Enhancing the Cultural Relevance of Empirically-Supported Mental Health Interventions

Evidence-based practice (EBP) has become a hot topic in clinical social work and other mental health disciplines. Mental health professionals have called attention to the need for clinical decision-making to be based on the best available empirically supported treatments integrated with client preferences, values, and circumstances. This movement has greatly stimulated mental health professionals to develop, test, and adopt efficacious treatments for clients with psychological problems, but what is missing in the literature is the cultural context in which these treatments must be implemented to be effective with racial/ethnic minority populations. Herein, we utilize the culturally centered framework of Bernal, Bonilla and Bellido (1995) to examine its utility in assessing to what extent empirically supported mental health treatments incorporate culturally relevant components.

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Creating Public Health Policy

The Oxford Handbook of Clinical Psychology ◽

10.1093/oxfordhb/9780199328710.013.012 ◽

2014 ◽

pp. 210-223

Author(s):

Bruce F. Chorpita ◽

Jeanne Miranda ◽

Adam Bernstein

Keyword(s):

Mental Health ◽

Health Policy ◽

Real World ◽

Clinical Decision Making ◽

Mental Health Policy ◽

Clinical Decision ◽

Quality Practices ◽

Mental Health Treatments ◽

And Training ◽

The Way

In recent years, clinical psychology has made significant contributions to mental health policy through its increasing focus on the notion of evidence-based practice and an empirical approach to clinical decision-making. These developments have not been without challenges, however. Most notable are issues with the acceptability of treatment design among practitioners and the difficulty of implementing and sustaining high-quality practices in real-world contexts. Two specific barriers central to these challenges are discussed, namely, the highly specialized architecture of most research-based mental health treatments and the unavailability of a dedicated supervisory and training infrastructure. Solutions are proposed that suggest the need to rethink both the way treatments are packaged and the way they are supported in real-world practice.

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Values and ethics in mental-health education and training: a different perspective

The Journal of Mental Health Training Education and Practice ◽

10.1108/jmhtep-08-2014-0024 ◽

2015 ◽

Vol 10 (3) ◽

pp. 189-204 ◽

Cited By ~ 1

Author(s):

Riya Elizabeth George ◽

Nisha Dogra ◽

Bill Fulford

Keyword(s):

Mental Health ◽

Health Education ◽

Mental Health Professionals ◽

Health Professionals ◽

Clinical Decision Making ◽

Diversity Training ◽

Education And Training ◽

Mental Health Education ◽

Content Type ◽

And Training

Purpose – The purpose of this paper is to review the challenges of teaching values and ethics in mental-health, explore the differing perspectives of the key stakeholders and stimulate further questions for debate in this area; leading to a proposal of an alternative approach to educating mental-health professionals on values and ethics. Originality/value – In current mental-health care settings, very few professionals work with homogeneous populations. It is imperative that mental-health education and training ensures health professionals are competent to practice in diverse settings; where ethics and values are bound to differ. Establishing professional practice not only involves considering concepts such as values and ethics, but also equality, diversity and culture. Incorporating values-based practice and cultural diversity training holds promise to education and training, that is truly reflective of the complexity of clinical decision making in mental-health. Further research is needed as to how these two frameworks can be unified and taught.

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Staff Competence in Dealing with Traditional Approaches

European Psychiatry ◽

10.1016/s0924-9338(08)70063-4 ◽

2008 ◽

Vol 23 (S1) ◽

pp. s59-s68 ◽

Cited By ~ 12

Author(s):

M. Kastrup

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Professionals ◽

Health Professionals ◽

Cultural Context ◽

Systems Of Care ◽

Health Care Systems ◽

Value Systems ◽

Care Systems ◽

Traditional Approaches

AbstractHealth care and health care systems should be seen and understood in their socio-cultural context. Modern urbanized societies are likely to exhibit health care pluralism, and different therapeutic approaches are available side-by-side. The various models may take their origin in different cultural traditions, but in most societies one type of care is at a given time considered “above” the others. However health care activities in all societies show a degree of interrelation, reflecting societal changes in which normative practices, value systems and structures change over time. In the current Western health systems evidence-based biomedical care is the prevailing system taught to all professionals.The present paper outlines the prevailing health paradigms, and the advantages and shortcomings of the various approaches and their relation to modern care will be discussed. With increased multicultural backgrounds of patients there is a need for mental health professionals to recognize the existence of traditional approaches and be aware of the parallel systems of care. Competent treatment of such patients requires that mental health professionals are aware of this and exhibit a willingness and ability to bridge between the more traditional and the Western approaches to treatment. The delineations and various aspects of the concept cultural competence and its dimensions will be discussed from a clinical perspective.Comparative studies of the various Western and the traditional approaches respectively will be reviewed.

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Implementation and Effectiveness of Interpersonal Psychotherapy in a Community Mental Health Service

Australasian Psychiatry ◽

10.1046/j.1440-1665.2003.00574.x ◽

2003 ◽

Vol 11 (3) ◽

pp. 284-289 ◽

Cited By ~ 7

Author(s):

Rebecca Reay ◽

Scott Stuart ◽

Cathy Owen

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Mental Health Professionals ◽

Health Professionals ◽

Post Partum ◽

Training Programme ◽

Interpersonal Psychotherapy ◽

Community Mental Health Service ◽

Community Practice ◽

Empirically Supported

Objective: Although the efficacy of a number of psychotherapeutic interventions has been well established in tightly controlled, randomized trials, there remains a paucity of literature examining the effectiveness of these interventions in community practice settings. In light of this, the Australian Capital Territory Mental Health Services (Canberra, ACT) set out to investigate the effectiveness of an empirically supported psychotherapeutic intervention, interpersonal psychotherapy (IPT). The present study describes a pilot evaluation of the training programme for health professionals and the IPT treatment programme. Methods: Forty community mental health professionals participated in intensive IPT training. Clinicians who completed a course of supervision were asked to apply the treatment with non-psychotic acutely depressed patients. Measures of patients’ health outcomes were taken before and after treatment using a standardized outcome measure. Results: A total of 17 out of 21 patients who were selected completed a course of 12–16 weeks of IPT. The majority of the patients had a depression originating in the post-partum period. A comparison of pre- and post-treatment scores of treatment completers revealed a significant decrease in mean depression scores. Clinicians who completed a course of training and supervision found that they were able to confidently apply IPT in a clinical setting. Conclusions: Although there were a number of barriers and obstacles to the introduction of an evidenced-based treatment, the results are promising and demonstrate that IPT can be readily taught to experienced mental health professionals. Further study is required to determine the feasibility of IPT in other non-academic settings using larger sample sizes and homogenous groups of patients.

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Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments

JMIR Mental Health ◽

10.2196/mental.5481 ◽

2016 ◽

Vol 3 (2) ◽

pp. e17 ◽

Cited By ~ 15

Author(s):

Ursula M Sansom-Daly ◽

Claire E Wakefield ◽

Brittany C McGill ◽

Helen L Wilson ◽

Pandora Patterson

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Practice Guidelines ◽

Health Professionals ◽

Best Practice ◽

Professional Organizations ◽

Special Populations ◽

International Consensus ◽

Best Practice Guidelines ◽

Mental Health Treatments

Background Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. Objective This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. Methods This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations’ published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. Results In the study, 19 guidelines were included, yielding 11 specific "firm" and a further 123 "tentative-level" recommendations regarding the appropriateness of e-mental health, competence, legal and regulatory issues, confidentiality, consent, professional boundaries, and crisis management. International consensus yielded firm guidance across almost all areas except professional boundaries and some aspects of determining the appropriateness of e-mental health. Few guidelines specifically addressed special populations. Overall guideline quality varied; however, 42% (8/19) of the guidelines scored at least 5 out of 7. Conclusions This synthesis of guidelines provides a foundation for clinicians and researchers utilizing e-mental health worldwide. The lack of specific guidance relating to special populations is an area warranting further attention in order to strengthen mental health professionals’ and researchers’ capacity to ethically and effectively tailor e-mental health interventions to these groups.

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The Effect of Client Case Complexity on Clinical Decision Making

European Journal of Psychological Assessment ◽

10.1027/1015-5759/a000184 ◽

2014 ◽

Vol 30 (2) ◽

pp. 150-158 ◽

Cited By ~ 1

Author(s):

Marleen Groenier ◽

Jules M. Pieters ◽

Cilia. L. M. Witteman ◽

Souja R. S. Lehmann

Keyword(s):

Mental Health ◽

Clinical Decision Making ◽

Clinical Decision ◽

Treatment Decisions ◽

Case Formulation ◽

Empirically Supported Treatment ◽

Case Complexity ◽

Empirically Supported ◽

Descriptive Information ◽

Explanatory Information

In mental health care, clinicians’ treatment decisions are expected to be based on the formulation (i.e., exploration of the causing and maintaining mechanisms) of the client’s problems. Previous research showed two things: clinicians’ case formulations mainly contain descriptive information instead of explanatory information and it is unclear to what extent treatment decisions are actually based on case formulations. In this study, we tested whether the complexity of client problems influences case formulation quality and we investigated to what extent case formulations explain treatment decisions for simple and complex client problems. Results show that case formulations for complex problems were of lower quality than those for simple problems. Also, we found that case formulations are only weakly associated with treatment decisions, for both types of problems. We conclude that clinicians give higher quality case formulations when these may be least needed, that is: for simple cases, for which an empirically supported treatment is available. Clinicians appear to base treatment decisions on descriptions of overt client symptoms rather than on case formulations.

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Criticism of psychiatric diagnosis

The Medical Model in Mental Health ◽

10.1093/med/9780198807254.003.0006 ◽

2019 ◽

pp. 89-104

Author(s):

Ahmed Samei Huda

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Clinical Utility ◽

Clinical Decision Making ◽

Mental Health Problems ◽

Medical Model ◽

Clinical Decision ◽

Negative Consequences ◽

Causative Factors ◽

Medical Diagnostic

Criticisms of psychiatric diagnostic constructs from a clinical/scientific view have been made on several points: reliability, such as how often two clinicians agree on the same diagnosis; validity, such as clear separation between diagnostic constructs or presence of objective validators; utility, such as predicting outcomes and treatment responses; implying an inaccurate conception of mental health problems as diseases that also minimizes the influence of social causative factors, high rates of co-occurrence, and association with negative consequences such as stigma. Many psychiatric diagnostic constructs lack validity but often have clinical utility. This clinical utility depends on how the clinician works therefore psychiatric diagnostic constructs are well suited to the medical model but may have little utility for other mental health professionals who work differently or for researchers testing hypotheses. Diagnostic constructs have utility for administrative purposes. The criticisms can be used to generate a set of questions to evaluate psychiatric diagnostic constructs. Psychiatric diagnostic constructs are best compared with general medical diagnostic constructs because they are used for similar purposes in clinical decision-making. A comparison will be made to see if there is no overlap, some overlap, or near total overlap between general medical and psychiatric diagnostic constructs.

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The Assessment and Management of Stalking Perpetrated by Clients Against Their Counselors

Violence and Victims ◽

10.1891/vv-d-19-00107 ◽

2020 ◽

pp. VV-D-18-00107

Author(s):

Jennifer E. Storey ◽

Stephen D. Hart

Keyword(s):

Mental Health ◽

Risk Factors ◽

Risk Management ◽

Mental Health Professionals ◽

Health Professionals ◽

Management Strategies ◽

Empirically Supported ◽

Risk Management Strategies ◽

Management Plans ◽

Perpetrators And Victims

Mental health professionals are at heightened risk of stalking victimization, however minimal research has examined empirically supported risk factors for stalking and the efficacy of risk management strategies. Three hundred and six counselors were surveyed, and the present study focuses on the 7% (n = 23) who had been stalked by clients. Results describe the characteristics of stalking, perpetrators, and victims and the perceived efficacy of management strategies employed. Stalking behaviors tended to be of lower severity. Common perpetrator risk factors included relationship problems, anger, and obsession. Victim vulnerabilities were identified, where many victims engaged in behavior considered ineffective in response to stalking. Victims often encountered problems coping with victimization due to inadequate access to resources. Results indicate that risk management plans must be individualized and highlight ways that mental health professionals can and would like to be protected from stalking.

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Bringing Psychotherapy to the Underserved

10.1093/med-psych/9780190912727.001.0001 ◽

2019 ◽

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Health Professionals ◽

The United States ◽

Problem Area ◽

Treatment Needs ◽

Underserved Communities ◽

Empirically Supported ◽

Systemic Factors ◽

Barriers To Service

Providing psychotherapy services to the underserved is a significant problem with far-reaching consequences. This book brings together discussions of multiple groups of underserved persons, some of whom are generally neglected by much of the literature. This book is designed to help mental health professionals who provide psychotherapy to increase their awareness of the key issues related to many different peoples. The contributors focus on many underserved communities within and outside the United States. Chapters are written by experts in their respective fields, offering their thoughts and practical advice. The first four sections of the book focus on systemic factors, discrimination, people who are in transition or living in underserved locations, and people who are often overlooked or are “invisible.” Each of these chapters follows the same format to provide a consistent reading experience. The authors begin by discussing the scope and offer a description of the problem area they are addressing. They then discuss barriers to service delivery, how to create or improve cultural competence, and effective strategies and empirically supported treatments to meet the treatment needs of this population. They conclude by discussing future steps. The fifth section of the book addresses challenges related to ethics and research. Bringing Psychotherapy to the Underserved will be a valuable resource for mental health professionals as they strive to approach underserved communities in socially responsible, culturally sensitive, ethical, and effective ways.

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