Stepped Care and Telehealth Delivery

2021 ◽  
pp. 147-161
Author(s):  
Judy H. Hong ◽  
Alison Salloum ◽  
Jafar Bakhshaie ◽  
Thanh T. Truong ◽  
Jill Ehrenreich-May ◽  
...  
Keyword(s):  
Decision Making ◽  
Children And Adolescents ◽  
Emotional Disorders ◽  
Cost Effective ◽  
Stepped Care ◽  
Service Delivery System ◽  
Transdiagnostic Treatment ◽  
Response Status ◽  
Care Models ◽  
Collaborative Decision

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) have been adapted into a stepped care intervention (UP-C/A-SC) that may be delivered via telehealth. Stepped care models are a type of service delivery system designed to be efficient, effective, accessible, and cost-effective and to personalize service by matching clients to the most appropriate dosage or the best type of treatment for their needs. This chapter discusses the adaptations to the original interventions necessary to deliver UP-C/A-SC as a two-step intervention via telehealth. A case example of a child who responded to the first step of UP-C/A-SC illustrates the components of the stepped care model, including a collaborative decision-making process to determine treatment response status after the first step. To address common implementation issues, barriers to providing UP-C/A-SC and solutions are discussed.

Applications of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

2021 ◽  
Keyword(s):  
Children And Adolescents ◽  
Emotional Disorders ◽  
Stepped Care ◽  
Community Practice ◽  
Obsessive Compulsive ◽  
Transdiagnostic Treatment ◽  
Structural Modifications ◽  
User Friendly ◽  
Internalizing Distress ◽  
Modular Structures

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A) are evidence-based, transdiagnostic intervention programs that target core emotion regulation processes that may be shared across varying presentations of internalizing distress or disorders in youth. Given their popular transdiagnostic and modular structures, the UP-C and UP-A have quickly been disseminated and implemented with a variety of populations and in differing treatment settings. This volume aims to aid UP-C and UP-A therapists in understanding varied applications and modifications of these approaches and assist them in applying such in their own practice. To that end, chapters are offered on not only standard UP-C and UP-A research and practice but also applications for youth with obsessive-compulsive symptoms, tic-related concerns, substance use, serious mental illness, and eating disorders. Structural modifications to the UP-C and UP-A using a stepped care model and when delivering care in pediatric or community practice settings and in differing cultures or languages are also discussed. To aid in their use, each chapter includes a brief, user-friendly description of the modifications or adaptations of the UP-C and/or UP-A that are described therein.

Culturally and Linguistically Sensitive Applications in Other Countries

2021 ◽  
pp. 180-194
Author(s):  
Hiroko Fujisato ◽  
Noriko Kato ◽  
Dominique Phillips ◽  
Estefany Sáez-Clarke
Keyword(s):  
Children And Adolescents ◽  
Emotional Disorders ◽  
Cultural Context ◽  
Japanese Culture ◽  
Cultural Groups ◽  
Cultural Adaptations ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Intervention Protocol

Cultural adaptation can help maintain a balance between scientifically rigorous interventions and culturally sensitive, effective practice. When introducing the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) into a new cultural context, translating the treatment may be sufficient in some countries and regions, while others may require more systematic modification. This chapter discusses specific steps that were taken for adapting the UP-C/A in the context of Japanese culture and presents a case study in Japan. When introducing the UP-C/A into the Japanese context, modifications were made to increase the treatment’s acceptability and comprehension, but there were no significant modifications in the content of the intervention protocol. In the future, as the UP-C/A is introduced into other cultures, its effectiveness will be further evaluated and the cultural adaptations needed to accommodate new cultural groups will become increasingly apparent.

Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

2017 ◽  
Author(s):  
Jill Ehrenreich-May ◽  
Sarah M. Kennedy ◽  
Jamie A. Sherman ◽  
Emily L. Bilek ◽  
Brian A. Buzzella ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Emotional Disorders ◽  
Depressive Disorders ◽  
Treatment Strategies ◽  
Tic Disorders ◽  
Evidence Based ◽  
Obsessive Compulsive ◽  
Evidence Based Treatment ◽  
Transdiagnostic Treatment ◽  
Obsessive Compulsive Disorders

The therapy manuals included in this volume—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) and Adolescents (UP-A)—include evidence-based treatment strategies to assist child and adolescent clients to function better in their lives. The manuals include specific guidelines for treatment delivery, and they also contain information about how to introduce parent-directed strategies to help promote long-term uptake of youth-directed therapy skills. The evidence-based treatment skills presented may be applied by therapists to children and adolescents with a wide variety of emotional disorders. This treatment guide takes a transdiagnostic approach to the treatment of emotional disorders. Some of the disorders that may be targeted include anxiety disorders and depressive disorders. This treatment is flexible enough for use with some trauma and stress-related disorders (including adjustment disorders), somatic symptom disorders, tic disorders and obsessive-compulsive disorders. The transdiagnostic presentation of evidence-based intervention techniques within these treatments may be particularly useful for children and adolescents presenting with multiple emotional disorders or mixed/subclinical symptoms of several emotional disorders.

Collaborative Care Models in Psychiatry

2019 ◽  
Author(s):  
Danielle M. Gainer ◽  
Karley B. Fischer ◽  
Parvaneh K. Nouri
Keyword(s):  
Behavioral Health ◽  
Integrated Care ◽  
Collaborative Care ◽  
Cost Effective ◽  
Stepped Care ◽  
Health Provider ◽  
Behavioral Health Provider ◽  
Care Approach ◽  
Care Models ◽  
Barriers To Implementation

Integrated care models allow a team of providers to interact in a systematic manner, producing cost-effective and superior outcomes for patients. The collaborative care model (CCoM), one type of integrated care, has emerged as one approach with over 80 randomized controlled trials to support its efficacy. In this model, a behavioral health provider offers evidence-based, brief interventions but also serves as a liaison between the patient, medical providers, and the psychiatric consultant. The team also monitors outcomes through a registry and provides a stepped care approach to adjust interventions collaboratively, as needed. If the barriers to integrated care implementation are surmounted, psychiatrists working as consultants in this model can provide care in an efficient and sustainable manner. This review contains 5 figures, 5 tables, and 48 references. Key Words: barriers to implementation, behavioral health provider, collaborative care, cost-effective, integrated care, psychiatric consultant, cost-effective, registry, stepped care

Introduction to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

2021 ◽  
pp. 3-16
Author(s):  
Sarah M. Kennedy ◽  
Jill Ehrenreich-May
Keyword(s):  
Children And Adolescents ◽  
Emotional Disorders ◽  
Historical Development ◽  
Anxiety And Depression ◽  
Evidence Based ◽  
Transdiagnostic Treatment ◽  
Practical Guidance ◽  
Weekly Therapy

This chapter provides a brief historical and theoretical introduction to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A), followed by practical guidance for using this volume to treat children and adolescents. The chapter situates transdiagnostic treatments within the historical development of evidence-based interventions for children and adolescents and distinguishes core-dysfunction–focused transdiagnostic treatments, such as the UP-C and UP-A, from other types of transdiagnostic treatments. The chapter reviews key core dysfunctions underlying emotional disorders that are addressed through treatment with the UP-C and UP-A. The authors discuss the rationale for this volume, which focuses on applications of the UP-C and UP-A to youth with diagnoses other than anxiety and depression and youth being treated in delivery settings outside of the standard weekly therapy format. Tips for using this volume in conjunction with the UP-C and UP-A therapist guide and workbooks are offered.

Current Evidence Base for the UP-C and UP-A

2021 ◽  
pp. 31-38
Author(s):  
Niza Tonarely ◽  
Dominique Phillips
Keyword(s):  
Randomized Controlled Trial ◽  
Children And Adolescents ◽  
Emotional Disorders ◽  
Controlled Trial ◽  
Evidence Base ◽  
Current Evidence ◽  
Controlled Trials ◽  
Transdiagnostic Treatment ◽  
Randomized Controlled ◽  
Current Evidence Base

This chapter summarizes current research support for Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A), which have been found to be efficacious for children and adolescents with a range of emotional concerns. The UP-A has been investigated in randomized controlled trials and has demonstrated efficacy in treating anxiety and depressive symptoms, with significant decreases in symptoms during treatment and maintenance of gains following treatment. The UP-C has been investigated using open and randomized controlled trial designs and was found to be as efficacious as an established anxiety protocol. This chapter also presents research on patterns of change across symptoms and individuals in response to the UP-C and UP-A, including response trajectories, the timing of change, and comparisons of rates of change by symptom and reporter.

Delivery of Standard UP-C and UP-A Treatment for Youth with Emotional Disorders

2021 ◽  
pp. 17-30
Author(s):  
Rinatte Gruen ◽  
Dylan Braun
Keyword(s):  
Children And Adolescents ◽  
Emotional Disorders ◽  
Presenting Problems ◽  
Transdiagnostic Treatment ◽  
The Core ◽  
Developmental Levels

This chapter describes the standard delivery of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A). It is intended to help therapists understand how the flexible modules within each treatment are typically presented, and serves to supplement the existing UP-C/A therapist guide. This chapter outlines the core transdiagnostic treatment components that are common to the UP-C and UP-A while also highlighting key differences in treatment presentation for different developmental levels to help therapists select the most appropriate intervention for their clients. While this chapter focuses on the delivery of UP-C and UP-A for youth with depression, anxiety, and related concerns, it also provides greater context for treatment adaptations for other presenting problems that are described later in this book.

Access and organization: putting low intensity interventions to work in clinical services

2010 ◽  
pp. 19-34
Author(s):  
David A. Richards
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Stepped Care ◽  
Clinical Services ◽  
Low Intensity ◽  
Psychological Therapies ◽  
Measuring Outcomes ◽  
Patient Centredness

Chapter 2 unpacks the term ‘access’, suggesting that it has six interlinked components—availability, utilization, effectiveness, equity, efficiency, and patient-centredness—that need to be satisfied if access is to be increased and setting out key strategies for improvement. These include providing cost-effective forms of CBT (low intensity), organizing systems so that they function more effectively (stepped care, collaborative care), routinely measuring outcomes, and providing a clear rationale for clinical decision making. These strategies are now encapsulated in the English Improving Access to Psychological Therapies (IAPT) initiative.

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