Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies.

Background There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. Objective This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. Methods Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). Results In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. Conclusions The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials

Twelve tips to support healthcare teams to incorporate interprofessional education and collaborative practice into day-to-day workplace practices

Despite a growing body of research into interprofessional education and collaborative practice (IPECP), practical strategies and initiatives are required to assist healthcare workers with implementation. Practical strategies and tips outlined in this paper can support healthcare teams to incorporate IPECP into day-to-day workplace practices. Beyond IPECP engagement, the proposed tips will assist with refining current workplace practices and processes to make them more collaborative, intentional, and streamlined at the point of care. Bearing in mind that there is no ‘one size fits all’ approach to IPECP, these tips have been developed to suit a variety of contexts and are able to be adapted and contextualised by healthcare workers and teams. These 12 tips would not only assist with the implementation of new ideas related to IPECP, but also influence sustainability considerations of these initiatives within healthcare settings

Stepped-care versus therapist-guided, internet-based cognitive behaviour therapy for childhood and adolescent anxiety: A non-inferiority trial

Objective: This preregistered randomized trial examined whether a stepped-care approach to internet-delivered cognitive behaviour therapy (ICBT-SC) is non-inferior to therapist-guided ICBT (ICBT-TG) for child and adolescent anxiety. Method: Participants were 137 Australians, aged 8–17 years (56 male), with a primary anxiety disorder. This randomized, non-inferiority trial compared ICBT-SC to an evidence-based, ICBT-TG program with assessments conducted at baseline, 12 weeks and 9-months after treatment commencement. All ICBT-SC participants completed the first 5 online sessions without therapist guidance. If they responded to treatment in the first 5 sessions (defined as reductions of anxiety symptoms into non-clinical range), they continued without therapist guidance for the final 5 sessions. If they did not respond to treatment in the first 5 sessions, the final five sessions were supplemented with therapist-guidance (through email). All ICBT-TG participants received therapist guidance (email) after each session, for all 10 sessions. Measures included clinical diagnostic interview (severity rating as primary outcome), as well as parent and child reported anxiety and anxiety-related interference (secondary outcomes). Results: ICBT-SC was found to be non-inferior to ICBT-TG on primary and secondary outcomes, according to clinician, parent and young person report at 12-weeks and 9-months. Treatment satisfaction was moderate to high for both conditions. Significant clinical benefits were evident for participants in both treatments. Of participants who remained in the study, 77 % (50.7 % ITT) of ICBT-SC and 77 % (57.1 % ITT) of ICBT-TG were free of their primary anxiety diagnosis by 9-month follow-up, with no differences between conditions. Conclusion: A stepped-care ICBT approach for clinically anxious children and adolescents may offer an acceptable treatment model that can increase access to evidence-based treatment

Geographic variation in compliance With FOBT colorectal cancer screening programs: the role of attitudes toward health and help seeking

Introduction: Colorectal cancer (CRC) patients in regional and rural areas tend to be diagnosed at a more advanced stage than metropolitan patients and have poorer 5-year survival rates. Environmental and cultural factors in non-metropolitan areas often facilitate a more reactive approach to health care, which can result in lower participation in preventative health measures such as screening for early signs of cancer. Individual differences in attitudes and cognitive styles can also act as barriers to cancer screening. Currently, evidence regarding geographical disparity in CRC screening is inconclusive and based largely on test return in nationwide screening programs as opposed to compliance with program guidelines. This study investigates the effect of attitudinal and cognitive traits on compliance with, as opposed to participation in, population CRC screening programs in rural, regional and metropolitan environments. Methods: A representative cross-section of recipients (n=371, 71% female) of a faecal occult blood test as part of the National Bowel Cancer Screening Program were surveyed in 2017 (mean age = 61.26, standard deviation = 7.05). Participants were asked if they completed and returned the kit or had a valid reason not to (ie prior screening). Postcodes were used to identify participants as metropolitan, regional or rural using the Australian Standard Geographical Classification system. Fatalism, minimisation of problems and resignation (MPR), need for control and selfreliance, and consideration of future consequences (CFC) were measured as traits known to effect health-related help-seeking behaviour. Program compliance rates were compared between rural, regional and metropolitan areas, and logistic regression models with interaction terms were applied to test the differential effects of attitudinal and cognitive factors on program compliance across metropolitan, regional and rural groups. Results: Compliance was significantly lower in regional compared to metropolitan areas (odds ratio (OR)=0.49, 95% confidence interval (CI)=0.29–0.84). Rural status significantly moderated the effect of MPR (OR=0.28, 95%CI=0.11–0.71) and CFC (OR=6.66, 95%CI=1.80–24.63) on compliance and regional status significantly moderated the effect of CFC on compliance (OR=3.41, 95%CI=1.37–8.44). Simple slopes analyses showed that high MPR was associated with lower bowel screening program compliance in rural (OR=0.26, 95%CI=0.11–0.59) and regional (OR=0.60, 95%CI=0.38–0.95) areas, but not in metropolitan areas. High CFC was associated with higher bowel screening program compliance in rural (OR=4.46, 95%CI=1.39–14.47) and regional (OR=2.30, 95%CI=1.19–4.43), but not metropolitan, areas. Conclusions: Sub-optimal compliance rates are evident in nonmetropolitan areas with intervention most needed in regional areas where compliance is lowest, leaving residents at a potentially higher risk of CRCs going undetected. Efforts to increase CRC screening in rural and regional areas should promote the consideration of one’s future and discourage attitudes that minimise health issues. This research highlights the way in which individual attitudes and thinking styles may impact preventive health behaviours differently in non-metropolitan communities

Information needs and preferences among rural cancer survivors in Queensland, Australia: a qualitative examination

Objective: This study aimed to understand how cancer survivors in rural Queensland seek and receive information, as well as their preferences regarding the content and delivery of health-related information. Methods: This study explored cancer survivors’ experiences in seeking and comprehending health information using a qualitative descriptive approach. Semi-structured interviews were conducted with 24 participants. Data were analysed using reflexive thematic analysis. Results: Two major themes and six sub-themes were identified including 1) information content and gaps – a) information about diagnosis and treatment, b) survivorship information gaps and c) practical support needs and 2) delivery and acceptance of information – a) sources of information, b) personalised information needs and c) information seeking or avoidance. Findings suggested that health information provision was inconsistent; survivors’ attitudes towards seeking information varied greatly; and survivors’ had difficulty processing information due to emotional distress. Conclusion: The role of the health professional is critical in providing information and support to rural cancer survivors. Information provided should be tailored to meet the needs and preferences of individuals taking into consideration demographic factors and attitudes. Implications for public health: The current findings imply that quality information provision after cancer treatment would facilitate improvements in satisfaction among rural cancer survivors.</p