Stepped care provides the least intrusive intervention to individuals seeking treatment by providing a range of treatment intensities. In the past two decades, computers and the internet have provided a new and efficient medium that lends well to adding steps in a stepped-care model. While there is ample evidence to support the positive effects of bibliotherapy or self-help books, computer-aided therapy (also known as e-health) has the potential to take these effects even further. This volume will be of interest to practitioners and organizations attempting to serve rural and underserved communities. The book focuses on evidence-based treatment, making it consistent with quality improvement initiatives.
This book is a primer on Stepped Care 2.0. It is the first book in a series of three. This primer addresses the increased demand for mental health care by supporting stakeholders (help-seekers, providers, and policy-makers) to collaborate in enhancing care outcomes through work that is both more meaningful and sustainable. Our current mental health system is organized to offer highly intensive psychiatric and psychological care. While undoubtedly effective, demand far exceeds the supply for such specialized programming. Many people seeking to improve their mental health do not need psychiatric medication or sophisticated psychotherapy. A typical help seeker needs basic support. For knee pain, a nurse or physician might first recommend icing and resting the knee, working to achieve a healthy weight, and introducing low impact exercise before considering specialist care. Unfortunately, there is no parallel continuum of care for mental health and wellness. As a result, a person seeking the most basic support must line up and wait for the specialist along with those who may have very severe and/or complex needs. Why are there no lower intensity options? One reason is fear and stigma. A thorough assessment by a specialist is considered best practice. After all, what if we miss signs of suicide or potential harm to others? A reasonable question on the surface; however, the premise is flawed. First, the risk of suicide, or threat to others, for those already seeking care, is low. Second, our technical capacity to predict on these threats is virtually nil. Finally, assessment in our current culture of fear tends to focus more on the identification of deficits (as opposed to functional capacities), leading to over-prescription of expensive remedies and lost opportunities for autonomy and self-management. Despite little evidence linking assessment to treatment outcomes, and no evidence supporting our capacity to detect risk for harm, we persist with lengthy intake assessments and automatic specialist referrals that delay care. Before providers and policy makers can feel comfortable letting go of risk assessment, however, they need to understand the forces underlying the risk paradigm that dominates our society and restricts creative solutions for supporting those in need.
In this issue, guest editors bring their considerable expertise to this important topic.Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize
This timely volume provides the practitioner with evidence based treatments for many of the clinical problems encountered in integrated care. It applies the core concepts of stepped care to integrating brief mental health interventions as a way to address ongoing problems in the modern healthcare landscape. It sets out in depth the state of the healthcare crisis in terms of costs, staffing and training issues, integration logistics and management, system culture, and a variety of clinical considerations. Central to the book is a best-practice template for providing behavioral stepped care in medical settings, including screening and assessment, levels of intervention and treatment, referrals, and collaboration with primary care and other specialties. Using this format, contributors detail specific challenges of and science-based interventions for a diverse range of common conditions and issues, including: Depression. Anxiety disorders. Adherence to chronic obstructive pulmonary disorder management. Alcohol and other substance misuse. Attention deficit hyperactivity disorder. Chronic pain. Neurocognitive disorders. Paraphilias: problematic sexual interests.[WU3] Sexual abuse and PTSD in children. A solid roadmap for widescale reform, Principle-Based Stepped Care and Brief Psychotherapy for Integrated Care Settings is deeply informative reading for health psychologists, social workers, psychiatrists, and clinical psychologists. It also clarifies the research agenda for those seeking improvements in healthcare quality and delivery and patient satisfaction.
Stepped Care 2.0: A Paradigm Shift in Mental Health, by Dr Peter Cornish, made a compelling argument for why the existing mental health care system has consistently struggled to meet the needs of clients from all walks of life, and laid out key principles and guidelines for how the system could be changed. But what challenges are involved in putting these ideas into practice? Stepped Care 2.0: The Power of Conundrums features essays, interviews, and arguments from a wide range of contributors who have tried to do just that. The Power of Conundrums dives deep into the practical application of the Stepped Care 2.0 model (SC2.0), looking at the ways SC2.0 has succeeded, the difficulties administrators face when implementing it, and how it could be improved. Chapters touch on topics including: the evidence for stepped care, the way SC2.0 can be stymied by the Western cultural values that dominate mental healthcare, implementation science and SC2.0, the risk paradigm and SC2.0, the model’s one-at-a-time approach to therapy, what co-design means in an SC2.0 context, a case study on how implementing SC2.0 can go wrong, the understanding of recovery put forward by the model, and how SC2.0 can work for clients experiencing complex, persistent, or chronic mental health issues. Each chapter is followed by a reflection from Cornish, and the book concludes with a roundtable discussion about how SC2.0 can evolve to meet the challenges it faces. This text brings theory and practice together by including an updated version of Stepped Care 2.0: A Paradigm Shift in Mental Health, as well as the full text of Stepped Care 2.0: The Power of Conundrums.
Recent literature suggests that patient participation and engagement may be the ideal solution to the efficacy of healthcare treatments, from a clinical and pragmatic view. Despite the growing discussions on the necessity of patient engagement, there is no set of universally endorsed, concrete guidelines or practices. Transformative Healthcare Practice through Patient Engagement outlines the best practices and global strategies to improve patient engagement. This book features a convergence of healthcare professionals and scholars elucidating the theoretical insights borne from successful patient education, and the technological tools available to sustain their engagement. This book is a useful reference source for healthcare providers, students and professionals in the fields of nursing, therapy, and public health, managers, and policy makers.
Electrical therapy of the heart has rapidly evolved over recent years with the development of the cardiac implantable defibrillator and the application of the cardiac resynchronization therapy to improve performance of the congestive failed heart. There is an impressive amount of literature produced to assess the efficacy and effectiveness of the electrical therapy. New technology is continuously introduced into the market for the treatment of electrical heart disease with optimized performance and implemented design, with approximately 600,000 new pacemakers implanted each year. Attention of the electrophysiology community has mainly focused on the biomedical aspects of electrical therapy, but the psychological, emotional, social and cognitive aspects of the implantable devices has been largely overlooked. Health-related quality of life (QoL) and, to a lesser extent, psychological disorders, i.e. anxiety and depression, have rarely been assessed as outcomes in clinical trials, and results are pointing towards the impact of the implantable devices on QoL and mental health not being direct but moderated and mediated by several biomedical as well as psychosocial variables. Furthermore, the cognitive effects of the implantable devices have rarely been assessed in empirical studies, although cognitive impairment is largely associated with the heart disorders that require implantation of an electrical device and cognitive benefits are strongly expected from the therapy. The aim of this book is to collect, appraise and condense the results of all empirical studies that have investigated, even marginally, the relationships between the implantable devices and any psychological, emotional, social and cognitive dimension. This book is a cornerstone for all involved in device utilization (physicians, nurses, technicians, industry representatives) that need to understand this topic.
This book demonstrates how clinical psychology and psychotherapy practices may reach a scientific level provided they change the three basic paradigms that have controlled those practices in the last century. These three, now outdated, paradigms, are: (1) one-on-one (2) personal contacts (3) through talk. These paradigms have served well in the past but they are no less helpful in the current digitally focused world.
The Oxford Guide to Low Intensity CBT Interventions is the first ever comprehensive guide to Low Intensity CBT. It brings together researchers and clinicians who have led the way in developing evidence-based low intensity CBT treatments - treatments for those who have hitherto had no access to mental health services.
