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Olthuis JV, Kaltenbach E, Giberson E, Saryeddine T, Asmundson GJG, Carleton RN, Cramm H, Crombach A, Devlin J, Mack J, Lingley-Pottie P, Rao S, Sullivan M, Wozney L, McGrath PJ. Paraprofessional delivery of online narrative exposure therapy for firefighters. J Trauma Stress 2023; 36:772-784. [PMID: 37291963 DOI: 10.1002/jts.22941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
Firefighters are at increased risk for developing posttraumatic stress disorder (PTSD) and face numerous barriers to accessing mental health care. Innovative ways to increase access to evidence-based interventions are needed. This study was a case series testing the acceptability, feasibility, and preliminary effectiveness of a paraprofessional-delivered, virtual narrative exposure therapy (eNET) intervention for PTSD. Participants were 21 firefighters who met the criteria for clinical or subclinical probable PTSD and completed 10-12 sessions of eNET via videoconference. Participants completed self-report measures pre- and postintervention and at 2- and 6-month follow-ups as well as a postintervention qualitative interview. Paired samples t tests evidenced statistically significant decreases in PTSD, anxiety, and depressive symptom severity and functional impairment from pre- to postintervention, ds = 1.08-1.33, and in PTSD and anxiety symptom severity and functional impairment from preintervention to 6-month follow-up, ds = 0.69-1.10. The average PTSD symptom severity score fell from above to below the clinical cutoff for probable PTSD at postintervention and follow-ups. Qualitative interviews indicated that paraprofessionals were considered central to participants' success and experience with the intervention. No adverse events or safety concerns were raised. This study is an important step in demonstrating that appropriately trained and supervised paraprofessionals can effectively deliver eNET to firefighters with PTSD.
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Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Emma Giberson
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Tina Saryeddine
- Canadian Association of Fire Chiefs, Ottawa, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | | | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Anselm Crombach
- Department of Psychology, Universität des Saarlandes, Saarbrücken, Germany
| | - Julie Devlin
- Conservation and Protection, Fisheries and Oceans Canada, Ottawa, Ontario, Canada
| | - Jeff Mack
- Fredericton Fire Department, Fredericton, New Brunswick, Canada
| | - Patricia Lingley-Pottie
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjay Rao
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Sullivan
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Lori Wozney
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Patrick J McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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McQuillin SD, Hagler MA, Werntz A, Rhodes JE. Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:201-220. [PMID: 34318526 DOI: 10.1002/ajcp.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.
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Affiliation(s)
- Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Matthew A Hagler
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Alexandra Werntz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jean E Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Diebold A, Ciolino JD, Johnson JK, Yeh C, Gollan JK, Tandon SD. Comparing Fidelity Outcomes of Paraprofessional and Professional Delivery of a Perinatal Depression Preventive Intervention. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:597-605. [PMID: 32086657 PMCID: PMC7253394 DOI: 10.1007/s10488-020-01022-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mothers and Babies (MB), a perinatal depression preventive intervention, has proven effective in decreasing depressive symptoms and preventing onset of major depression. An ongoing cluster-randomized trial is comparing the effectiveness of the six-session MB group intervention led by paraprofessionals versus mental health professionals. Twenty percent of all audio-recorded intervention sessions were randomly selected for fidelity checks. Analyses assessed mean facilitator adherence and competency overall, by study arm, and by session; and, examined site, facilitator, and client-specific effects. There were no significant differences found between study arms. Findings show paraprofessionals can deliver MB with similar fidelity as mental health professionals.
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Affiliation(s)
- Alicia Diebold
- Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA.
| | - Jody D Ciolino
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica K Johnson
- Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jackie K Gollan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - S Darius Tandon
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Landreville P, Gosselin P, Grenier S, Carmichael PH. Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:324. [PMID: 34022795 PMCID: PMC8140311 DOI: 10.1186/s12877-021-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults. Methods We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes. Discussion This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce. Trial registration The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.
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Affiliation(s)
- Philippe Landreville
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec City, Quebec, G1V 0A6, Canada. .,Centre d'Excellence sur le Vieillissement de Québec, Quebec City, Canada. .,VITAM - Centre de Recherche en Santé Durable, Quebec City, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Canada.
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Canada.,Institut Universitaire de Première Ligne en Santé et Services Sociaux (IUPLSSS), Sherbrooke, Canada
| | - Sébastien Grenier
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Canada
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Smith AM, Stewart K, Baul T, Valentine SE. Peer delivery of a brief cognitive-behavioral treatment for posttraumatic stress disorder: A hybrid effectiveness-implementation pilot study. J Clin Psychol 2020; 76:2133-2154. [PMID: 32632945 PMCID: PMC7665989 DOI: 10.1002/jclp.23020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/02/2020] [Accepted: 06/04/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) treatment delivery by peer specialist providers could increase access to and engagement with PTSD treatment in low resource settings. The current pilot study tested the feasibility, acceptability, and initial effectiveness of a peer-delivered, brief cognitive-behavioral therapy for PTSD. METHOD Four certified peer specialists delivered the intervention to 18 participants with probable PTSD. We assessed PTSD symptoms weekly and administered surveys and interviews at baseline and posttreatment. RESULTS Our mixed-methods approach suggests that the intervention was feasible and acceptable, demonstrating high client satisfaction. We also found significant improvements in PTSD, depressive, anxiety, and general stress symptoms. CONCLUSIONS Peer-delivered interventions may be a good fit for addressing posttraumatic stress symptoms for people accessing care in low resource settings. Future research should evaluate peer-delivered PTSD treatment as a strategy for both reducing symptoms and improving access and engagement in professional care.
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Affiliation(s)
- Ashley M. Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
| | - Kaylee Stewart
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
| | - Tithi Baul
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
| | - Sarah E. Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Suite 1150, Boston, MA, 02118, U.S
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Kunik ME, Mills WL, Amspoker AB, Cully JA, Kraus-Schuman C, Stanley M, Wilson NL. Expanding the geriatric mental health workforce through utilization of non-licensed providers. Aging Ment Health 2017; 21:954-960. [PMID: 27243369 PMCID: PMC5568805 DOI: 10.1080/13607863.2016.1186150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We evaluate policy and practice strategies for bolstering the geriatric mental healthcare workforce and describe costs and considerations of implementing one approach. METHOD Narrative overview of the literature and policy retrieved from searches of databases, hand searches, and authoritative texts. We identified three proposed strategies to increase the geriatric mental healthcare workforce: (1) production of more geriatric mental health providers; (2) team-based care; and (3) non-licensed providers. We evaluate each in terms of challenges and potential and provide estimates of costs, policy, and practice considerations for training, employing, and supervising non-licensed mental health providers. RESULTS Use of non-licensed providers is key to reforms needed to allow a more older adults to access necessary mental healthcare. Licensed and non-licensed providers have achieved similar improvements for generalized anxiety disorder among patients, although non-licensed providers did so at a lower cost. CONCLUSION Supervised non-licensed providers can extend the reach of licensed providers for specific mental health conditions, resulting in lower costs and increased number of patients treated. Although several barriers to implementation exist, policy and infrastructure changes that may support this type of care delivery model are emerging from reforms in financing and associated delivery initiatives created by the Affordable Care Act.
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Affiliation(s)
- Mark E. Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,South Central Mental Illness Research, Education and Clinical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Whitney L. Mills
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951
| | - Amber B. Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951
| | - Jeffrey A. Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,South Central Mental Illness Research, Education and Clinical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Cynthia Kraus-Schuman
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Melinda Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,South Central Mental Illness Research, Education and Clinical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Nancy L. Wilson
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951
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8
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Landry CM, Jackson AP, Tang L, Miranda J, Chung B, Jones F, Ong MK, Wells K. The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery. Psychiatr Serv 2017; 68:123-130. [PMID: 27629796 PMCID: PMC6320755 DOI: 10.1176/appi.ps.201500550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the effects of a depression care quality improvement (QI) intervention implemented by using Community Engagement and Planning (CEP), which supports collaboration across health and community-based agencies, or Resources for Services (RS), which provides technical assistance, on training participation and service delivery by primarily unlicensed, racially and ethnically diverse case managers in two low-income communities in Los Angeles. METHODS The study was a cluster-randomized trial with program-level assignment to CEP or RS for implementation of a QI initiative for providing training for depression care. Staff with patient contact in 84 health and community-based programs that were eligible for the provider outcomes substudy were invited to participate in training and to complete baseline and one-year follow-up surveys; 117 case managers (N=59, RS; N=58, CEP) from 52 programs completed follow-up. Primary outcomes were time spent providing services in community settings and use of depression case management and problem-solving practices. Secondary outcomes were depression knowledge and attitudes and perceived system barriers. RESULTS CEP case managers had greater participation in depression training, spent more time providing services in community settings, and used more problem-solving therapeutic approaches compared with RS case managers (p<.05). CONCLUSIONS Training participation, time spent providing services in community settings, and use of problem-solving skills among primarily unlicensed, racially and ethnically diverse case managers were greater in programs that used CEP rather than RS to implement depression care QI, suggesting that CEP offers a model for including case managers in communitywide depression care improvement efforts.
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Affiliation(s)
- Craig M Landry
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Aurora P Jackson
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Lingqi Tang
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Jeanne Miranda
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Bowen Chung
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Felica Jones
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Michael K Ong
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Kenneth Wells
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
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9
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Freshour JS, Amspoker AB, Yi M, Kunik ME, Wilson N, Kraus-Schuman C, Cully JA, Teng E, Williams S, Masozera N, Horsfield M, Stanley M. Cognitive behavior therapy for late-life generalized anxiety disorder delivered by lay and expert providers has lasting benefits. Int J Geriatr Psychiatry 2016; 31:1225-1232. [PMID: 26923925 DOI: 10.1002/gps.4431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Peaceful Living, a cognitive-behavioral treatment (CBT) for late-life generalized anxiety disorder (GAD), produced positive outcomes in GAD severity, anxiety, depression, insomnia, and mental health quality of life relative to usual care with treatment delivered by either bachelor-level lay providers (BLPs) or PhD-level expert providers (PLPs). We examined long-term maintenance of gains during 12 months following CBT for patients in this trial who received the intervention delivered by BLPs and PLPs and completed post-treatment assessments. METHODS Participants were 112 older adults (mean age, 66.83 years) with GAD recruited from primary care who received CBT from BLPs (n = 52) or PLPs (n = 60) and completed post-treatment assessments. Assessments were given at post-treatment and at 6- and 12-month follow-up. Primary outcomes assessed long-term maintenance of gains in worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory, Structured Interview Guide for the Hamilton Anxiety Scale). Secondary outcomes assessed depression (Patient Health Questionnaire), mental health quality of life (Medical Outcomes Study Short Form - mental wellness scale), and sleep (Insomnia Severity Index). RESULTS At 6- and 12-month follow-ups, post-treatment reductions in GAD severity, anxiety, depression, and improvements in mental health quality of life and sleep were maintained for patients in both groups. No differences were found, based on provider group. CONCLUSION Treatment of late-life anxiety delivered by nonexpert lay providers working under supervision of licensed providers has lasting benefits. These findings support the potential of new models of care for older adults that may expand reach of mental health services. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jessica S Freshour
- Michael E. DeBakey VA Medical Center, Houston, TX, USA. .,Baylor College of Medicine, Houston, TX, USA.
| | - Amber B Amspoker
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA
| | - Misung Yi
- The University of Texas School of Public Health, Houston, TX, USA
| | - Mark E Kunik
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Nancy Wilson
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA
| | | | - Jeffrey A Cully
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Ellen Teng
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | | | - Nicholas Masozera
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | | | - Melinda Stanley
- Baylor College of Medicine, Houston, TX, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBAKEY VA Medical Center, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
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10
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Olin SCS, Kerker B, Stein REK, Weiss D, Whitmyre ED, Hoagwood K, Horwitz SM. Can Postpartum Depression Be Managed in Pediatric Primary Care? J Womens Health (Larchmt) 2015; 25:381-90. [PMID: 26579952 DOI: 10.1089/jwh.2015.5438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Postpartum depression is prevalent among women who have had a baby within the last 12 months. Depression can compromise parenting practices, child development, and family stability. Effective treatments are available, but access to mental healthcare is challenging. Routine infant healthcare visits represent the most regular contact mothers have with the healthcare system, making pediatric primary care (PPC) an ideal venue for managing postpartum depression. METHODS We conducted a review of the published literature on postpartum depression programs. This was augmented with a Google search of major organizations' websites to identify relevant programs. Programs were included if they focused on clinical care practices, for at-risk or depressed women during the first year postpartum, which were delivered within the primary care setting. RESULTS We found that 18 programs focused on depression care for mothers of infants; 12 were developed for PPC. All programs used a screening tool. Psychosocial risk assessments were commonly used to guide care strategies, which included brief counseling, motivating help seeking, engaging social supports, and facilitating referrals. Available outcome data suggest the importance of addressing postpartum depression within primary care and providing staff training and support. The evidence is strongest in family practices and community-based health settings. More outcome data are needed in pediatric practices. CONCLUSION Postpartum depression can be managed within PPC. Psychosocial strategies can be integrated as part of anticipatory guidance. Critical supports for primary care clinicians, especially in pediatric practices, are needed to improve access to timely nonstigmatizing care.
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Affiliation(s)
- Su-Chin Serene Olin
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Bonnie Kerker
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Ruth E K Stein
- 2 Albert Einstein College of Medicine/Children's Hospital at Montefiore , Bronx, New York
| | - Dara Weiss
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Emma D Whitmyre
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Kimberly Hoagwood
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
| | - Sarah M Horwitz
- 1 Department of Child and Adolescent Psychiatry, New York University School of Medicine , New York, New York
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11
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Enabling lay providers to conduct CBT for older adults: key steps for expanding treatment capacity. Transl Behav Med 2015; 5:247-53. [PMID: 26327929 DOI: 10.1007/s13142-015-0306-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The Institute of Medicine advocates the examination of innovative models of care to expand mental health services available for older adults. This article describes training and supervision procedures in a recent clinical trial of cognitive behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD) delivered by bachelor-level lay providers (BLPs) and to Ph.D.-level expert providers (PLPs). Supervision and training differences, ratings by treatment integrity raters (TIRs), treatment characteristics, and patient perceptions between BLPs and PLPs are examined. The training and supervision procedures for BLPs led to comparable integrity ratings, patient perceptions, and treatment characteristics compared with PLPs. These results support this training protocol as a model for future implementation and effectiveness trials of CBT for late-life GAD, with treatment delivered by lay providers supervised by a licensed provider in other practice settings.
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12
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Bryan AEB, Arkowitz H. Meta-analysis of the effects of peer-administered psychosocial interventions on symptoms of depression. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 55:455-71. [PMID: 25861883 DOI: 10.1007/s10464-015-9718-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost-efficient adjunct providers. The effectiveness of these and other peer-administered interventions (PAIs) for treating depression symptoms has not been well-established. The current study is a meta-analysis of PAIs' effects on depression symptoms. Twenty-three eligible studies were identified. Study characteristics were coded by multiple raters, random-effects models were used to compare mean effect sizes, and mixed-effects models were used to test for moderation. PAIs produced significant pre-post reductions in depression symptoms (d = .5043 [95 % CI .3675-.6412]). In direct comparisons, PAIs performed as well as non-peer-administered interventions (.0848 [-.1455-.3151]), and significantly better than no-treatment conditions (.2011 [.0104-.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer-administered, and educational/skills-based PAIs produced better outcomes than those that were mainly supportive. Follow-up data, when available, indicated that PAIs' benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs' benefits, and whether they are better suited as stand-alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.
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Affiliation(s)
- Amanda E B Bryan
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA,
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13
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Watts SE, Andrews G. Internet access is NOT restricted globally to high income countries: so why are evidenced based prevention and treatment programs for mental disorders so rare? Asian J Psychiatr 2014; 10:71-4. [PMID: 25042956 DOI: 10.1016/j.ajp.2014.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mental disorders are widespread and universal. They are frequently accompanied by considerable harmful consequences for the individual and come at a significant economic cost to a community. Yet while effective evidence based prevention and treatment exists, there are a number of barriers to access, implement and disseminate. Cognitive behavior therapy programs, such as those available at www.thiswayup.com.au are widely available using the Internet in high income countries, such as Australia. With the ubiquitous uptake of Internet users globally, it is suggested that low and middle income countries should consider ways to embrace and scale up these cost effective programs. An explanation of why and some suggestions as to how this can be done are presented.
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Affiliation(s)
- Sarah E Watts
- Clinical Research Unit for Anxiety and Depression, Level 4 The O'Brien Centre, 394-404 Victoria Street, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia.
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, Level 4 The O'Brien Centre, 394-404 Victoria Street, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia.
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14
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Abstract
To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen's d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.
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15
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Coull G, Morris PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychol Med 2011; 41:2239-2252. [PMID: 21672297 DOI: 10.1017/s0033291711000900] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically. METHOD A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted. RESULTS Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals. CONCLUSIONS Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression.
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Affiliation(s)
- G Coull
- Clinical and Health Psychology, University of Edinburgh, UK.
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16
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McKirnan DJ, Tolou-Shams M, Courtenay-Quirk C. The Treatment Advocacy Program: a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men. J Consult Clin Psychol 2011; 78:952-63. [PMID: 20919760 DOI: 10.1037/a0020759] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM "peer advocates" in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). METHOD We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period. RESULTS At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, χ2(2, N = 249) = 6.6, p = .04. Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months: Transmission risk ranged from 23% to 25% among comparison participants. CONCLUSIONS TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP-computer-based and individually tailored session content, delivered by peers, in the primary care setting-warrant further exploration.
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Affiliation(s)
- David J McKirnan
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60607, USA.
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17
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Armstrong J. How effective are minimally trained/experienced volunteer mental health counsellors? Evaluation of CORE outcome data. COUNSELLING & PSYCHOTHERAPY RESEARCH 2010. [DOI: 10.1080/14733140903163284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Christensen H, Griffiths KM, Gulliver A, Clack D, Kljakovic M, Wells L. Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials. BMC FAMILY PRACTICE 2008; 9:25. [PMID: 18454878 PMCID: PMC2390560 DOI: 10.1186/1471-2296-9-25] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 05/05/2008] [Indexed: 11/28/2022]
Abstract
Background There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials. Methods Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure. Results Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective. Conclusion Case management is important in the provision of care in general practice. Certain community models of care (education programs) have potential while others are not successful in their current form (pharmacist monitoring).
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Affiliation(s)
- Helen Christensen
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
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