Low-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across a number of clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment. The present study analyzed provider open responses about recommending LITs for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process which yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress. Results suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient’s needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.
OBJECTIVES/GOALS: Waiting for psychotherapy is a major barrier to care and associated with negative outcomes. Individuals waiting for treatment may be particularly well-suited to receive low-intensity treatments (LITs), but few providers recommend LITs. We investigated provider-identified barriers to recommending LITs for patients on treatment waiting lists. METHODS/STUDY POPULATION: We recruited mental health professionals via social media and professional association listservs to participate in a brief survey. Participants were asked about their current waiting list practices and attitudes towards low-intensity resources for patients waiting for treatment. Participants were prompted to provide additional thoughts on recommending LITs for patients on waiting lists in an open-ended text box. Two members of the research team independently coded responses into themes, resolved discrepancies, and achieved total consensus. RESULTS/ANTICIPATED RESULTS: 141 mental health providers participated in the survey, and 65 (46%) provided a response to the open-ended question. The emerging themes included: Patient Barriers, Research Evidence/Efficacy, Feasibility, Patient Personal Contact, Patient Appropriateness, Liability, Systemic Problems, Trust in Programs, Downplaying Distress, Additional Resources, and Positive Attitudes. Providers were particularly concerned with giving a generalized intervention without having conducted a full evaluation or assessment with a patient. Many providers also reported concerns pertaining to the legal and ethical liability of providing LITs when a patient is not being seen face-to-face by a provider. DISCUSSION/SIGNIFICANCE: Many of the themes we identified parallel those identified in previous literature. Some barriers we identified from our providers, when thinking about integrating LITs on waiting lists, highlight the need for professional guidelines to address legal and ethical liability, as well as billing and reimbursement procedures.
Literary scholars have long debated the thematic significance of Voltaire's Candide, a 1759 novella that relentlessly satirizes Gottfried Leibniz’s philosophy of optimism. In Candide, Voltaire assails his readers with displays of violence so absurd they might inspire anything from laughter to hopelessness. The novella's crude humor is hinged upon an unexpectedly-compassionate acknowledgement of human suffering. Voltaire uses Candide's plotline to attack the human assumption that any force of good will ever offset the evil in a world pervaded by cruelty and selfishness. He provokes questions with no answers in sight. Deriving a theme from the novella only becomes more difficult after reading its conclusion, which leaves readers dissatisfied, desperate for some sort of call to action. We are urged to cultivate our garden but given no advice on what that might entail. We are convinced of Leibnizian optimism's failures but deprived of a more-pragmatic philosophy to replace it with. In this essay, I analyze the ways Voltaire uses humor, irony, and structure in Candide not only to denounce deceitful forms of optimism, but to provoke future thought on the questions he could not answer himself.
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