Cost-effectiveness analysis of single-session walk-in counselling.

BACKGROUND: An increasing number of family service agencies and community-based mental health service providers are implementing a single-session walk-in counselling (SSWIC) as an alternative to traditional counselling. However, few economic evaluations have been undertaken. AIMS: To conduct a cost-effectiveness analysis of two models of service delivery, SSWIC compared to being waitlisted for traditional counselling. METHODS: A quasi-experimental design was employed. Data were collected from two community-based Family Service Agencies, one using SSWIC and one using traditional counselling. Participants were assessed at baseline and four weeks after the baseline. Cost-effectiveness was estimated from the societal and payer's perspective. RESULTS: The societal and payer's costs for SSWIC were higher than for those waiting for traditional counselling, and health outcomes were better. SSWIC is not cost-effective compared to being on the waitlist for traditional counselling (or, for a few patients, having received counselling, but after a wait of several weeks). CONCLUSIONS: SSWIC has the potential to reduce the pressure on the mental health care system by reducing emergency visits and wait lists for ongoing mental health services and eliminating costly-no shows at counselling appointments. Long-term studies involving multiple walk-in counselling services and comparison services are needed to support the findings of this study.

A comparison of walk-in counselling and the wait list model for delivering counselling services.

BACKGROUND: Walk-in counselling has been used to reduce wait times but there are few controlled studies to compare outcomes between walk-in and the traditional model of service delivery. AIMS: To compare change in psychological distress by clients receiving services from two models of service delivery, a walk-in counselling model and a traditional counselling model involving a wait list. METHOD: Mixed-methods sequential explanatory design including quantitative comparison of groups with one pre-test and two follow-ups, and qualitative analysis of interviews with a sub-sample. Five-hundred and twenty-four participants ≥16 years were recruited from two Family Counselling Agencies; the General Health Questionnaire-12 assessed change in psychological distress. RESULTS: Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the four-week follow-up compared to the traditional service delivery model. Ten weeks later, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. The qualitative data confirmed participants highly valued the accessibility of the walk-in model, and were frustrated by the lengthy waits associated with the traditional model. CONCLUSIONS: This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery not conducive to randomized controlled trials.

The case for single-session therapy: does the empirical evidence support the increased prevalence of this service delivery model?

BACKGROUND: A significant increase in the number of walk-in counselling clinics offering single-session therapy (SST) prompted this review of the empirical support for the effectiveness of SST. AIMS: The article is intended to (1) increase practitioners' knowledge of the empirical support for the effectiveness of single-session counselling with client populations typically served in community-based mental health and counselling agencies and (2) identify priorities for future research on SST. METHOD: A thorough review of relevant databases was undertaken to locate published studies reporting client outcomes following SST. The focus of the review is research involving clients and presenting problems typically seen in community-based mental health and family counselling agencies. RESULTS: The findings suggest that the majority of clients attending either previously scheduled or walk-in SST find it sufficient and helpful. The studies imply that this model of service delivery leads to perceived improvement in presenting problems in general, and on specific measures of variables such as depression, anxiety, distress level and confidence in parenting skills. CONCLUSIONS: Many of the studies have methodological limitations, and future research requires increased use of standardized measures, control groups and larger and more diverse samples.

Do therapists' beliefs about sexual offending affect counseling practices with women?

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n = 164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.

Sustaining walk-in counselling services: an economic assessment from a pilot study.

Introducing single-session walk-in counselling services in a counselling agency virtually eliminated a lengthy wait list and reduced costly no-shows for scheduled counselling. A pilot study found that client distress decreased significantly following the single session, and a high proportion of clients were "ready for change." The service diverts clients from using hospitals and family doctors/walk-in clinics and toward using community social services. It also enables an earlier return to work and usual activities. The social benefits (reduced hospital use and faster return to work) exceed the cost of the service. This information is helping to make the case for sustaining and expanding these services.

Practical ways psychotherapy can support physical healthcare experiences for male survivors of childhood sexual abuse.

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2009), which is intended to help healthcare providers from all disciplines understand the effect of child sexual abuse on some survivors' abilities to access and benefit from health care. This paper discusses what psychotherapists can learn from the healthcare experiences of the male survivors who participated in this project. It also offers practical suggestions for supporting male clients who experience difficulty seeking treatment for physical health concerns.

Specialized inpatient trauma treatment for adults abused as children: a follow-up study.

OBJECTIVE: The authors investigated outcome at discharge and at follow-up assessments for adults abused as children who completed a 6-week inpatient program for traumatic stress recovery. METHOD: Participants were assessed at admission, discharge, and 3, 6, and 12 months postdischarge on measures of global symptom severity, posttraumatic stress disorder (PTSD), and disrupted beliefs. Two wait-list comparison groups were also assessed at two points in time for comparison with the discharge and 3-month postdischarge assessments of the treatment group. RESULTS: Relative to admission, the mean scores on all outcome measures for the treatment group were improved at discharge and at 6 and 12 months. Relative to a wait list group, the treatment group was significantly improved at discharge. After 3 months, the scores for the treatment group were not different from those of a wait list group because of deterioration in the treatment group. Age, source of income, and number of axis II disorders were associated with differing patterns of PTSD symptom change over time. Between 32% and 45%, depending on outcome measure, met stringent criteria for clinically significant change at 12 months postdischarge. CONCLUSIONS: At discharge from a specialized inpatient treatment program, adults with a history of abuse during childhood showed improvement relative to a wait list group. Scores tended to deteriorate in the 3 months following discharge but rebounded to discharge levels by 12 months postdischarge. Although many abused adults benefited from specialized inpatient treatment, a substantial proportion did not show clinically significant change 1 year later.

Providing dental care to survivors of childhood sexual abuse: treatment considerations for the practitioner.

BACKGROUND: Adults who experienced childhood sexual abuse frequently find dental treatment difficult to tolerate. Increased understanding of common long-term effects of this trauma may help dental professionals to respond more sensitively to patients who have experienced it. METHODS: The authors recruited 58 men and 19 women with self-reported histories of childhood sexual abuse from social agencies serving this population and interviewed the participants about their experiences with health care professionals, including dentists. The authors analyzed interview transcripts using the constant comparative method to identify main themes and patterns. RESULTS: Participants reported aspects of dental treatment that can be particularly difficult for them and offered ideas about how dental health professionals could make the experience more tolerable for them. The data analysis produced suggestions about how dentists might respond sensitively to patients who frequently cancel appointments, are distressed by certain body positions, need a sense of control and fear judgment. The authors also report participants' thoughts about questions from dental practitioners regarding a history of childhood sexual abuse. CONCLUSIONS: Adults who report a history of childhood sexual abuse are more likely to experience dental treatment more positively when dental professionals have some understanding of the long-term effects of such abuse, including how it can affect dental treatment interactions. Such knowledge enables dental professioinals to respond to their needs in a sensitive manner.

The case for integrating grounded theory and participatory action research: empowering clients to inform professional practice.

Grounded theory and participatory action research methods are distinct approaches to qualitative inquiry. Although grounded theory has been conceptualized in constructivist terms, it has elements of positivist thinking with an image of neutral search for objective truth through rigorous data collection and analysis. Participatory action research is based on a critique of this image and calls for more inclusive research processes. It questions the possibility of objective social sciences and aspires to engage people actively in all stages of generating knowledge. The authors applied both approaches in a project designed to explore the experiences of female survivors of childhood sexual abuse with physical therapy and subsequently develop a handbook on sensitive practice for clinicians that takes into consideration the needs and perspectives of these clients. Building on this experience, they argue that the integration of grounded theory and participatory action research can empower clients to inform professional practice.

Insecure attachment as a predictor of outcome following inpatient trauma treatment for women survivors of childhood abuse.

The role of insecure attachment as a predictor of outcome was investigated in 134 women who reported histories of child abuse and completed an inpatient program for treatment of traumatic stress. Multiple linear regressions were used to predict the change scores on four outcome measures at discharge and 6-month follow-up. Higher levels of feared loss of the attachment figure independent of demographics, symptomatic severity, and trauma exposure consistently predicted poorer outcome at both post-tests. Interventions that focus on internal models of attachment and current attachment relationships may improve outcome in women reporting severe abuse in childhood.

Women survivors of child sexual abuse. How can health professionals promote healing?

OBJECTIVE: To explore how health professionals can practise in ways sensitive to adult women survivors of child sexual abuse. DESIGN: Qualitative semistructured in-depth interviews. SETTING: Small and midsize cities in Ontario and Saskatchewan. PARTICIPANTS: Twenty-seven women survivors of childhood sexual abuse. METHODS: Respondents were asked about their experiences with physical therapists and other health professionals and asked how practice could be sensitive to their needs as survivors. A grounded-theory approach was used. After independent analyses, researchers achieved consensus on the main themes. Findings were checked with participants, other survivors, and mental health professionals. MAIN FINDINGS: A crucial theme was the need to feel safe when consulting any health professional. Participants described specific ways for clinicians to facilitate the feeling of safety. Disclosure of abuse history was another key theme; analysis revealed no one "right way" to inquire about it. CONCLUSION: Women survivors of child sexual abuse want safe, accepting environments and sensitive, informed health professionals with whom to work in partnership on all their health concerns.