also could have applied the intervention to any situation within the trajectory of cancer treatment and survivorship (returning to school, dealing with bullying, coming off treatment, relapse). The process can be used for a spectrum of problems associated with a specific time or event, or it can be used once to manage a specific issue.
Although often thought of in connection with instrumental or resource acquisition problems (How can I possibly keep my job when I have to be at the hospital? I wish people would stop calling me over and over again to see how my son is doing)), PSST is also a useful way to approach emotion-focused problems (my husband won’t talk with me about our daughter’s illness; I feel so tired and down all the time) that may be more a caretaker issue than directly related to the patient and treatment.
Facilitators: Bright IDEAS is an 8-session manualized intervention, usually delivered individually face-to-face or over the phone following 1 or 2 face-to-face sessions. Our trainers are experienced mental health providers, behavioral science trained professionals, or advanced psychology graduate students who are adept at relating to people in crisis. PSST is provided in a warm and friendly atmosphere and capitalizes on positive reinforcement.
Challenges: The greatest drawback is that the intervention as currently delivered is time intensive. Our particular study population did not lend itself to group presentation because of the many adjustments and uncertainties associated with early cancer treatment. An 8-week group approach at some later time during treatment might be a feasible solution, and could include other family members as well.
Adaptation: For purposes of our research, we have not, as yet, modified our approach in several ways that might make it more attractive to a resource-limited institution. Several adaptations include group presentation (as mentioned above). Another modification, offering the course over two 4-hour days a couple of weeks apart would allow participants to learn the specific steps, apply them to real-life situations, and then meet to discuss problems, ask questions, share successful and not-so-successful implementation of Bright IDEAS. Using what they have learned, participants couldproblem solve improvements. We have made limited use of the telephone and, thus far, no use of Skype, which might reduce the burden of the intervention.
Evaluation: We have used measures of problem-solving skill level, anxiety, and depression in our studies. These are available (some at a cost to be paid to the developer) and would be critical to measuring the effectiveness of the intervention, even as QI tools.
We were funded to develop an Online version of Bright IDEAS in mid 2012. We enrolled our first study participants in late 2013-early 2014 at our various data collection sites. We are enrolling mothers, fathers, and grandparents or other primary caregivers. The structure of the online manual or “workbook” is engaging enough that we could adapt it for use with even elementary school aged patients, with modest changes. We are also seeking support to broaden the group of trained professionals who can teach PSST to include not only psychologists but also physicians, nurses, and social workers. Training will be accomplished through 1 ½ day workshops with year-long follow-up by long-distance mentoring. All of our materials are available at the RTIPS website or by contacting me at OJ_Sahler@urmc.rochester.edu