Process evaluation of Prompt Mental Health Care (PMHC): the Norwegian version of Improving Access to Psychological Therapies

Abstract

Background: Prompt Mental Health Care (PMHC) is the Norwegian adaptation of Improving Access to Psychological Therapies (IAPT). Thus far, evaluations of PMHC have mostly focused on the effectiveness, rather than on contextual and implementation processes. Therefore, the objective of this study was to do a process evaluation and examine: 1) To what extent do the services follow guidelines provided by the Norwegian Directorate of Health (NDH), 2) what the therapists experienced as important barriers and facilitators in implementing the service, and 3) client treatment satisfaction and its associations with baseline variables. Method: The present study uses data from 526 clients who received PMHC treatment in the municipalities of Sandnes and Kristiansand. The therapists completed questionnaires about each client's course of treatment. We conducted semi-structured interviews with the therapists and analysed them using thematic analysis. Data from client questionnaires were used to report descriptive sample statistics including symptom severity and treatment satisfaction. Linear regression was adopted to examine the associations between client treatment satisfaction and baseline characteristics. Results: Several aspects of PMHC were implemented in line with the guidelines provided by NDH. Importantly, both services reached out to the intended target group, and could further be characterized as low-threshold with relatively short waiting times (median waiting time between initial contact and treatment start was 27 days, IQR 18-39), no waiting lists, and frequent use of self-referral (33.3%). From the client perspective, results indicated a high degree of treatment satisfaction (Mean = 3.93 (SD = .71, range 1-5)), and this was true across demographic characteristics and symptom severity at baseline (all p > .05). Most notable challenges that came forward were; the low provision of guided self-help (received by only 1.0% of clients), the lack of focus on work participation (low to some degree of focus in 70.8% among sick-listed clients), the collaboration with other services (no collaboration in 85.3% of the clients), and some aspects regarding future development of the service.

Social anxiety and agoraphobia symptoms effectively treated by Prompt Mental Health Care versus TAU at 6‐ and 12‐month follow‐up: Secondary analysis from a randomized controlled trial

“…A summary of interventions follows, we refer to the primary evaluation for further details (Knapstad et al, 2020; Lervik et al, 2020).…”

“…PMHC treatments are based on cognitive‐behavioral therapy (CBT). The service should supplement existing services, be free of charge, and without need for referral (see Lervik et al, 2020 for more details).…”

Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder

“…Treatment included both low-intensity (guided self-help and group-based psychoeducation) and high-intensity (face-to-face individual therapy) treatment forms. 37.5% of the clients primarily received low-intensity treatment, 33.0% received a mixture of low-and high-intensity treatment, whereas the remaining 29.5% primarily received high-intensity treatment (Lervik et al, 2020). Levels of fidelity to CBT in PMHC have been reported to be sufficient (Knapstad et al, 2020).…”

Long-term outcomes of Prompt Mental Health Care: A randomized controlled trial

“…In PMHC, CBT treatment is offered in both low intensity (guided selfhelp, psycho-educational courses) and high intensity (individual treatment) forms (Norwegian Directorate of health, 2013; Saether et al, 2019). The care is organized according to a type of matched-care model, in which information from the initial assessment and client preferences is used to determine the choice of treatment (M. Knapstad, Lervik, et al, 2020;Lervik et al, 2020). This indicates, different from a pure stepped-care approach, that the client does not necessarily start care at the lowest treatment level.…”