Implementation Of Psychological Treatments Research Articles

L’implémentation des soins psychologiques de première ligne en Belgique : profil et satisfaction des psychologues et orthopédagogues de première ligne

Primary psychological care was implemented in Belgium between January and April 2019 as part of the “psy 107” mental health reform. This is part of a wider trend of strengthening primary care at the international level. Belgium, like the Netherlands (Derksen, 2009), Ireland (Corcoran et Byrne, 2017), Australia (37), England (Clark, 2018) and the United States (McDaniel, DeGruy, 2014; McGough et al., 2016), has moved towards a public health model based on a community approach to improve access to psychological care. However, the implementation of psychological treatment in primary care is still relatively recent and has been promoted by the work of clinical researchers who have reported the need to integrate mental health care into their practice (Kaitz et al., 2020). From this perspective, integration can take different forms; in fact, there is no standard model for integrated care but rather several models (Runyan, 2011; Seaton et al., 2021). In line with the “psy107” mental health reform, the federal authorities have implemented first-line psychological care in Belgium for patients aged 18 to 64 with reimbursement from the National Institute for Health and Disability Insurance (RIZIV). For the first time in history, 4 and up to 8 primary psychological sessions per year are reimbursed for mild to moderate symptoms of anxiety, depression or dependence on alcohol or sleeping pills. The implementation of these agreements resulted in the setting up of 20 adult mental health networks delimited on a territorial basis and later the creation of 11 networks dedicated to children and adolescents. In the context of the COVID-19 health crisis, this measure was extended on 2 April 2020 to include patients under 18 years of age and over 64 years of age, as well as the reimbursement of video-consultations. Each session costs the patient 4 or 11.20 euros, depending on whether or not they have an enhanced intervention. ObjectivesThe research for this study was commissioned through a public procurement tender and led to the research project “Evaluation of Primary Care Psychology” (EPCAP) conducted by researchers from two universities. The research, which started in February 2020, has four components, focusing respectively on the epidemiological profile of the patients, the place of primary care psychologists and orthopedagogists (PPLs) in the health care network, the economic analysis of this measure, and the development of recommendations for the sustainability of this project. The purpose of this article is to present the profile of psychologists and orthopedagogists, their personal satisfaction, and the implementation of collaborative practices with general practitioners. MethodsAn online survey was distributed via network coordinators to all primary care psychologists and orthopedagogists who are engaged to provide this care in at least one adult network between September 2020 and January 2021. A census of the total population was carried out in September 2020 on the basis of FPS Health files. The final sample consists of 310 psychologists and orthopedagogists, out of 641 practitioners registered for first line psychological care in September 2020, of which the vast majority (74.5 %) is female and with 25.5 % male. ResultsThe 310 professionals, most of whom are experienced clinicians, also used different epistemological approaches. The results underline a commitment on the part of these professionals to the democratization of mental health care and their desire to adopt a community-based approach by promoting the accessibility of psychological cares to all patients. The majority of PPL were satisfied with this activity and the collaboration with general practitioners. More specifically, the results highlight the fact that the implementation of collaborative practices is a contributing factor in professional fulfilment. However, certain points are a subject of expressed dissatisfaction such as disparities in remuneration and contact with colleagues and collaborators. ConclusionThe implementation of these new systems in Belgium and internationally is a major step forward in preventive and early mental health care. Taking these results into account, a new agreement was adopted on 2 November 2021 as part of the psy107 reform and was accelerated in the context of the health crisis. This new agreement is currently being implemented in the various networks with significant changes. The withdrawal of the medical prescription is an important change, while at the same time raising the question of how collaboration between GPs, PPLs and, more broadly, the care network will be organized.

Implementation of Law Enforcement and Disciplinary Policies in the Instruction of the Minister of Home Affairs No. 15 of 2021 in Banten

This research investigated the implementation of the law enforcement and disciplinary policies of the Governor’s Instruction number 15 of 2021, focusing on the province of Banten, where during the pandemic period, law enforcement and discipline experienced many obstacles. George C. Edward’s policy implementation theory was used, which examines four variables that affect the success of policy implementation, namely communication, resources, disposition, and bureaucratic structure. A qualitative research method was used and data were collected through literature studies, observations and interviews. Triangulation techniques were used. The results demonstrated that the central government’s policy regarding emergency PPKM was only able to reduce in small quantities according to the target, due to the many inhibiting factors. The authors conclude that it may be time to focus on herd immunity, and that we must understand that to solve this problem we need to increase antibodies or community immunity, so the policies issued must lead to increasing these factors. The research also focused on helical trauma and the implementation of psychological treatment.
 Keywords: policy implementation, law enforcement, COVID-19, PPKM

Acceptability and feasibility of peer-administered group interpersonal therapy for depression for people living with HIV/AIDS\u2014a pilot study in Northwest Ethiopia

BackgroundPsychological treatments are widely tested and have been effective in treating depressive symptoms. However, implementation of psychological treatments in the real world and in diverse populations remains difficult due to several interacting barriers. In this study, we assessed the acceptability and feasibility of peer-administered group interpersonal therapy for depressive symptoms among people living with HIV/AIDS in Northwest Ethiopia.MethodWe conducted a single-arm, peer-administered, group interpersonal therapy intervention with eight weekly sessions from 15 August to 15 December 2019 among people living with HIV/AIDS in Northwest Ethiopia. Four interpersonal therapy groups were formed for the intervention with a total of 31 participants.ResultsOf the 31 recruited participants, 29 completed the intervention providing a retention rate of 93.5%. The process of the intervention and its outcomes were highly acceptable as most participants expressed success in resolving their psychosocial problems, adjusting to life changes and coping with stigma. The intervention was also reported to be feasible despite anticipated barriers such as access to transportation, perceived stigma and confidentiality concerns. The post-intervention assessment revealed significant reduction in depressive symptoms (mean difference (MD) = 9.92; t = − 7.82; 95% CI, − 12.54, − 7.31; p < 0.001), improvement in perceived social support (MD = 0.79; t = 2.84; 95% CI, 0.22, 1.37; p = 0.009) and quality of life (MD = 0.39; t = 4.58; 95% CI, 0.21, 0.56; p < 0.001).ConclusionGroup interpersonal therapy is feasible and acceptable, and people living with HIV/AIDS can benefit from group interpersonal therapy in managing depressive symptoms and in improving perceived social support and quality of life. Future studies should examine the effectiveness of group interpersonal therapy in this setting.

A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service

BackgroundPsychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT.MethodsSixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT).ResultsThe use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to ‘sell’ treatments to a patient population who are not generally expecting treatment in this form.ConclusionsPerceptions of a need to ‘sell’ telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes.

Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists.

BackgroundOne of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence.ObjectiveThe aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit.MethodsA cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks.ResultsA total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95% CI 3.1-3.8; P<.001). After training, 52% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45% (95% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95% CI 1.2-4.1).ConclusionsIndependent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments.

Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods.

BackgroundOne of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise.ObjectiveThe goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects.MethodsEligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training.ResultsA total of 160 therapists expressed interest in the study, and 156 (97.5%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being –0.06 (95% Cl –1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9%) scored above the competence threshold; three-quarters (43/58, 74%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95% Cl –1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference –0.70, 95% CI –1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95% Cl 0.34 to 2.62; P=.92).ConclusionsWeb-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments.

Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale

Lack of reliable and valid measures of therapist competence is a barrier to dissemination and implementation of psychological treatments in global mental health. We developed the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale for training and supervision across settings varied by culture and access to mental health resources. We employed a four-step process in Nepal: (1) Item generation: We extracted 1081 items (grouped into 104 domains) from 56 existing tools; role-plays with Nepali therapists generated 11 additional domains. (2) Item relevance: From the 115 domains, Nepali therapists selected 49 domains of therapeutic importance and high comprehensibility. (3) Item utility: We piloted the ENACT scale through rating role-play videotapes, patient session transcripts, and live observations of primary care workers in trainings for psychological treatments and the Mental Health Gap Action Programme (mhGAP). (4) Inter-rater reliability was acceptable for experts (intraclass correlation coefficient, ICC(2,7) = 0.88 (95% confidence interval (CI) 0.81–0.93), N = 7) and non-specialists (ICC(1,3) = 0.67 (95% CI 0.60–0.73), N = 34). In sum, the ENACT scale is an 18-item assessment for common factors in psychological treatments, including task-sharing initiatives with non-specialists across cultural settings. Further research is needed to evaluate applications for therapy quality and association with patient outcomes.

Disseminating evidence-based psychological treatments for eating disorders.

The research-practice gap is of concern in the treatment of eating disorders. Despite the existence of empirically supported treatments, few receive them. The barriers to wider dissemination and implementation of evidence-based treatment include clinician attitudes towards such treatments and the lack of sufficient numbers of suitably trained therapists to provide treatment. In this review we discuss these barriers in the context of the wider issue of the dissemination and implementation of psychological treatments and review the research with regard to the treatment of eating disorders. Particular emphasis is placed on examining recent efforts to expand the availability and reach of treatments by making treatment delivery and training more scalable. We highlight promising developments and areas where further research is needed.

The dissemination and implementation of psychological treatments: Problems and solutions

Treatment researchers expend their efforts identifying effective treatments, and for whom and how they work, but there are matters over and above these that are of concern when it comes to dissemination and implementation. These include the clinical range of the interventions concerned, the ease with which they can be learned, and their mode of delivery. It is these three topics, as they apply to the psychological treatment of eating disorders, that form the focus of this article. Alongside these considerations, we discuss how modern technology has the potential to transform both treatment and training.