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Mareya S, Watts MC, Zhao L, Olasoji M. Exploring the Stepped Care Model in Delivering Primary Mental Health Services-A Scoping Review. Int J Ment Health Nurs 2024. [PMID: 39301997 DOI: 10.1111/inm.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/17/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024]
Abstract
The stepped care model (SCM) is a patient-centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword-based search using terms like "stepped care model," "mental health," and "primary care"; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross-sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost-effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally.
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Affiliation(s)
- Shingai Mareya
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
| | - Mimmie Claudine Watts
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
| | - Lin Zhao
- RMIT University, Melbourne, Australia
| | - Michael Olasoji
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
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Michael B, Kellett S, Delgadillo J. Is clinical decision making in stepped-care psychological services influenced by heuristics and biases? Behav Cogn Psychother 2023:1-12. [PMID: 37185218 DOI: 10.1017/s1352465823000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The manner in which heuristics and biases influence clinical decision-making has not been fully investigated and the methods previously used have been rudimentary. AIMS Two studies were conducted to design and test a trial-based methodology to assess the influence of heuristics and biases; specifically, with a focus on how practitioners make decisions about suitability for therapy, treatment fidelity and treatment continuation in psychological services. METHOD Study 1 (N=12) used a qualitative design to develop two clinical vignette-based tasks that had the aim of triggering heuristics and biases during clinical decision making. Study 2 (N=133) then used a randomized crossover experimental design and involved psychological wellbeing practitioners (PWPs) working in the Improving Access to Psychological Therapies (IAPT) programme in England. Vignettes evoked heuristics (anchoring and halo effects) and biased responses away from normative decisions. Participants completed validated measures of decision-making style. The two decision-making tasks from the vignettes yielded a clinical decision score (CDS; higher scores being more consistent with normative/unbiased decisions). RESULTS Experimental manipulations used to evoke heuristics did not significantly bias CDS. Decision-making style was not consistently associated with CDS. Clinical decisions were generally normative, although with some variability. CONCLUSIONS Clinical decision-making can be 'noisy' (i.e. variable across practitioners and occasions), but there was little evidence that this variability was systematically influenced by anchoring and halo effects in a stepped-care context.
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Affiliation(s)
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, United Kingdom
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Jaime Delgadillo
- Rotherham Doncaster and South Humber NHS Foundation Trust, United Kingdom
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Andrews B, Klein B, Van Nguyen H, Corboy D, McLaren S, Watson S. Efficacy of a digital mental health biopsychosocial transdiagnostic intervention with or without therapist-assistance for adults with anxiety and depression: An adaptive randomised clinical trial (Preprint). J Med Internet Res 2022. [DOI: 10.2196/45135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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Tracing the missteps of stepped care: Improving the implementation of stepped care through contextual behavioral science. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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van Bronswijk SC, van Dijk DA, van den Boogaard TM, Deen ML, Ruhé HG, Spijker J, Peeters FPML. Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care. Am J Psychother 2021; 74:150-156. [PMID: 34905935 DOI: 10.1176/appi.psychotherapy.202120200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of personality disorder on treatment effectiveness for depression has been debated, and study results have been inconsistent. However, studies that report a negative impact of personality disorders on depression treatment outcomes are often characterized by uncontrolled treatment designs. Within such contexts, individuals with depression and personality disorders are at risk to receive suboptimal treatment. The aim of this retrospective observational study was to investigate whether and to what extent comorbid personality disorders were associated with the type and amount of depression treatment received in routine outpatient care. METHODS Retrospectively extracted data from electronic records of 1,455 outpatients treated for depression at several sites of a nationwide mental health provider in the Netherlands were included. The type and number of treatment sessions and visits were analyzed by using regression models. RESULTS Individuals with depression and comorbid personality disorders received more psychotherapy sessions than individuals without personality disorders, irrespective of depression severity. The number of pharmacotherapy sessions and supportive and crisis visits did not differ between individuals with and without comorbid personality disorders. CONCLUSIONS Individuals with depression and personality disorders received more intensive treatment than individuals without comorbid personality disorders. These results conflict with treatment guidelines and recommendations from high-quality studies and may be indicative of overtreatment among this large group of patients.
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Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Dyllis A van Dijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Th Michael van den Boogaard
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Mathijs L Deen
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Henricus G Ruhé
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Jan Spijker
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
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van Bronswijk SC, van Dijk DA, van den Boogaard TM, Deen ML, Ruhé HG, Spijker J, Peeters FPML. Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care. Am J Psychother 2021:appipsychotherapy20200046. [PMID: 34134502 DOI: 10.1176/appi.psychotherapy.20200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of personality disorder on treatment effectiveness for depression has been debated, and study results have been inconsistent. However, studies that report a negative impact of personality disorders on depression treatment outcomes are often characterized by uncontrolled treatment designs. Within such contexts, individuals with depression and personality disorders are at risk to receive suboptimal treatment. The aim of this retrospective observational study was to investigate whether and to what extent comorbid personality disorders were associated with the type and amount of depression treatment received in routine outpatient care. METHODS Retrospectively extracted data from electronic records of 1,455 outpatients treated for depression at several sites of a nationwide mental health provider in the Netherlands were included. The type and number of treatment sessions and visits were analyzed by using regression models. RESULTS Individuals with depression and comorbid personality disorders received more psychotherapy sessions than individuals without personality disorders, irrespective of depression severity. The number of pharmacotherapy sessions and supportive and crisis visits did not differ between individuals with and without comorbid personality disorders. CONCLUSIONS Individuals with depression and personality disorders received more intensive treatment than individuals without comorbid personality disorders. These results conflict with treatment guidelines and recommendations from high-quality studies and may be indicative of overtreatment among this large group of patients.
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Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Dyllis A van Dijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Th Michael van den Boogaard
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Mathijs L Deen
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Henricus G Ruhé
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Jan Spijker
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
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van Bronswijk SC, Lemmens LHJM, Huibers MJH, Peeters FPML. Selecting the optimal treatment for a depressed individual: Clinical judgment or statistical prediction? J Affect Disord 2021; 279:149-157. [PMID: 33049433 DOI: 10.1016/j.jad.2020.09.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/25/2020] [Accepted: 09/27/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Optimizing treatment selection is a way to enhance treatment success in major depressive disorder (MDD). In clinical practice, treatment selection heavily depends on clinical judgment. However, research has consistently shown that statistical prediction is as accurate - or more accurate - than predictions based on clinical judgment. In the context of new technological developments, the current aim was to compare the accuracy of clinical judgment versus statistical predictions in selecting cognitive therapy (CT) or interpersonal psychotherapy (IPT) for MDD. METHODS Data came from a randomized trial comparing CT (n=76) with IPT (n=75) for MDD. Prior to randomization, therapists' recommendations were formulated during multidisciplinary staff meetings. Statistical predictions were based on Personalized Advantage Index models. Primary outcomes were post-treatment and 17-month follow-up depression severity. Secondary outcome was treatment dropout. RESULTS Individuals receiving treatment according to their statistical prediction were less depressed at post-treatment and follow-up compared to those receiving their predicted non-indicated treatment. This difference was not found for recommended versus non-recommended treatments based on clinical judgment. Moreover, for individuals with an IPT recommendation by therapists, higher post-treatment and follow-up depression severity was found for those that actually received IPT compared to those that received CT. Recommendations based on statistical prediction and clinical judgment were not associated with differences in treatment dropout. LIMITATIONS Information on the clinical reasoning behind therapist recommendations was not collected, and statistical predictions were not externally validated. CONCLUSIONS Statistical prediction outperforms clinical judgment in treatment selection for MDD and has the potential to personalize treatment strategies.
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Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD Maastricht, the Netherlands.
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD Maastricht, the Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands; Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104-6241, USA
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200, MD Maastricht, the Netherlands
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Delgadillo J, Overend K, Lucock M, Groom M, Kirby N, McMillan D, Gilbody S, Lutz W, Rubel JA, de Jong K. Improving the efficiency of psychological treatment using outcome feedback technology. Behav Res Ther 2017; 99:89-97. [PMID: 29024821 DOI: 10.1016/j.brat.2017.09.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/30/2017] [Accepted: 09/27/2017] [Indexed: 11/16/2022]
Abstract
AIMS This study evaluated the impact of applying computerized outcome feedback (OF) technology in a stepped care psychological service offering low and high intensity therapies for depression and anxiety. METHODS A group of therapists were trained to use OF based on routine outcome monitoring using depression (PHQ-9) and anxiety (GAD-7) measures. Therapists regularly reviewed expected treatment response graphs with patients and discussed cases that were "not on track" in clinical supervision. Clinical outcomes data were collected for all patients treated by this group (N = 594), six months before (controls = 349) and six months after the OF training (OF cases = 245). Symptom reductions in PHQ-9 and GAD-7 were compared between controls and OF cases using longitudinal multilevel modelling. Treatment duration and costs were compared using MANOVA. Qualitative interviews with therapists (N = 15) and patients (N = 6) were interpreted using thematic analysis. RESULTS OF technology was generally acceptable and feasible to integrate in routine practice. No significant between-group differences were found in post-treatment PHQ-9 or GAD-7 measures. However, OF cases had significantly lower average duration and cost of treatment compared to controls. CONCLUSIONS After adopting OF into their practice, this group of therapists attained similar clinical outcomes but within a shorter space of time and at a reduced average cost per treatment episode. We conclude that OF can improve the efficiency of stepped care.
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Affiliation(s)
- Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK.
| | - Karen Overend
- Department of Health Sciences, University of York, UK
| | - Mike Lucock
- Centre for Applied Research in Health, University of Huddersfield, South West Yorkshire Partnership NHS Foundation Trust, UK
| | | | | | - Dean McMillan
- Department of Health Sciences, University of York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, UK
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Germany
| | | | - Kim de Jong
- Institute of Psychology, Leiden University, The Netherlands
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Castelnuovo G, Pietrabissa G, Cattivelli R, Manzoni GM, Molinari E. Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis. Front Psychol 2016; 7:563. [PMID: 27242562 PMCID: PMC4860399 DOI: 10.3389/fpsyg.2016.00563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 01/17/2023] Open
Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
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