Adapting empirically supported treatments in the era of integrated care: A roadmap for success.

Abstract

The emerging era of integrated care represents a major opportunity for clinical psychology to migrate empirically supported treatments (ESTs) into the mainstream of public health. To succeed will require us to modify current ESTs to make them brief, cost‐effective, patient‐centered and acceptable to and easily learned by both the mental health and health‐care professionals that will deliver them. Changes to the recently modified standards for designating ESTs are proposed that will facilitate adoption of a population health model of treatment development and testing, designed to promote rapid dissemination of empirically supported interventions that are a “good fit” for integrated settings. Defining characteristics of the “new look” for ESTs are examined.

I don't know where we're going, but I sure know where we've been: Continuing the journey of empirically supported treatments in primary care.

“…The results of the Cigrang et al () study were highlighted by Pomerantz () as a groundbreaking primary care study that challenges many commonly held beliefs about effective interventions for PTSD. The results are consistent with a number of other studies summarized by Strosahll and Robinson () in which abbreviated treatment protocols for primary care settings demonstrated similar effect sizes as found in corresponding full treatment protocols evaluating empirically supported treatments. Unfortunately, a number of other studies have found diminished effects with abbreviated primary care protocols.…”

Empirically supported treatments for the population, by the population: Commentary on Strosahl and Robinson.

“…Though there are many models of integration, at its heart, integrated primary care takes a public health perspective on care provision, attempting to provide brief, lower-intensity consultation and intervention to improve the mental and behavioral health of the entire population of primary care patients at a practice. Strosahl and Robinson (2018) point out that the uptake of primary care behavioral health creates a "once in a lifetime opportunity to move psychological interventions into the mainstream of public health" and to spread evidencebased psychological services. I argue that that these models create more than opportunity, they create an imperative; a call to action.…”

“…ADDRESS THE POPULATION HEALTH NEED? Strosahl and Robinson (2018) discuss means to adapt ESTs for population health. One such idea is further testing of essential, common elements of ESTs.…”

“…Much of Strosahl and Robinson's (2018) article focuses on the suggestion to add a "population value index (PVI)" to the EST standards. Whereas Tolin et al (2015) EST recommendations include an increased focus on treatment effectiveness in nonresearch settings and duration of treatment effects, Strosahl and Robinson's PVI takes this further, adding a number of metrics on which the usefulness of an intervention would be evaluated.…”

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Strosahl and Robinson (2018) thoughtfully propose adaptations to the revised (Tolin, McKay, Forman, Klonsky, & Thombs, 2015) recommendations for designating an empirically supported treatment (EST). They discuss the need for clinical psychology to adapt a population health model and describe how adjusting EST criteria could facilitate this paradigm shift, via changes in how we develop and test treatments.

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