Week 7 - Intervention & Prevention Overview Flashcards
What is a universal preventative intervention?
Applied to an ENTIRE. POP
EX) include immunization programs, “body break,” public education programs
What is a selective preventative intervention?
Targets ppl who are at elevated RISK of developing a particular disorder or problem.
EX) using screen tests to identify 1st graders reading disabilities
What is an indicated preventative intervention?
Targets ppl who do NOT meet the criteria for a disorder, but have elevated RISK & may show detectable, subclinical SIGNS of the disorder
EX) quarantines, youth at high risk for acting out behaviour
What factors does the risk model contain?
What is the risk reduction model?
Risk: THREAT/HAZARD incompletely understood
Risk factors: a characteristic, event etc… PRECEDES the occurance of a hazard (may make it worse)
Protective factors: help to MITIGATE the risk/occurance from happening
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Risk reduction model: an approach that REDUCES risks and PROMOTES protective factors
What are some examples of risk factors?
5 examples…
- Individual
Poor nutrition, intellectual disabilities,
attachment problems - School
Bullying, rejection, poor behaviour
management - Family
Harsh or inconsistent discipline, inadequate
supervision and monitoring - Life
Trauma, poverty, poor housing - Community/Cultural
Socioeconomic disadvantage, social or
cultural discrimination, exposure to
community violence or crime
What are some examples of protective factors?
5 examples…
- Individual
Easy temperament, adequate nutrition,
school achievement, positive attachment - School
Prosocial peer group, school norms against
violence - Family
authoritative parenting, family harmony,
attachments with other role models - Life
Adequate income, adequate housing - Community/Cultural
participation in church or other community
group, strong cultural identity and ethnic
pride, access to support services
What are 3 ways to evaluate a prevention program?
- Incidence rates:
- the # of NEW cases of a specific problem - # needed to treat:
- # of people who NEED to receive the intervention (in order to prevent)
- Effectiveness:
- the extent to which a prevention program achieves DESIRED OUTCOMES when used in an APPLIED setting
How was evidence-based parenting promoted?
- Home visiting programs (services low-income teenagers single mothers = improved quality of life)
- Incredible years (train parents in skills)
- Triple P positive parenting program (designed to enhance knowledge, kills and confidence of parents)
What are 2 programs designed for the prevention of violence?
- Anti-bullying programs
- Fast-track program
- designed to decrease conduct disorder, 10-yr program
- child and parent component
How effective are anxiety prevention programs?
Meta-analysis of 65 outcome trials found SMALL but SIGNIFICANT effects in reduction of both symptoms and diagnosis of anxiety
How effective are depression intervention programs?
Horowitz and Garber examined a wide range of programs designed to prevent depressive systems in children and adolescents
Found LITTLE meta-analytic evidence that universal programs are effective in preventing depression, but observed SMALL, yet SIGNIFICANT effects for indicated/selective intervention
Preventative intervention reduce incidence of depressive episodes by 22%
What is used in the prevention of substance abuse?
Skills development
Youth, peer groups, school, home and community
Programs should be SENSITIVE to developmental stage and include adequate training and support
Use of interactive programs is crucial for success
What is used in the prevention of problems w/ those exposed to loss & trauma?
Be cautious about well-intended programs & assumptions
Cognitive-behavioural interventions (individual/group), can have (+) impact
- provide knowledge about trauma
- emphasize skills
- develop skills
What are 4 things that determine if someone seeks out psychotherapy?
Are people more likely to seek psychotherapy VS medication?
Why does the typical demographic look like who seek therapy?
- Realizing that there IS a problem
- Deciding that therapy might be of VALUE
- Actually deciding to SEEK therapy
- Contacting a THERAPIST/CLINIC
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People are 3x more likely to seek psychological treatment than medication
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Two thirds of clients are female, half have college/university degree, half are married, and the majority of young -middle aged adults
What are two (main) ethical considerations in therapy?
5.1 A psychologist shall provide only
supportable professional services; a
supportable professional service refers
to a service based upon the client’s
needs and relevant issues and which is
in accordance with reasonable and
generally accepted common practice
and/or a theoretical and scientific
knowledge base of the discipline
5.2 A psychologist shall not provide a
professional service when there are
reasonable grounds to believe that the
treatment may lead to harm and no
demonstrable evidence of benefit exists,
even if the client has consented to the
treatment and/or intervention
What does evidence-based practice consist of?
Best research evidence
Clinical expertise
Patient preferences and values
What is there is no evidence-based treatment that matches your client needs exactly?
Adopt the one that’s CLOSEST
ADAPT if necessary
ABADON evidence that does NOT fit and REPLACE w/ another EBP
What is a randomized controlled trial (RCT)?
An experiment in which research participants are randomly assigned to one of TWO/MORE treatment conditions
What is effect size?
A STANDARDIZED metric, typically expressed in standard deviation units or correlations, that ALLOWS the results of research studies to be combined & analyzed
Typically expressed in standard deviation units and are called d or standardized mean difference (SMD)
• d = .4 indicates that 66% of patients in treated group score below the mean of
untreated participants
When correlational analyses are used to determine the strength of association between variables (e.g., r or R), the effect size is expressed as an r statistic
Majority of people in therapy attend for “________” than “___” sessions
Fewer; 10
“___%” of clients end treatment prematurely
20%
Up to “___%” of people fail to follow up on a referral for psychotherapy
50%
One-third of painters attended only a single session of psychotherapy, w/ the median # being “______”
Three
Some studies show only “___%” of clients “________” following therapy
30%; improved
***MOST PAITENTS ATTENDED TOO FEW SESSIONS AND MOST THERAPISTS DID NOT PROVIDE EVIDENCE-BASED TREATMENTS
What are some strategies to increase attendance of therapy?
ALLOWING clients to choose a therapist & appointment
times
Using motivational interviewing techniques to explore
CLIENTS REASONS for seeking treatment
Preparing clients for what will be REQUIRED of them in therapy
Using appointment REMINDERS
IMPLEMENTING a case management service for severely
distressed clients
What did Hansen et al find in evidence-based treatment?
Examined RCTs of evidence-based treatments:
◦ Across 28 studies and more than 2,100 patients, the average dose of therapy was 12.7 sessions
◦ 57.6% of patients met criteria for recovery (and 67.2% meeting criteria for improvement or recovery)
◦ Concluded that w/ EBT = success rate of psychotherapy IMPROVES substantially compared with treatment as usual.
◦ Evidence-based psychological treatments are AT LEAST as efficacious as psychotropic medication in the treatment of depression and anxiety disorders
◦ A meta-analysis of 32 studies comparing evidence-based treatments with usual clinical care found that evidence-based care consistently OUTPERFORMED usual clinical care for children and adolescents
What did Smith & Glass find in evidence-based treatment?
• Review of 475 controlled studies
• d = .85
• Average person receiving treatment was BETTER OFF at the END of treatment than 80% of those who did not receive
treatment
• Largest effect sizes (d values of 1.31 and 1.24, respectively) for cognitive and cognitive-behavioural treatments, followed by behavioural (.91), psychodynamic (.78), and humanistic treatments (.63)
What did Weisz et al find in evidence-based treatment?
Examined effect of therapy for children and adolescents:
• Reported a mean effect size of .79, with LARGER effects found for BEHAVIOUR APPROACHES than for non-behavioural
approaches
• Weisz et al. (2013) conducted a meta-analysis of 52 randomized trials that directly compared an evidence-based treatment for children and adolescents to usual care.
The effect size for the difference in outcome between evidence-
based psychotherapy and usual care was d = 0.29
On average, youth receiving EBT would have a better outcome than 60% of youth receiving usual care
What is clinical practice guidelines?
A summary of SCIENTIFIC RESEARCH (dealing with the diagnosis, assessment, and/or treatment of a disorder) designed to provide GUIDANCE to clinicians providing services to patients with the disorder
What is empirically supported treatment?
Is this more stringent than “evidence-based”?
A psychotherapy that has been found, in a series of RANDOMIZED CONTROLLED TRIALS or single-participant designs, to be efficacious in the treatment of a SPECIFIC condition
MORE stringent criteria than “evidence-based”
What is Norman & Gorman’s review for research in practice?
Compare evidence found with adults VS children…
ADULTS:
- there are evidence-based therapies for almost ALL commonly encountered mental disorders for adults
- strength of the evidence supporting the use of CBT
treatment (cognitive-behavioural
interventions have been found to be efficacious in
many independent replications)
- increasing number of process-experiential, interpersonal,
and psychodynamic therapies that have been demonstrated to be efficacious in the treatment of SOME clinical conditions
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CHILDREN:
- many of the efficacious treatments for children
involve parents LEARNING STRATEGIES to respond to their
children’s behaviour
- most effective treatments of childhood disorders fall
under the umbrella of behavioural, cognitive-behavioural,
and interpersonal approaches
What are treatment factors influencing clinicians treatment selection decisions?
◦ Treatment FLEXIBILITY
◦ RESEARCH support in an EFFECTIVENESS study
◦ RECOMMENDED by trusted colleague(s)
◦ PAST SUCCESS with the treatment in own
practice
◦ Easy to LEARN/IMPLEMENT
◦ Easily ACCESSIBLE TRAINING and supervision in
the treatment
◦ RESEARCH support in an EFFICACY study
◦ A focus on the THERAPEUTIC RELATIONSHIP
◦ REIMBURSEMENT for treatment by insurance
company
◦ SHORT treatment duration
What must informed consent and intervention contain?
◦ PURPOSE/NATURE of the activity
◦ MUTUAL responsibilities
◦ CONFIDENTIALITY protections and limitations
including how information will be stored and who may have access
◦ HOW confidential information can be ACCESSED
◦ HOW communication will HAPPEN between the
psychologist and client(s), guardian(s) or third- parties
◦ likely BENEFITS/RISKS
◦ ALTERNATIVE modalities of assessment/treatment
◦ likely consequences of NON-ACTION
◦ option to REFUSE/WITHDRAWAL at any time, without prejudice by the psychologist
◦ TIME PERIOD covered by the consent
◦ HOW to RESCIND consent, if a decision to rescind consent is made
◦ FEES/FINANCIAL arrangement
What must consent and minors contain?
A Patient UNDER the age of 18 is presumed to be a Minor Patient without Capacity UNLESS they have been deemed to be a Mature Minor
The Psychologist must be INFORMED of
consent laws specific to:
◦ Education services
◦ Health services
◦ Child protection
◦ Separated or divorced parents
◦ Mature minors
The Psychologist must CLARIFY from the outset of services the circumstances under which confidentiality will be maintained and what information will be SHARED with parents
What are some good ways to start of therapy w/ the client?
Attend to therapy ENVIRO
Attend to your PRESENTATION
Attend to SUBTLE ASPECTS that may reinforce POWER differences
In comparison to assessment, the first session of therapy is often the FIRST OF MANY sessions
May be more assumptions and stigma attached to therapy
Have to balance INFORMING the client with COLLABERATION
Discuss what therapy IS and what clients can EXPECT and/or process any prior experiences or misconceptions
Discuss EXPECTATIONS of therapy – both for client and clinician
Focus is all on building rapport and developing a THERAPEUTIC RELATIONSHIP
Engaged clients are more likely to what?
◦ BOND with therapists and counselors
◦ ENDORSE treatment goals
◦ PARTICIPATE to a greater degree
◦ REMAIN in treatment LONGER
◦ report HIGHER levels of satisfaction
What are some effective elements of the therapeutic relationship?
Compare this with the different types of therapy…
EMPATHY
COLLECTING client feedback
ADAPTING to client reactance/resistance level, client treatment preferences, client culture & client religion/spirituality
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***ALLIANCE in individual adult psychotherapy, youth psychotherapy & couples/family therapy
***COHESION in group therapy
What are 3 aspects of a therapeutic alliance?
- Understanding & empathy:
- communicate empathy- check for accuracy & sense of being understood - Acceptance & prizing:
- attitude of consistent, genuine, noncritical interest and tolerance for all aspects of the clients life - Presence & genuineness:
- being authentic, transparent and in emotional contact
What are 4 main therapy skills?
- Empathy:
- ACCURATE PERCEPTION of and communication about another’s experience
• empathic exploration – asking tentative questions to promote client self-exploration
• empathic attunement – resonate with client’s experiences; focus on what seems to be central - Active listening:
- ATTENDING to the CONTENT/PROCESS of what the client is saying and demonstrating an understanding of the same
- demonstrate listening through nonverbals – open body posture, nodding, leaning forward, eye contact, facial expressions, mirroring, hmms, mmms, and uh huhs
• paraphrasing – reflecting the content of what the client is saying - Clear communication:
- CLEAR, CONCISE & THOUGHTFUL in communicating
- avoid mumbling, side thoughts, tangents
- use language that is easily understood
- explain jargon that is necessary to use
***ASK if you are making sense and take responsibility if you don’t - Interpretation:
- PROVIDING ALTERNATIVE meanings, explanations, or hypotheses for client experiences
- present them as tentative and questioning
- point out themes or patterns that seem apparent
- provide meaning to nonverbal or process information
- use research and/or clinical experience
What are some general therapy skills?
Thoughtful curiosity
Socratic questioning
Silence
Avoid the “but”
Avoid advice and judgement
Attend to ruptures
Acknowledge mistakes and apologize
***?Self-disclosure? = tricky
Why is authenticity so important in therapy?
Finding your identity as a therapist is one of the greatest CHALLENGES for early clinicians
Transition from mimicking supervisors to testing out approaches to finding your AUTHENTIC SELF
Comfort and ease come with time and experience
ACKNOWLEDGE your faults or deficits when clinically relevant
Yet, always continue to have SELF-REFLECTION as authenticity does not guarantee a connection with your client
What is corrective emotional experience?
You’re NOT just representing your OWN practice, but MENTAL HEALTH as a CONCEPT
