RESUMEN
In this study, the authors measured and described the costs of coordinated specialty care (CSC) for first-episode psychosis in Ohio. A microcosting tool was used to estimate personnel and nonpersonnel costs of service delivery at seven CSC programs. Average annual cost per participant (N=511 participants) was estimated as $17,810 (95% CI=$9,141-$26,479). On average, 61% (95% CI=53%-69%) of annual program costs were nonbillable. Key cost drivers included facility costs, administrative tasks, and social services. Novel financing models may redress reimbursement gaps incurred by CSC programs.
Asunto(s)
Trastornos Psicóticos , Humanos , Trastornos Psicóticos/terapia , Ohio , Servicio SocialRESUMEN
This exploratory case comparison examines the influence of case management activities on engagement and progress in psychotherapy for clients with schizophrenia. Six clients were recruited to participate in ten sessions of Cognitive Behavioral Therapy for psychosis (CBT-p). Three clients who had received Cognitive Behavioral techniques for psychosis (CBt-p, a low-intensity case management intervention) prior to receiving therapy were selected from referrals. A comparison group of three clients who had received standard case management services was selected from referrals. Cases within and across groups were compared on outcome measures and observations from case review were offered to inform future research. Delivering CBT-p services on a continuum from low- to high-intensity is discussed.
Asunto(s)
Gestores de Casos , Terapia Cognitivo-Conductual/métodos , Servicios Comunitarios de Salud Mental , Trastornos Psicóticos/terapia , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The purpose of this article is twofold: (a) to describe the adaptation of an evidence-based practice and, (b) using a dissemination framework, to describe the process of implementing the practice at a community mental health agency. METHOD: The authors describe the training concept and dissemination framework of implementing an emerging practice: high-yield cognitive behavioral techniques for psychosis, which is rooted in cognitive behavioral therapy. RESULTS: Thirteen case managers who represented teams from across the agency delivered the adapted practice at a community mental health agency. Implementation required buy in from all stakeholders, communication across disciplines, persistence, and flexibility. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It appears that the use of a dissemination framework that is grounded in the literature, yet flexible, eases the process of implementing an adapted practice. Further research focusing on the effectiveness of this approach, along with the impact of implementing a full spectrum of cognitive behavioral therapy services for individuals with persistent psychotic symptoms, based on cognitive behavioral therapy principles, is indicated.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Servicios Comunitarios de Salud Mental , Difusión de Innovaciones , Accesibilidad a los Servicios de Salud , Trastornos Psicóticos/terapia , Esquizofrenia/terapia , Adulto , Manejo de Caso , Terapia Cognitivo-Conductual/educación , Conducta Cooperativa , Práctica Clínica Basada en la Evidencia/educación , Práctica Clínica Basada en la Evidencia/métodos , Femenino , Humanos , Capacitación en Servicio , Relaciones Interinstitucionales , Masculino , Resultado del Tratamiento , Reino Unido , Estados UnidosRESUMEN
Interest in the practice of Cognitive Behavioral Therapy for persistent psychotic symptoms (CBT-p) has increased dramatically in the last decade. Despite the widespread interest, it remains challenging to obtain adequate training in this approach in the United States. This article provides a few hypothetical examples of the types of interventions commonly used in CBT-p. We provide information about the theoretical basis for the techniques and related research support. We also provide references that offer more detailed discussion of the theory and application of the techniques.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Procesos Psicoterapéuticos , Trastornos Psicóticos/terapia , Adulto , Conducta Cooperativa , Cultura , Mecanismos de Defensa , Deluciones/psicología , Deluciones/terapia , Femenino , Alucinaciones/psicología , Alucinaciones/terapia , Humanos , Control Interno-Externo , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Trastornos Paranoides/psicología , Trastornos Paranoides/terapia , Trastornos Psicóticos/psicología , Esquizofrenia/terapia , Psicología del EsquizofrénicoRESUMEN
Across two continents, Cognitive-Behavioral Therapy for Psychosis (CBT-P) has been endorsed as an adjunctive treatment for individuals who experience persistent positive symptoms of schizophrenia. The moderate effect sizes reported in early studies and reviews were followed by better controlled studies indicating more limited effect sizes. This article provides a review of the literature that addresses the effectiveness of CBT-P, including particular areas of emphasis and practice elements associated with this approach. In addition, because the majority of research on CBT-P has been performed in the United Kingdom, implications for implementation and sustainability of this practice in the United States are presented.