E-Book, Englisch, 96 Seiten
Tucker / Grimley Public Health Tools for Practicing Psychologists
1. Auflage 2011
ISBN: 978-1-61334-330-2
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 96 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-330-2
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Essential public health techniques to make psychological and behavioral health practices more effective.
Many people in need of behavioral health measures or psychotherapy do not seek clinical care and are simply not being “reached” by current practices and services. This book shows psychologists how to integrate public health tools into psychological practice – and so better meet today’s demands for effective and cost-effective therapeutic and preventive care.
Readers learn about intervention approaches, how they work and for what populations, and how clinical treatment fits into such a scheme. The goal is to complement and expand current clinical and psychotherapeutic approaches, reaching more people in need with services that vary in scope and intensity based on their needs and preferences. This “integrated behavioral health care” approach maintains a degree of individualization while finding “teachable moments” for behavior change interventions, enhancing motivation for change, and making use of print, telephone, and computer dissemination strategies.
This clearly structured book provides practice suggestions and examples for incorporating a public health approach into clinical work, as well as useful appendices to help expand these applications. It is both compelling reading for those already in clinical practice and an ideal text for courses on behavioral health problems and strategies to promote behavior change.
Autoren/Hrsg.
Fachgebiete
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Public Health, Gesundheitsmanagement, Gesundheitsökonomie, Gesundheitspolitik
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Präventivmedizin, Gesundheitsförderung, Medizinisches Screening
- Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
Weitere Infos & Material
1 Description 1.1 Terminology This section introduces concepts, terms, and intervention approaches from public health and contrasts them with clinical approaches. Understanding how the approaches differ and complement one another is basic to effective integration. 1.1.1 Clinical and Public Health Practice Models Clinical interventions generally achieve greater risk reduction for individuals, but population approaches reach more people in need. Until recently, interventions for promoting psychological well-being and behavioral health tended to be either individual or small-group intensive clinical treatments delivered by mental health specialists, or large-scale public health programs delivered to at-risk populations, such as school-based programs (e.g., the President’s Challenge Youth Physical Fitness Awards and Project D.A.R.E. [Drug Abuse Resistance Education]). Clinical interventions generally are client-centered, individualized, and delivered to motivated individuals who seek care. They tend to have greater benefits in reducing risk behaviors on a per-person basis than do public health interventions, which typically are generic, less intensive and costly per person, and delivered to a heterogeneous audience. However, clinical interventions reach only the small subset of persons who reactively seek services, whereas public health interventions generally have broad reach into the population in need. This reach is achieved via proactive intervention delivery to large numbers of people who are not otherwise seeking services. 1.1.2 Population Impact of Practice Approaches Recent work integrates public health and clinical strategies in order to target larger risk groups with interventions that are individualized, at least in part, thereby increasing the potential overall impact of services on population health. Advances in computer and communication technologies have helped to combine the best of clinical and public health strategies so that large segments of the population in need can be reached with individualized interventions. Concurrently, behavior change theories and techniques have broadened to support proactive recruitment and intervention delivery to less motivated persons who are not reactively seeking services. Combining clinical and population approaches achieves the greatest impact. Impact = Reach × Efficacy. These advances in behavior change theories and techniques, in concert with information technology, have increased the scope and potential public health impact of behavior change programs. Impact is defined as the product of the intervention’s reach, or the percentage of individuals who receive the intervention, and its efficacy, or the percentage of individuals who show a defined benefit, that is: impact = reach × efficacy (Abrams & Emmons, 1997). Table 1 illustrates the concept of impact as it applies to clinical, public health, and integrated approaches to behavioral health care that vary in their reach and efficacy. The text box describes intervention “efficacy,” an essential determinant of population impact, and its companion concept of intervention “effectiveness.” Public health interventions are typically generic, less intensive and costly than clinical treatments, and can reach more persons in need. Integrated behavioral health care combines some degree of tailoring with public health dissemination strategies to increase reach into the community. Although distinctions between clinical and public health approaches have blurred somewhat in recent years, clinical interventions tend to be more intensive, costly, efficacious, and “higher threshold” in that they require entry into the health care system. Public health interventions can be disseminated more widely to target audiences in the broader community. They tend to be generic and typically are less intensive, costly, and efficacious on a per-person basis. Clinical interventions require active help-seeking on the part of recipients. In contrast, public health programs actively target recipients who often are not motivated to seek services. As shown in Table 1, a more efficacious individuallevel intervention may have lower overall impact than a less efficacious public health intervention that reaches many more people. For example, whereas hospital-based alcohol treatment for one alcohol-dependent patient may cost in excess of US $10,000, for about US $70,000, a health care organization could implement alcohol screening and brief intervention with about 10,000 adults (Fleming et al., 2002). Thus, well-conducted integrated behavioral health programs have potential for greater population impact compared with clinical or public health approaches alone. Integrated behavioral health care typically involves some degree of individualization that can improve efficacy on a perperson basis, coupled with dissemination concepts and strategies pioneered in public health practice to reach more persons in need. Table 1
Impact of Behavioral Interventions With Varying Reach and Efficacy Intervention approach Practice target and methods % Population Reached Efficacy (% improved) Population impact Clinical One-on-one or small group; 6-12 visits; reactive health care 5 30 1.5 Public health Community-population based; mass media delivery; proactive 90 2 1.6 Integrated Community/population; technology-assisted, individualized interventions; proactive, targeted 60 20 12.0 Note. Adapted from “Health Behavior and Health Education: The Past, Present, and Future,” by D. B. Abrams, & K. M. Emmons, in Health Behavior and Health Education: Theory, Research, and Practice, K. Glanz., B. K. Rimer, & F. M. Lewis, Eds., 1997, San Francisco, CA: Jossey-Bass, pp. 453–478. Intervention Efficacy and Effectiveness The terms efficacy and effectiveness both relate to the basic question in evaluation research: “Did an intervention work?” However, they address different questions along the continuum of decision-making about the strength, meaning, and generalizability of research findings. Borrowing from Flay’s (1986) analysis, efficacy trials evaluate whether an intervention does more good than harm when delivered under optimum conditions, as in a well-resourced randomized controlled trial (RCT). In an efficacy trial, participants with pure forms of a disorder who are motivated to comply can be selected for inclusion; treatment and control conditions can be implemented with high fidelity; and outcomes are assessed on a preplanned follow-up schedule. These design features promote high internal validity, but the generalization of findings to more diverse populations in less well controlled and resourced settings may be limited. Effectiveness trials evaluate whether an intervention does more good than harm under real-world conditions of availability, implementation, and utilization (Flay, 1986). Participants tend to be more heterogeneous along demographic and disorder-relevant dimensions, including having comorbid conditions that may adversely affect outcomes. Intervention and follow-up procedures may be implemented less consistently, and randomization to treatment or control conditions may be impractical or unethical. Effectiveness studies thus may have lower internal validity than efficacy studies, but they tend to have higher external validity. They contribute important information about the extent to which an intervention can be successfully translated into routine practice. Ideally, an intervention established as efficacious in RCTs will be evaluated in usual practice or community settings to determine whether it provides benefits under less well controlled conditions. Effectiveness studies that do not involve random assignment allow investigation of how extratherapeutic patient and contextual variables may affect outcomes; e.g., how do the environmental circumstances that surround treatment-seeking affect treatment engagement, retention, and outcomes? Such extratherapeutic factors influence behavior change and can be studied better in effectiveness than efficacy trials. 1.1.3 Developing an Intervention Spectrum An emerging strategy is to combine public health, integrated behavioral health, and clinical care in a coordinated service delivery system that encompasses prevention and treatment and allocates limited helping resources based on population and individual need and risk. Figure 1 shows a population-based allocation scheme adapted from an early IOM (1994) model to broaden MH/SU clinical services in the direction of prevention. As the figure shows, a far greater proportion of the population will need and benefit from preventive interventions compared with the minority in need of treatmentrelated services that range from initial case-finding, to acute treatment, to long-term care. Figure 1 System of care spanning the intervention spectrum for psychological and behavioral disorders. Proportions in the pie graph reflect segments of the population that...
