The Case for Evidence-Based Stepped Care as Part of a Reformed Delivery System

2010 ◽  
pp. 1-16 ◽  
Author(s):  
William T. O’Donohue ◽  
Crissa Draper
Keyword(s):  
Delivery System ◽  
Stepped Care ◽  
Evidence Based

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

2021 ◽  
Vol 35 (3) ◽  
pp. 221-231
Author(s):  
Alessandro S. De Nadai ◽  
Joseph L. Etherton
Keyword(s):  
Stepped Care ◽  
Insurance Companies ◽  
Evidence Based ◽  
Efficiency Ratio ◽  
Low Intensity ◽  
Clinical Efficiency ◽  
Referral Decisions ◽  
New Perspective ◽  
Evidence Based Care ◽  
Widespread Dissemination

Nearly all patients interact with critical gatekeepers—insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

The Expanding Role of Clinical Sociology in Australia

2009 ◽  
Vol 3 (2) ◽  
pp. 56-62
Author(s):  
Les Spencer
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
Social Transformation ◽  
Care Delivery ◽  
The United States ◽  
Health Care Delivery System ◽  
Evidence Based ◽  
Australian Health

This paper introduces clinical sociology as a humanistic, multidisciplinary specialty seeking to improve the quality of people's lives. It traces the emergence of clinical sociology in the United States in 1931, and in Australia in the late 1950s in the context of the pioneering clinical sociology research into social transformation at Australian society's margins by Neville Yeomans. A contemporary illustration is given demonstrating how a biopyschosocial model of health is now being implemented as world best-evidence-based practice within the Australian health care delivery system. Further arguments, citing national and international evidence based on sociotherapeutic models of intervention, support a proposal for the Australian Sociology Association to engage in dialogues with health care agencies with the view of establishing clinical sociologists as an integral part of the Australian health-care delivery system.

Case Management

2013 ◽  
Author(s):  
Maria Roberts-DeGennaro
Keyword(s):  
Decision Making ◽  
Service Delivery ◽  
Case Management ◽  
Delivery System ◽  
Case Managers ◽  
Evidence Based ◽  
Care Providers ◽  
Service Delivery System ◽  
Generic Set ◽  
Management Functions

A generic set of case management functions are performed in most practice settings. To improve outcomes within a complex service delivery system, case managers need to collaboratively work with clients and care providers. By incorporating the paradigm of evidence-based practice, case managers can improve decision making through integrating their practice expertise with the best available evidence, and by considering the characteristics, circumstances, values, preferences, and expectations of clients, as well as their involvement in the decision making.

scholarly journals Stepped-Care Approaches to Posttraumatic Stress Disorder: Sharpening Tools for the Clinician’s Toolbox

2017 ◽  
Vol 13 (2) ◽  
pp. 142 ◽  
Author(s):  
Jeffrey A. Cigrang ◽  
Alan L. Peterson
Keyword(s):  
Stress Disorder ◽  
Research Literature ◽  
Stepped Care ◽  
Current Status ◽  
Traumatic Experiences ◽  
Evidence Based ◽  
Care Model ◽  
Evidence Based Treatment ◽  
Potential Value ◽  
Care Models

<p> Austern (2017) presents three composite Veteran case studies using Written Exposure Therapy (WET; Sloan, Lee, Litwack, Sawyer, &amp; Marx, 2013) as a first-level intervention in a larger stepped-care model for PTSD.  The relatively minimalist WET intervention may be appealing to Veterans with PTSD who have opted not to seek out more time and therapist-intensive treatments.  In addition, writing has been used effectively in other protocols as a method of achieving exposure to memories of traumatic experiences.  Austern’s three cases demonstrate a range of success in using WET to engage Veterans in evidence-based treatment and reduce suffering associated with PTSD.  We comment on the current status of the research literature on stepped-care models for PTSD, the potential value of incorporating Motivational Interviewing principles and specific homework tasks into these efforts, and the promise that abbreviated interventions and stepped-care approaches may hold for helping clinicians manage their clinical caseloads and avoid burnout.</p><p> </p>

Part II: Psychological Factors In Delayed And Failed Recovery and Unnecessary Disability

2019 ◽  
Vol 24 (4) ◽  
pp. 3-14
Author(s):  
Garson Caruso ◽  
Les Kertay
Keyword(s):  
Psychological Factors ◽  
Cost Utility ◽  
Stepped Care ◽  
Evidence Based ◽  
Mind And Body ◽  
Compensation Claims ◽  
Management Approaches ◽  
Health Cognitions ◽  
Difficult Cases ◽  
Specific Evaluation

Abstract Part two of this two-part article on psychological factors in delayed and failed recovery and resultant unnecessary work disability (DFRUD) considers both conceptual and practical interventions, including specific evaluation and treatment methods. The authors propose five categories of intervention for DERUD: 1) advance and operationalize our knowledge base; 2) make conceptual and practical shifts in our approaches; 3) place greater emphasis on prevention; 4) improve recognition of potentially difficult cases, and 5) apply specific management approaches and tools. Further, the authors propose conceptual and practical changes that should be made: Eliminate the dualistic separation of mind and body and the scientific reductionism that follows; change the focus from disability to capability; reduce improper workers’ compensation claims; improve the administrative and medical management of valid claims; enhance collegiality and communication among all stakeholders; and adopt a cost-utility vs absolute cost approach. The overarching goals of managing DFRUD include optimizing administrative and clinical treatment of the worker; protecting all stakeholders from excess; and overcoming barriers to intervention. To these ends, three activities can optimize the process: Intervene early; avoid iatrogenicity (ie, shorten claim durations and reduce costs); and stratify risk and employ stepped care. Barriers to meaningful intervention in DFRUD include questions of jurisdiction and responsibility for management (eg, does management of DFRUD fall to insurers or clinicians); who will pay; what are the maladaptive health cognitions and/or psychiatric comorbidities; and how can clinician behavior be altered to implement evidence-based practice?

scholarly journals Innovations in the psychosocial treatment of youth with anxiety disorders: implications for a stepped care approach

2018 ◽  
Vol 21 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Thomas H Ollendick ◽  
Lars-Göran Öst ◽  
Lara J Farrell
Keyword(s):  
Anxiety Disorders ◽  
High Intensity ◽  
Care Delivery ◽  
Psychosocial Interventions ◽  
Psychosocial Treatment ◽  
Stepped Care ◽  
Future Research ◽  
Evidence Based ◽  
Low Intensity ◽  
Care Approach

Anxiety disorders are highly prevalent among children and adolescents and frequently result in impairments across multiple domains of life. While psychosocial interventions, namely cognitive-behavioural therapy (CBT), have been found to be highly effective in treating these conditions, significant numbers of youth simply do not have access to these evidence-based interventions, and of those who do, a substantial proportion (up to 40%) fail to achieve remission. Thus, there is a pressing need for innovation in both the delivery of evidence-based treatments and efforts to enhance treatment outcomes for those who do not respond to standard care. This paper reviews current innovations attempting to address these issues, including evidence for brief, low-intensity approaches to treatment; internet delivered CBT and brief, high-intensity CBT. Moreover, we propose a model of stepped care delivery of evidence-based mental health interventions for children and youth with anxiety. In general, a stepped care approach begins with a lower intensity, evidence-based treatment that entails minimal therapist involvement (ie, brief, low-intensity self-help or internet delivered CBT) and then proceeds to more intensive treatments with greater therapist involvement (ie, brief high-intensity CBT), but only for those individuals who show a poor response at each step along the way. Future research is needed in order to evaluate such a model, and importantly, to identify predictors and moderators of response at each step, in order to inform an evidence-based, fully-integrated stepped care approach to service delivery.

scholarly journals Health Impact of and Policy Regulations on Electronic Cigarettes

2019 ◽  
Vol 52 (5) ◽  
Author(s):  
Hilton Y. Lam ◽  
Carlo Irwin A. Panelo ◽  
Ofelia P. Saniel ◽  
Carmelita C. Canila ◽  
Jonathan P. Guevarra ◽  
...  
Keyword(s):  
Tobacco Control ◽  
Delivery System ◽  
The Philippines ◽  
Policy Position ◽  
Policy Statement ◽  
Evidence Based ◽  
Policy Makers ◽  
Safety And Efficacy ◽  
Nicotine Delivery ◽  
New Findings

Background. New findings on the detrimental health effects of electronic nicotine delivery system (ENDS)/ electronic non-nicotine delivery system (ENNDS) confounds the “harm reduction” perspective of using it as an alternative to conventional cigarettes. In the Philippines, the pressing debate on its safety and efficacy had initiated actions from policy makers on legislative issues such as draft DOH Administrative Order, House Bill 4325 and House Bill 532. Objective. The study aimed to craft an evidence-based policy position on the regulation of ENDS/ENNDS. Method. Review of literature was conducted, and the proposed scope and measures on electronic cigarette regulation were compared with WHO Framework Convention on Tobacco Control (WHO-FCTC) and existing policies of US FDA regulations on ENDS. Further, UP Manila convened experts of various related fields for evidence-based review and discussion of policy issues to arrive at a consensus policy statement and recommendations. Results. Findings showed that ENDS/ENNDS still need further research to have conclusive results on long term safety and efficacy as smoking cessation methods. Conclusion. Regulations for tobacco control should be clear and supported with strict guidelines in manufacturing, distribution, advertisement, selling, and usage restrictions in public. With the current review, it is recommended that ENDS/ENNDS regulation be under the mandate of the FDA in alignment to WHO-FCTC and to engage different stakeholders from policy makers, implementers, and other involved organizations.

scholarly journals One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

2019 ◽  
Vol 16 (19) ◽  
pp. 3606 ◽  
Author(s):  
David A. Jobes ◽  
Samantha A. Chalker
Keyword(s):  
Mentally Ill ◽  
Health Management ◽  
Clinical Care ◽  
Cost Effective ◽  
Evidence Base ◽  
Stepped Care ◽  
Clinical Approach ◽  
Evidence Based ◽  
Suicidal Risk ◽  
The One

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, the “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical of suicidal risk that is cost-effective, least-restrictive, and evidence-based.

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