Outcomes of telephone-delivered low-intensity cognitive behaviour therapy (LiCBT) to community dwelling Australians with a recent hospital admission due to depression or anxiety: MindStep™

Abstract

BackgroundIn 2006, the British government launched ‘Improving Access to Psychological Therapies’ (IAPT), a low intensity cognitive behaviour therapy intervention (LiCBT) designed to manage people with symptoms of anxiety and depression in the community. The evidence of the effectiveness of IAPT has been demonstrated in multiple studies from the UK, USA, Australia and other countries. MindStep™ is the first adaptation of IAPT in Australia, delivered completely by telephone, targeting people with a recent history of a hospital admission for mental illnesses within the private health system. This paper reports on the outcome of the first 17 months of MindStep™ implemented across Australia from March 2016.MethodsThis prospective observational study investigated the MindStep™ program in a cohort of clients with a recent hospitalisation for mental illnesses. The study used quantitative methods to compare pre-post treatment clinical measures (N = 680) using Patient Health Questionnaire (PHQ-9) and the Generalised Anxiety Disorder (GAD-7). This study also included in-depth interviews with participants (N = 14) and coaches (N = 4) to determine the feasibility and acceptability of the program.ResultsOf the 867 clients referred to MindStep™, 757 had initial assessments by phone making an enrolment rate of 87.3%. Following assessment, 680 commenced treatment and of them, 427 (62.7%) completed treatment. According to ‘per-protocol’ analysis (N = 427), there was a large effect size for post-treatment PHQ-9 (d = 1.03) and GAD-7 (d = 0.99) scores; reliable recovery rate was 62% (95% CI: 57–68%). For intent-to-treat analysis using multiple imputation (N = 680), effect sizes were also large for pre-post treatment change: PHQ-9 (d = 0.78) and GAD-7 (d = 0.76). The reliable recovery rate was 49% (95% CI: 45–54%). Qualitative findings supported these claims where participants were positive about MindStep™ and found the telephone delivery and use of mental health coaches highly acceptable.ConclusionsMindStep™ has demonstrated encouraging outcomes that suggest LiCBT can be successfully delivered to people with a history of hospital admissions for anxiety and depressive disorders and achieve target recovery rates of > 50%. Other promising evaluation findings indicate the MindStep™ option is acceptable, feasible and safe within the stepped models of mental health care delivery in Australia.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1987-1) contains supplementary material, which is available to authorized users.

Guided Self-Help for People with Chronic Pain: Integrated Care in a Public Tertiary Pain Clinic—A Pilot Study

“…Psychological improvements were small to moderate in effect size, and somewhat smaller than those reported in other studies [17,18]. Whilst some participants did not experience improvements, scores significantly reduced overall.…”

“…These improvements may also enhance engagement with PMU staff and support access the multidisciplinary supports available. Worth noting is that whilst psychological outcomes improved (as per previous comparable GSH studies [17,18], pain-related outcomes (severity and interference) did not. This result was not unexpected given the program did not focus directly on pain reduction, but rather on self-management and quality of life with chronic pain.…”

“…Response options range from 0 'not at all' to 3 'nearly every day'. Scores are summed and used to categorise individuals as having no symptoms (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19) or severe depression (20)(21)(22)(23)(24)(25)(26)(27). Score changes of five or more points constitute clinically significant change [21].…”

“…Integrating stepped care models that yield a diverse, multi-skilled workforce that shifts, redistributes and extends the provision of evidence-based psychosocial treatments to nonspecialist health workers such as community health workers, peer or lived experience persons, and other frontline health workers as opposed to psychiatrists and psychologists has emerged as a highly promising approach to increase access to treatments [12,13]. Despite the growing body of evidence and the demonstrated outcomes of implementing scalable GSH programs for people with various non-communicable and chronic health conditions, both within and outside of Australia, there is inconsistent implementation and scarcity of GSH provisions in tertiary chronic pain services [14][15][16][17][18]. It is proposed that the implementation of a GSH program within a tertiary chronic pain service addresses existing gaps through the provision of a high-dose, narrow-bandwidth treatment provision that matches a person's readiness and need to treatment type, dose and intensity.…”

Internet-Administered Cognitive Behavioral Therapy for Common Mental Health Difficulties in Parents of Children Treated for Cancer: Intervention Development and Description Study

“…Innovative strategies to address barriers and improve access to evidence-based psychological interventions are being implemented worldwide [ 26 ]. One such innovation is the Improving Access to Psychological Therapies (IAPT) program in England [ 27 , 28 ], which is now also being piloted in countries including Australia [ 29 ] and Norway [ 30 ]. The IAPT program was established in recognition that improving access to evidence-based psychological therapies required a fundamental transformation of mental health service delivery.…”