E-Book, Englisch, 96 Seiten
Tucker / Grimley Public Health Tools for Practicing Psychologists
1. Auflage 2011
ISBN: 978-1-61676-330-5
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, 96 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61676-330-5
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF 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
- Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
- 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
Weitere Infos & Material
1;Table of Contents;12
2;Preface;6
3;Acknowledgments;7
4;Introduction: The Changing Practice Environment;8
5;1 Description;14
6;2 Theories and Models of BehaviorChange in Behavioral Health Practice;24
7;3 Diagnosis and Treatment Indications;39
8;4 Treatment;50
9;5 Case Vignette;72
10;6 Further Reading;77
11;7 References;79
12;8 Appendices: Tools and Resources;86
1.3 Epidemiology
Development of a viable continuum of behavioral health services rests on understanding the population distribution and dynamics of behavioral health problems, patterns of care-seeking, and relationships between the two (Tucker, Phillips, Murphy, & Raczynski, 2004). The relevant behavioral epidemiology findings are summarized next.
1.3.1 Behavioral Health Problems in the General Population
Worldwide, MH/SU disorders contribute substantially to the global burden of disease and disability, and the great majority of persons with problems do not receive treatment (Wang et al., 2005; WHO World Mental Health Survey Consortium, 2004). About a third of the population experiences one or more diagnosable disorders on a lifetime basis, and many others experience subclinical signs and symptoms that may develop further or remit on their own. Mood disorders, including anxiety and depressive disorders, and alcohol and other substance use disorders are among the most prevalent disorders and contribute significantly to the global burden of disease and disability. Schizophrenia and other psychotic disorders, while much less common (< 3%), also contribute significantly (US Surgeon General, 1999; WHO World Mental Health Survey Consortium, 2004).
1.3.2 Behavioral Health Problems in Medical Patients
Many medical patients have behavioral health problems such as depressive or substance use disorders (SUDs), or they engage in behavior patterns that adversely affect their health status, medical treatment adherence, and outcomes (Tucker et al., 2004). People who seek help for psychological symptoms often ask their primary care providers for help first, and the main complaint of many primary care patients has a psychological or behavioral component. The “worried well” are common in medical settings. Their problems may benefit from brief interventions or resolve without treatment. Some medical patients, however, will have more serious problems and will need more intensive evaluation, referral, and treatment.
Behavioral health problems can be difficult to detect because medical patients often do not self-identify as having such problems; their problems often are fairly mild and do not meet diagnostic criteria; and busy primary care providers may not screen for them effectively (Pini, Perkonnig, Tansella, & Wittchen, 1999). Uncomplicated depressive, anxiety, and alcohol-related problems are most common and can be treated in medical settings. Most people who receive an intervention for depression are treated by primary care physicians, who write the majority of prescriptions for antidepressant medications (Lieberman, 2003). Treating depression is important because it is comorbid with many medical disorders and often contributes to poor medical outcomes.
As another example, SBIs for alcohol problems are recommended in primary care and emergency departments because such problems are prevalent among their patients. See http://pubs.niaaa.nih.gov/publications/Practitioner/ CliniciansGuide2005/clinicians_guide.htm for an example of an evidencebased SBI recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2005).
1.3.3 Economic Impact
Behavioral health problems, especially when untreated, pose a substantial economic burden on the health care system and broader economy (US Surgeon General, 1999). Including behavioral health services in primary care and covering them in comprehensive health plans reduces the use and cost of medical services (Cummings, O’Donohue, & Ferguson, 2002). This medical cost offset effect provides an economic basis for covering behavioral health services in MCOs and other health plans and provider organizations. Despite the cost savings, however, behavioral health services are often among the first to be cut in cost-containment efforts, particularly before federal parity legislation was enacted.
1.4 Course and Prognosis
MH/SU disorders typically emerge in adolescence and early adulthood before age 25, and subthreshold symptoms often predate full clinical diagnosis (WHO World Mental Health Survey Consortium, 2004). Early adulthood is an important period for early case-finding and preventive interventions, in addition to treatment when indicated. Some disorders (e.g., SUDs) remit in many cases without treatment, particularly in early adulthood, whereas other disorders that occur early in life presage increased risk for future recurrences (e.g., schizophrenia, major depression).
For many MH/SU problems, partial or full improvement to premorbid levels of functioning occurs without treatment or with brief interventions. In some cases, improvements are sustained; in others, the risk of relapse remains high. The informed behavioral health practitioner will understand how population segments differ in the distribution and severity of MH/SU problems and the range of variations in the long-term course and need for continued monitoring with linkages to care.
Depression illustrates relationships between subthreshold and clinical presentations of disorders and how this can inform screening and practice patterns (Tucker et al., 2004). In the general US adult population, 20% to 30% of individuals experience subthreshold depressive symptoms, which may remit without intervention. However, only a minority of depressed individuals seek treatment, and even fewer receive specialty mental health care (Wang et al., 2005). Major depression, the most severe form of the disorder, occurs in less than 10% of cases, but it tends to recur; 50% of persons who have had one major depressive episode will have another, and 70% who have had two episodes will have a third. Thus, long-term monitoring of individuals with a history of major depression is a high priority in behavioral health care.
1.5 Differential Diagnosis
As discussed in Chapter 3, formal clinical diagnosis is not highly relevant to public health or integrated behavioral health practice. Rapid, macroscopic determination of whether care is needed, and if so the appropriate level of care, is more central to practice. This is the case because the focus of public health and integrated behavioral health care often is on the large untreated population segment with risk factors or subclinical forms of disorders. This untreated segment tends to have less severe problems than clinical samples, and they often fall short of fulfilling all diagnostic criteria.
1.6 Comorbidities
Comorbid conditions are common among persons with MH/SU disorders. For example, more than 20% of people with a mental disorder in the United States also have a substance use disorder (Wang et al., 2005). Persons with comorbidities generally need specialty clinical care that falls outside the services discussed in this book.
1.7 Diagnostic Procedures and Documentation
The psychological and behavioral problems of individuals need to be considered in an integrated behavioral health model of practice, and practitioners need to be competent with established assessment procedures and diagnostic systems. However, as discussed in Chapter 3, the scope of assessment is generally broader than the focus of traditional clinical assessment and diagnosis on individual characteristics. In an expanded population approach to practice, primary objectives of assessment are to identify opportunities for intervention delivery to persons who do not present for treatment and to characterize their motivations for change and determine where they are in the change process.
