Guided self-help supported by paraprofessional mental health workers: an uncontrolled before-after cohort study
Guided self-help supported by paraprofessional mental health workers: an uncontrolled before-after cohort study
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DOI：
10.1111/j.1365-2524.2008.00792.x
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发表时间：
2009-02-01
影响因子：
2.4
通讯作者：
Shaw, Steve
中科院分区：
文献类型：
--
作者：
Farrand, Paul;Confue, Phil;Shaw, Steve
初级保健领域的引导式自助诊所取得了长足的发展。这项不受控制的前后队列研究检验了这些诊所在缺乏心理健康培训和经验的辅助心理健康工作者的支持下的效率和效果。数据由位于英格兰西南部的七名研究生心理健康工作者 (GMHW) 收集。除了对诊所出勤率和退出率进行分析之外，还根据就诊次数和时长来衡量效率，以支持患者了解针对问题严重程度检查的干预措施的有效性。在 15 个月的时间里，有 1162 名患者被转诊至 GMHW 诊所，其中 658 名患者采取了引导自助方式。使用引导式自助的患者收到的平均输入信息（不包括评估）为 4 次 40 分钟的疗程。退出率与其他由经验丰富的心理健康专业人员支持的初级保健心理健康诊所相当，有 458 名患者完成了所有支持课程。然而，只有 233 名患者继续参加 3 个月的随访。由专业心理健康工作者支持的引导式自助诊所的有效性与经验丰富的心理健康护士支持的效果相当。问题严重程度的改善具有统计学显着性，分别有 55% 和 58%（最终支持会议）以及 63% 和 62%（3 个月的随访）患者经历了焦虑和抑郁的临床显着且可靠的变化。然而，人们对 GMHW 诊所的效率存在担忧，特别是在使用较长的支持课程和 3 个月的随访课程中的高退出率方面。该论文最后强调了在专业心理健康工作者的支持下引导自助的有效性，但对提出协作护理方法作为替代方案的二加一服务提供模式的实用性提出了质疑。
There has been considerable development of guided self-help clinics within primary care. This uncontrolled before-after cohort study examines efficiency and effectiveness of these clinics when supported by paraprofessional mental health workers having little mental health training and experience. Data were collected by seven Graduate Mental Health Workers (GMHW) located in South-west England. Alongside an analysis of clinic attendance and dropout, efficiency was measured with respect to the number and length of sessions to support patients with the effectiveness of the interventions examined with respect to problem severity. Over a 15-month period, 1162 patients were referred to the GMHW clinics with 658 adopting guided self-help. Patients using guided self-help received an average input per patient, excluding assessment, of four sessions of 40 minutes. Dropout rate was comparable to other primary-care-based mental health clinics supported by experienced mental health professionals with 458 patients completing all support sessions. However, only 233 patients went on to attend the 3 months of follow-up session. Effectiveness of guided self-help clinics supported by paraprofessional mental health workers was comparable to that supported by an experienced mental health nurse. Improvements in problem severity were statistically significant, with 55% and 58% (final support session) and 63% and 62% (3 months of follow-up) of patients experiencing clinically significant and reliable change for anxiety and depression, respectively. However, concerns exist over the efficiency of the GMHW clinic especially with respect to the use of longer support sessions and high dropout rate at the 3 months of follow-up session. The paper concludes by highlighting the effectiveness of guided self-help when supported by paraprofessional mental health workers, but questions the utility of the two-plus-one model of service delivery proposing a collaborative care approach as an alternative.