Guided self-help supported by paraprofessional mental health workers: An uncontrolled before--after cohort study
Open accessAbstract
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.
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In a study by Farrand et al., use of paraprofessional mental health workers within primary care guided self-help clinics led to a significant reduction in anxious and depressive symptoms among patients at 3-month follow-up.
“In a study by Farrand et al., use of paraprofessional mental health workers within primary care guided self-help clinics led to a significant reduction in anxious and depressive symptoms among patients at 3-month follow-up.”
From A Mixed Method Investigation of Parent-Adolescent Communication About Mental Health (2024) · cites this paper as [38]
The Statistical analysis section (page not available) reports significantly lower anxiety and depression scores at 3-month follow-up than at assessment (both P < 0.001). But this was an uncontrolled before–after study, and only 233 patients attended follow-up. The observed reductions support the outcome claim, not the stronger assertion that use of paraprofessional workers caused them. (LLM, conf=0.85)
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Jacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770 · see citing works
Unützer, J., Katon, W., Callahan, C. M., Williams, Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H. B., et al. (2002) · JAMA · doi:10.1001/jama.288.22.2836 · Cited by 2,405 · see citing works
Treatment gap in mental health care.
Abramowitz, M. Z., Greenberg, D., & Levav, I. (2008) · PubMed · Cited by 1,482 · see citing works
The treatment gap in mental health care.
(2004) · Europe PMC (PubMed Central) · Cited by 1,419 · see citing works
Bower, P., & Gilbody, S. (2005) · British Journal of Psychiatry · doi:10.1192/bjp.186.1.11 · Cited by 1,084 · see citing works
Normative data for the HADS from a large non-clinical sample
Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P. (2001) · British Journal of Clinical Psychology · doi:10.1348/014466501163904 · Cited by 815 · see citing works
Understanding and Improving Patient Compliance
Eraker, S. A., KIRSCHT, J. P., & BECKER, M. H. (1984) · Annals of Internal Medicine · doi:10.7326/0003-4819-100-2-258 · Cited by 790 · see citing works
Katon, W., Korff, M. V., Lin, E., Simon, G., Walker, E., Unützer, J., Bush, T., Russo, J., & Ludman, E. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.12.1109 · Cited by 697 · see citing works
Moorey, S., Greer, S., Watson, M., Gorman, C., Rowden, L., Tunmore, R., Robertson, B., & Bliss, J. M. (1991) · The British Journal of Psychiatry · doi:10.1192/bjp.158.2.255 · Cited by 654 · see citing works
Mental Illness in the Community: The Pathway to Psychiatric Care.
Higgins, A. C., Goldberg, D. P., & Huxley, P. (1982) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2068429 · Cited by 627 · see citing works
Evans, C., Margison, F., & Barkham, M. (1998) · Evidence-Based Mental Health · doi:10.1136/ebmh.1.3.70 · Cited by 483 · see citing works
GELLATLY, J., BOWER, P., HENNESSY, S., RICHARDS, D., GILBODY, S., & LOVELL, K. (2007) · Psychological Medicine · doi:10.1017/s0033291707000062 · Cited by 419 · see citing works
Stepped care as a heuristic approach to the treatment of alcohol problems.
Sobell, M. B., & Sobell, L. C. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.4.573 · Cited by 345 · see citing works
Lovell, K., & Richards, D. (2000) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465800004070 · Cited by 216 · see citing works
Posternak, M. A., & Miller, I. (2001) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00304-9 · Cited by 215 · see citing works
Mental Illness in the Community
Goldberg, D. P., Goldberg, D. P., Huxley, P. J., & Huxley, P. J. (2012) · Routledge eBooks · doi:10.4324/9780203714904 · Cited by 202 · see citing works
A brief behavioral activation treatment for depression
Lejuez, C. W., Hopko, D. R., LePage, J. P., Hopko, S. D., & McNeil, D. W. (2001) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(01)80022-5 · Cited by 191 · see citing works
Pragmatic evaluation of computer-aided self-help for anxiety and depression
Marks, I. M., Mataix-Cols, D., Kenwright, M., Cameron, R., Hirsch, S., & Gega, L. (2003) · British Journal of Psychiatry · doi:10.1192/bjp.183.1.57 · Cited by 185 · see citing works
Neurotic disorders and the receipt of psychiatric treatment
Bebbington, P., Brugha, T. S., Meltzer, H., Jenkins, R., Ceresa, C., Farrell, M., & Lewis, G. (2000) · Psychological Medicine · doi:10.1017/s0033291799002974 · Cited by 166 · see citing works
Lovell, K., Cox, D., Haddock, G., Jones, C., Raines, D., Garvey, R., Roberts, C., & Hadley, S. (2006) · BMJ · doi:10.1136/bmj.38940.355602.80 · Cited by 162 · see citing works
Barkham, M., Shapiro, D. A., Hardy, G. E., & Rees, A. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.2.201 · Cited by 159 · see citing works
Effectiveness and cost effectiveness of counselling in primary care
Bower, P., Rowland, N. E., Clark, J. M., Heywood, P., Godfrey, C., & Hardy, R. (2002) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001025 · Cited by 121 · see citing works
El-Rufaie, O. E. F., & Absood, G. H. (1995) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/bf00784431 · Cited by 119 · see citing works
Predictors of missed appointments for psychiatric consultations in a primary care clinic
Grunebaum, M. F., Luber, P., Callahan, M. A., Leon, A. C., Olfson, M., & S, L. P. M. (1996) · Psychiatric Services · doi:10.1176/ps.47.8.848 · Cited by 117 · see citing works
Adherence to mental health treatment in a primary care clinic
Gonzalez, J., Williams, J. W., Noel, P. H., & Lee, S. (2005) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.18.2.87 · Cited by 110 · see citing works
Written and computer-based self-help treatments for depression.
Williams, C., & Whitfield, G. (2001) · British Medical Bulletin · doi:10.1093/bmb/57.1.133 · Cited by 75 · see citing works
The Effectiveness of Time Limits in Counseling and Psychotherapy: A Critical Review
Johnson, D. H., & Gelso, C. J. (1981) · The Counseling Psychologist · doi:10.1177/001100008000900115 · Cited by 52 · see citing works
Stresspac: A Controlled Trial of a Self-Help Package for the Anxiety Disorders
White, J. (1995) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465800014363 · Cited by 47 · see citing works
Effectiveness and cost effectiveness of counselling in primary care
Bower, P., & Rowland, N. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001025.pub2 · Cited by 46 · see citing works
Non-attendance at psychiatric outpatient clinics: communication and implications for primary care.
Killaspy, H. T., Banerjee, S., King, M., & Lloyd, M. (1999) · Europe PMC (PubMed Central) · Cited by 42 · see citing works
Access and effectiveness in psychological therapies: self-help as a routine health technology
Richards, D. A., Lovell, K., & McEvoy, P. (2003) · Health & Social Care in the Community · doi:10.1046/j.1365-2524.2003.00417.x · Cited by 40 · see citing works
Runkewitz, K., Kirchmann, H. A., & Strauss, B. M. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.09.003 · Cited by 39 · see citing works
Primary care mental health workers: role expectations, conflict and ambiguity
Bower, P., Jerrim, S., & Gask, L. L. (2004) · Health & Social Care in the Community · doi:10.1111/j.1365-2524.2004.00503.x · Cited by 33 · see citing works
The evolving randomised controlled trial in mental health: studying complexity and treatment process
Green, J. (2006) · Advances in Psychiatric Treatment · doi:10.1192/apt.12.4.268 · Cited by 29 · see citing works
White, J. (1998) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465898000149 · Cited by 28 · see citing works
Improving access to primary mental health care: uncontrolled evaluation of a pilot self-help clinic.
Lovell, K., Richards, D. A., & Bower, P. (2003) · Europe PMC (PubMed Central) · Cited by 27 · see citing works
PHASE: a 'health technology' approach to psychological treatment in primary mental health care
Richards, D. A., Richards, A., Barkham, M., Cahill, J., & Williams, C. (2002) · Primary Health Care Research & Development · doi:10.1191/1463423602pc103oa · Cited by 20 · see citing works
Impact of graduate mental health workers upon primary care mental health: a qualitative study
Farrand, P. A., Duncan, F., & Byng, R. (2007) · Health & Social Care in the Community · doi:10.1111/j.1365-2524.2007.00707.x · Cited by 14 · see citing works
Reducing the Burden of Depression
Wells, K. B., & Miranda, J. M. (2007) · JAMA · doi:10.1001/jama.298.12.1451 · Cited by 10 · see citing works
Very brief dynamic psychotherapy
Aveline, M. O. (2001) · Advances in Psychiatric Treatment · doi:10.1192/apt.7.5.373 · Cited by 8 · see citing works
Roles undertaken by graduate mental health workers across South West England
Farrand, P. A., Duncan, F., & Byng, R. (2006) · Primary Care and Community Psychiatry · doi:10.1185/135525706x104993 · Cited by 2 · see citing works
Flagged first, then by citations
4 of the 46 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Bower P. & Gilbody S. (2005) Stepped care in psychological therapies: access, effectiveness and efficiency. British Journal of Psychiatry 186, 11-17.
- Frude N. (2005) Prescription for a good read. Healthcare Coun- selling and Psychotherapy Journal 5, 9-13.
Cited by
Sorted by citations
Taylor, S. J., Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H. L., Schwappach, A., Purushotham, N., Jacob, S., Griffiths, C. J., Greenhalgh, T., et al. (2014) · Health Services and Delivery Research · doi:10.3310/hsdr02530 · Cited by 431 · see citing works
Høifødt, R. S., Lillevoll, K. R., Griffiths, K. M., Wilsgaard, T., Eisemann, M., Waterloo, K., & Kolstrup, N. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2714 · Cited by 154 · see citing works
“In fact, studies show that guidance may be delivered effectively not only by trained clinicians, but also by mental health workers with limited experience and by computer technicians [114,115].”
BackgroundIncreasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice
Williams, C., & Martinez, R. (2008) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465808004864 · Cited by 81 · see citing works
Moise, N., Shah, R. N., Essock, S. M., Jones, A., Carruthers, J. W., Handley, M. A., Peccoralo, L. A., & Sederer, L. I. (2018) · Implementation Science · doi:10.1186/s13012-018-0818-6 · Cited by 57 · see citing works
Reynolds, J., Griffiths, K., Cunningham, J., Bennett, K., & Bennett, A. (2015) · JMIR Mental Health · doi:10.2196/mental.4200 · Cited by 61 · see citing works
Shepardson, R. L., Buchholz, L. J., Weisberg, R. B., & Funderburk, J. S. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.12.004 · Cited by 44 · see citing works
Puszka, S., Dingwall, K. M., Sweet, M., & Nagel, T. (2016) · JMIR Mental Health · doi:10.2196/mental.5837 · Cited by 32 · see citing works
Youth work service providers' attitudes towards computerized CBT for adolescents
Fleming, T., & Merry, S. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000306 · Cited by 37 · see citing works
The many faces of depression in primary care
Hegadoren, K., Norris, C. M., Lasiuk, G. C., da Silva, D. M. G. V., & Chivers-Wilson, K. (2009) · Texto & Contexto - Enfermagem · doi:10.1590/s0104-07072009000100019 · Cited by 13 · see citing works
A Mixed Method Investigation of Parent-Adolescent Communication About Mental Health
Wecht, S., Hendrixson, M., & Radović, A. (2024) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2024.07.012 · Cited by 11 · see citing works
Owen, J., Cross, S., Mergia, V., & Fisher, P. (2022) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x22000356 · Cited by 10 · see citing works
Modernizing the Traditional Psychologist Role: Paraprofessionals in Psychological Health Care
McGrath, P. J., Crombach, A., Preston, J. M., & Kaltenbach, E. (2021) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00148-5 · Cited by 3 · see citing works
Mental health programs and services
Milgate, G. (2011)
An alternative educational model for providing psychological therapy in primary care
Zolle, O., Rickenbach, M. A., & Dunkley, C. (2010) · Primary Health Care Research & Development · doi:10.1017/s1463423610000010
Can sense of coherence predict therapeutic outcome of a brief guided self-help intervention?
Williams, M. E. (2010) · ERA
- Authors
- Farrand, P., Confue, P., Byng, R., & Shaw, S.
- Affiliations
- University of Plymouth (GB)
- Peninsula College of Medicine and Dentistry (GB)
- Venue
- Health & Social Care in the Community
- Publisher
- Hindawi Limited
- Published
- 2009-01
- Volume
- 17
- Issue
- 1
- Pages
- 9-17
- ISSN
- 0966-0410 (ISSN-L)
- 1365-2524
- OpenAlex
- W1971353627
- Cited by
- 15
- References
- 46
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 1 · 2018: 2 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health & Social Care in the Community (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- guided self-help, dropout rates, treatment efficiency, anxiety, depression, problem severity, collaborative care, psychiatric nursing
- MeSH terms
- Workforce, Adult, Allied Health Personnel, Anxiety, Community Mental Health Services, Depression, England, Female, Health Services Research, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Acceptance of Health Care, Patient Dropouts, Primary Health Care, Referral and Consultation, Self Care, Social Support, Cohort Studies, Models, Organizational, Efficiency, Organizational, Directive Counseling
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