Practical Strategies and Tools to Promote Treatment Engagement by William O'Donohue Larry James & Cassandra Snipes

Author:William O'Donohue, Larry James & Cassandra Snipes
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Step Three: Increased Provider Involvement

Within a stepped-care approach, the third level of treatment for depression involves an increase in provider involvement. These strategies include a variety of technology-based interventions, primary care interventions, and cognitive behavioral therapy . All these approaches may be effective in the treatment of mild, moderate, or even severe depression and may be utilized prior to the use of more intensive treatments.

Technology-Based Interventions. In recent years, technology-based interventions have garnered increasing attention for a variety of reasons. Technology has the potential to increase the capacity of mental health services, and to overcome some of the barriers to accessing mental health services, including stigma, traveling time for rural patients, treatment delays, and the low availability of skilled providers. A growing body of evidence supports the efficacy of technology-based interventions and in particular supports the efficacy of computerized cognitive behavioral therapy (Titov, 2007).

Technology-based interventions vary in the amount of provider involvement and the degree of invasiveness. Research to date has suggested that predominately self-help computerized cognitive behavioral therapy interventions are efficacious in the treatment of sub-threshold mood disorders and offer a less-intensive, cost-effective way to deliver treatments, but that provider-assisted interventions are more efficacious (Newman, Szkodny, Llera, & Przeworski, 2011).

Telephone-Based Interventions. Telephone-based interventions may involve assessment or psychological interventions delivered via phone calls between the provider and patient. These sessions may vary widely in duration and focus. A variety of studies have evaluated the use of telephone-delivered interventions to increase treatment engagement.

A study conducted by Mohr et al. (2012) compared telephone-delivered CBT to face-to-face CBT. In this study, the two treatment groups followed identical treatment protocols and varied only in the modality used to deliver treatment. The results of this study indicated that while the telephone-delivered intervention improved adherence, it also resulted in some increased risk of poorer maintenance of gains following the conclusion of treatment.

Motivational interviewing (MI) provided over the phone has been investigated as a possible method to increase treatment engagement. A study conducted by Seal et al. (2012) evaluated the efficacy of telephone-delivered in enhancing treatment engagement in veterans with mental health concerns. The intervention involved four 20–30 min telephone MI sessions conducted at baseline and 2, 4, and 8 weeks. The baseline session involved personalized feedback regarding psychological assessment, open-ended questioning about concerns, and empathic reflective listening. Subsequent sessions focused on building motivation and strengthening commitment to treatment. The use of a MI intervention resulted in 62 % of Veterans engaging in treatment compared to only 26 % in the control group.

Another study evaluated a telephone-based referral care management program implemented in a population of African Americans between the ages of 22–83, of whom 39 % had severe depression comorbid with substance use. The intervention involved addition of one or two MI sessions, averaging 15 min per week, which involved discussing patient symptoms, goals, and attitudes toward treatment. These brief MI sessions were provided in addition to the usual-care model, which involved session scheduling and a letter and telephone reminder of the scheduled appointment. The

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