scholarly journals Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression

2019 ◽  
Vol 16 (23) ◽  
pp. 4689
Author(s):  
Jennifer Nicholas ◽  
Kathryn E. Ringland ◽  
Andrea K. Graham ◽  
Ashley A. Knapp ◽  
Emily G. Lattie ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Care Delivery ◽  
Behavioral Therapy ◽  
Health Care Delivery System ◽  
Stepped Care ◽  
Treatment Preference ◽  
Intensive Intervention ◽  
Pre Treatment

Internet-based cognitive behavioral therapy (iCBT) may overcome barriers to mental health care and has proven efficacious. However, this approach currently exists outside the existing mental health care delivery system. Stepped care is a proposed framework for integrating digital mental health (DMH) into health systems by initiating iCBT and “stepping up” care to a more intensive intervention should iCBT prove ineffective. This study explores pre-treatment factors associated with reaching stepping criteria among patients receiving iCBT. This exploratory analysis of a stepped care arm of a larger randomized trial examined participants who were stepped to a more intensive intervention if they did not respond to iCBT. The association of pre-treatment factors on stepping were examined using Kruskal–Wallis and Chi-square tests. One-fifth of the 151 participants met criteria for stepping within the 20-week treatment period. Only pre-treatment depression severity and treatment preference were associated with increased likelihood of stepping (p = 0.049 and 0.048, respectively). The low number of individuals who stepped provides support for iCBT as an effective, low intensity treatment for depression. The modest association of pre-treatment depression and preference to not receive iCBT may be useful in identifying patients who are less likely to respond.

scholarly journals Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program (Preprint)

2020 ◽  
Author(s):  
Nazanin Alavi ◽  
Megan Yang ◽  
Callum Stephenson ◽  
Niloofar Nikjoo ◽  
Niloufar Malakouti ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Regression Analysis ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Care Delivery ◽  
Behavioral Therapy ◽  
Online Psychotherapy ◽  
Therapy Program ◽  
Electronically Delivered

BACKGROUND The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. OBJECTIVE This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. METHODS This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. RESULTS This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. CONCLUSIONS If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. CLINICALTRIAL ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/24913

scholarly journals Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program

10.2196/24913 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e24913
Author(s):  
Nazanin Alavi ◽  
Megan Yang ◽  
Callum Stephenson ◽  
Niloofar Nikjoo ◽  
Niloufar Malakouti ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Regression Analysis ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Care Delivery ◽  
Behavioral Therapy ◽  
Online Psychotherapy ◽  
Therapy Program ◽  
Electronically Delivered

Background The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. Objective This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. Methods This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. Results This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. Conclusions If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. Trial Registration ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667 International Registered Report Identifier (IRRID) DERR1-10.2196/24913

scholarly journals Evaluation Of District Mental Health Programme In The District Of Dharmapuri, Tamil Nadu, India And Evolution Of Mental Health Care Delivery System For Our State

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2586-2590
Author(s):  
Kannapiran R.Thiruvengadam ◽  
Indiran Meenakshi
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Tamil Nadu ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Paramedical Personnel ◽  
Mental Health Programme ◽  
The Impact ◽  
Health Programme

District mental health programme was started in India with the idea of decentralizing mental health care. The plan was to train the general medical officers working in primary health centers so that they can identify and treat psychiatric disorders. After the district mental health programme was started, it is time to review its effects. In Dharmapuri, a district in Tamil Nadu, India, medical officers and paramedical personnel were trained and sensitized to identify psychiatric disorders and a district psychiatrist was posted in the district headquarters hospital, who would conduct psychiatric clinics in headquarters and taluk hospitals. We are evaluating the impact of these in terms of actual benefit to the community. A number of new case registrations, before and after the training of the paramedical personnel, a pattern of referral and the impact of starting the psychiatric clinics in taluk hospitals are all assessed. When the peripheral clinics were started, new case registrations increased by 142% in the taluk hospitals. After the training of the paramedical personnel, there was an increase of new cases in the peripheral clinics from 56 to 70. Based on this experience, a suitable pattern of community mental health care delivery system for our state is evolved, taking into consideration availability of qualified manpower, resources, an expectation of the public and WHO guidelines.

scholarly journals Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study (Preprint)

2021 ◽  
Author(s):  
Elissa Kozlov ◽  
Meghan McDarby ◽  
Maximo Prescott ◽  
Myra Altman
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Treatment ◽  
Care Delivery ◽  
Cross Sectional Study ◽  
Stepped Care ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Treatment

BACKGROUND Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. OBJECTIVE The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. METHODS This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. RESULTS Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; <i>P</i>&lt;.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; <i>P</i>&lt;.001) or depression (OR 0.79, 95% CI 0.66-0.95; <i>P</i>=.02) were more likely to prefer one-on-one care. CONCLUSIONS Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. CLINICALTRIAL

Managed Mental Health Care: Implications for Administrators and Managers of Community-Based Agencies

1993 ◽  
Vol 74 (3) ◽  
pp. 171-177 ◽  
Author(s):  
Norman Winegar
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Care Delivery ◽  
Clinical Care ◽  
The United States ◽  
Health Care Delivery System ◽  
Community Based ◽  
Early Management ◽  
Financial Arrangements

A revolution is occurring in the private mental health care delivery system in the United States, marked by increased employer interest in how health care dollars are spent, new financial arrangements between payers and providers, and a reshaping of clinical practice to focus on efficacy and efficiency according to objective clinical care guidelines. Managed mental health care (MMHC) evolved from early management processes such as retroactive review into networks of providers in partnership with MMHC firms whose goal is to pursue effective management of benefits and care. Areas of cooperation and potential pitfalls of relationships between community' based agencies and MMHC entities are discussed.

scholarly journals New Perspectives for Mental Health Care Delivery Systems

1973 ◽  
Vol 18 (6) ◽  
pp. 501-504 ◽  
Author(s):  
Michael G. Thompson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Delivery ◽  
Human Services ◽  
Care Delivery ◽  
Collective Responsibility ◽  
Health Care Delivery System ◽  
Mental Health Care Delivery ◽  
Health Care Delivery Systems

This paper describes the movement from a doctor-centred, fragmented mental health care delivery system to a system of collective responsibility on the policy level, and individualized attention on the client level. This may be achieved through the creation of a Human Services Council.

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