4 Implementation and dissemination of low intensity interventions: challenges and solutions Tereza Ruzickova Psychopharmacology and Emotion Research Lab University of Oxford 2nd June 2021 What stands out in your memory from the past few lectures? What issues might come up if we tried implementing these interventions? • B-G: younger and older age groups What issues might come up if we tried implementing these interventions? What issues might come up if we tried implementing these interventions? • B-G: younger and older age groups • H-J: non-western cultures, cultural, religious and sexual minority groups What issues might come up if we tried implementing these interventions? What issues might come up if we tried implementing these interventions? • B-G: younger and older age groups • H-J: non-western cultures, cultural, religious and sexual minority groups • L-M: groups with low socioeconomic status and low income countries What issues might come up if we tried implementing these interventions? What issues might come up if we tried implementing these interventions? • B-G: younger and older age groups • H-J: non-western cultures, cultural, religious and sexual minority groups • L-M: groups with low socioeconomic status and low income countries • N-S: patients with physical illness or addiction comorbidity What issues might come up if we tried implementing these interventions? What issues might come up if we tried implementing these interventions? • B-G: younger and older age groups • H-J: non-western cultures, cultural, religious and sexual minority groups • K-M: groups with low socioeconomic status and low income countries • N-S: patients with physical illness or addiction comorbidity • Š-V: current Czech mental healthcare system What issues might come up if we tried implementing these interventions? What issues might come up if we tried implementing these interventions? Implementation and dissemination - important factors • Robust clinical & economic evidence • Lobbying - Lord Layard writing and speaking to ministers for years + coalition of mental health charities “We Need To Talk” • Strategic political timing & consistency with broader government policy around social care and evidence-based treatment provision Political influence • Involving service users and carers in key decision making • Creating a legislative framework • Creating a management framework • E ff ective leadership & its consensus (politics, healthcare, professional bodies) • Measuring change to supply evidence of e ffi cacy • Long-term technical and fi nancial sustainability Change management • Involving service users and carers in key decision making • Creating a legislative framework • Creating a management framework • E ff ective leadership & its consensus (politics, healthcare, professional bodies) • Measuring change to supply evidence of e ffi cacy • Long-term technical and fi nancial sustainability Change management Take the long term view! • Crucial to understand individual situation and needs of each target group • Developing new systems collaboratively to make a change rather than just telling people what to do • Inner context: leadership, organisational culture, individual attitudes • Outer context: policy, insurance, public attitudes • Ongoing support rather than one-time training is ideal Change management Developing new types of education • Client and healthcare workers awareness & preference • Not viewing LI interventions as “second choice” • Media outreach • Strong partnership with charities & community groups • Creating a new language? Public awareness Wulsin et al. (2002) • Many panic disorder patients get misdiagnosed with a physical health condition at emergency services • A screening measure and 5min structured interview increased panic disorder diagnosis and relevant referral GP awareness 73% of those seeking psychological help turn to their GPs (OECD, 2011) Private investment Continuation of care Ali et al. (2017) • Longitudinal cohort of over 400 patients • 50% participants found to relapse within 1 year, particularly if they had residual symptoms at the end of treatment • Recommend that patients are treated until residual symptoms are gone and follow-up care is provided “We suggest taking the long view, recognising that problems like depression often have to be managed as recurrent long-term conditions.” STEPS system Podcasts, school workshops, media GPs, nurses, peer support, emergency services, psychological assistants / wellbeing practitioners Specialist practitioners Books, phone calls, digital interventions Network Overwhelmed? Lobby politicians? Lobby politicians? Economic measurements? Lobby politicians? Economic measurements? Media campaigns? Lobby politicians? Economic measurements? Media campaigns? Public awareness campaigns? Lobby politicians? Economic measurements? Media campaigns? Train GPs? Public awareness campaigns? Lobby politicians? Economic measurements? Media campaigns? Train GPs? Public awareness campaigns? Train teachers in BA? Lobby politicians? Economic measurements? Media campaigns? Train GPs? Public awareness campaigns? Train teachers in BA? Build a low intensity intervention app? Lobby politicians? Economic measurements? Media campaigns? Train GPs? Public awareness campaigns? Train teachers in BA? Build a low intensity intervention app? Create a BA center in Afganistan? Lobby politicians? Economic measurements? Media campaigns? Train GPs? Public awareness campaigns? Train teachers in BA? Build a low intensity intervention app? Create a BA center in Afganistan? Build software for easier continuation of care? Lobby politicians? Economic measurements? Media campaigns? Train GPs? Public awareness campaigns? Train teachers in BA? Build a low intensity intervention app? Create a BA center in Afganistan? Build software for easier continuation of care? Establish a new masters course? National Cancer Act (1971) Problem solving 1. Explain problem solving 2. Identify main problems 3. Generate potential solutions 4. Evaluate pros and cons 5. Select the solution that seems best 6. Make a speci fi c plan: what, where, when, with whom 7. Attempt the solution 8. Review & problem solve Problem solving 1. Explain problem solving 2. Identify main problems 3. Generate potential solutions 4. Evaluate pros and cons 5. Select the solution that seems best 6. Make a speci fi c plan: what, where, when, with whom 7. Attempt the solution 8. Review & problem solve Problem solving 1. Explain problem solving 2. Identify main problems 3. Generate potential solutions 4. Evaluate pros and cons 5. Select the solution that seems best 6. Make a speci fi c plan: what, where, when, with whom 7. Attempt the solution 8. Review & problem solve Thank you for your attention! Don’t forget fi lling in your anonymous feedback: https://forms.gle/j8K5hLY1uEoKktGb7