HIV, Mental Health Issue, Substance Use
Conditions
Keywords
Brief narrative therapy, Implementation outcome, Stepped care, Psychotherapy, Integrated primary care
Brief summary
This pilot research study will provide timely access to behavioral health services through the provision of a single-session narrative therapy intervention. The goal of this 6-month study is to test the acceptability, feasibility, and fit of the intervention in an integrated primary care clinic serving people living with HIV.
Detailed description
Single-session interventions are designed to address barriers to engaging in care and address the issues of long waitlists and limited provider availability. Offering a single session intervention soon after a referral is made is a strategy on a stepped-care continuum model that has been found to be an effective approach to manage population mental health needs. This study aims to 1) pre-pilot a single-session narrative therapy intervention with patients currently on the waitlist for psychotherapy services at an HIV primary care clinic to evaluate the acceptability of this treatment option for patients and the feasibility of proposed data collection followed by 2) a 6-month pilot study of the same intervention to evaluate intervention acceptability, fit, and impact on service and clinical outcomes. At the end of this study, patient and provider-level data on the utility of integrating a single-session psychotherapy service as part of the continuum of behavioral health services in an integrated care setting will be obtained, which the investigators can utilize to design a larger implementation-effectiveness trial.
Interventions
BEHAVIORALSingle Session Narrative Therapy
Single-session narrative psychotherapy intervention is an evidence-based strategy on a stepped care continuum that can assist patients in accessing care when they most need it and can lead to the most effective utilization of scarce resources. It offers a transdiagnostic, strengths, solution-oriented, and non-pathologizing intervention to address patients' behavioral health needs.
Sponsors
University of Washington
National Institute of Mental Health (NIMH)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Patient Inclusion Criteria * Adults (age 18 years and older) who are patients at \[Blinded\] Clinic * Have agreed to participate in the single session intervention * Ability to complete the interview and research surveys in English Patient
Exclusion criteria
* Participants with need for urgent mental health treatment (e.g., at imminent risk of suicide or harm to others; disabling symptom presentation) * Inability to provide informed consent Provider Inclusion Criteria: * Adults (age 18 years and older) * Referring providers at \[Blinded\] clinic (social worker, primary care physician, mental health professional etc.) * Ability to complete the research survey or interview in English. Provider
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Health Questionnaire-9 (PHQ-9) | 1 month | The Patient Health Questionnaire-9 (PHQ-9) is a 9-item validated self-report measure used to screen for depression, diagnose it, monitor its severity, and measure treatment response. The PHQ-9 ranges from 0 to 27 points, with higher scores reflecting more severe symptoms. Scores ≥ 10 indicate moderate depression. This measure was only collected and reported for patient participants. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Generalized Anxiety Disorder- 7 (GAD-7) | 1 month | The Generalized Anxiety Disorder 7-item (GAD-7) is a validated brief self-report tool that measures anxiety symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. The total score ranges from 0 to 21, with higher scores indicating greater severity. Scores ≥ 10 indicate moderate anxiety. This measure was only collected and reported for patient participants. |
| Remoralization Scale | 1 month | The Remoralization Scale is a validated 12-item self-report measure rated on a 4-point scale ranging from 1 ("Totally disagree") to 4 ("Totally agree") that assesses the level of remoralization. The total score ranges from 12 to 48, with higher scores indicating higher levels of remoralization. This measure was only collected and reported for patient participants. |
| Social Connectedness Scale-Original (SCS-Original) | 1 month | The Social Connectedness Scale is an 8-item instrument that assesses the degree to which one feels connected to others in their social environment. Items are measured on a 6-point Likert scale ranging from 1 ("Strongly Agree") to 6 ("Strongly Disagree"). Total scores range from 8 to 48 points. Higher total scores indicate a greater sense of social connectedness. This measure was only collected and reported for patient participants. |
| State-Trait Assessment of Resilience Scale (Trait Sub-scale Only) | 1 month | The State-Trait Assessment of Resilience Scale measures resilience using a state and trait approach, based on the conceptualization of resilience as being influenced by a combination of state and trait factors. This study will only measure the 'Trait' level of resilience, using the trait sub-scale (7-item instrument), which is construed as more distal and enduring. Items are measured on a 4-point Likert scale ranging from 1 ("Disagree") to 4 ("Strongly agree"). Total sum scores are calculated for the sub-scale and range from 7 to 28 points; higher scores reflect greater resilience. This measure was only collected and reported for patient participants. |
| Brief Services Evaluation | 1 month | The Brief Services Evaluation is a 6-item self-report measure assessing patients' perceptions of their skills, ideas, and knowledge related to the primary problem that brought them to counseling. Items are rated on a 6-point Likert scale ranging from 1 ("Strongly disagree") to 6 ("Strongly agree"). Item-level score totals range from 1 to 6. We report item-level changes and significance levels consistent with the Canadian study. The BSE was completed by pilot participants immediately before and one month after their first SSNT session. This measure was only collected and reported for patient participants. |
| Acceptability of Intervention Measure (AIM) | 1 Month for patient participants; 0 Month for referring providers | The Acceptability of Intervention Measure is a 4-item measure of perceived intervention acceptability. Items are measured on a 5-point Likert scale 1 ("Completely Disagree") to 5 ("Completely Agree"). Score is a calculated mean that ranges from 1-5. Higher mean scores indicating greater perceived intervention acceptability. |
| Intervention Appropriateness Measure (IAM) | 0 Month for referring providers | The Intervention Appropriateness Measure is a 4-item measure of perceived intervention appropriateness. Items are measured on a 5-point Likert scale 1 ("Completely Disagree") to 5 ("Completely Agree"). Score is a calculated mean that ranges from 1-5. Higher mean scores indicating greater perceived intervention acceptability. |
| Feasibility of Intervention Measure (FIM) | 0 Month for referring providers | The Feasibility of Intervention Measure is a 4-item measure of perceived intervention feasibility. Items are measured on a 5-point Likert scale 1 ("Completely Disagree") to 5 ("Completely Agree"). Score is a calculated mean that ranges from 1-5. Higher mean scores indicating greater perceived intervention feasibility. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAkansha Vaswani-Bye
University of Washington
Participant flow
Recruitment details
51 patients on the waitlist for psychotherapy accepted the SSNT intervention as routine clinic care and received at least one SSNT session. All patients who accepted the SSNT intervention were invited to participate in the research study. Of these, 43 patients provided informed consent and were enrolled in the research study. After patient enrollment and participation were completed, 21 referring providers consented and completed feedback assessments.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 8 Participants |
| Age, Categorical Between 18 and 65 years | 34 Participants |
| Brief Services Evaluation Awareness of strengths to solve the problem | 3.93 Score on items STANDARD_DEVIATION 1.18 |
| Brief Services Evaluation Ideas to solve the problem | 3.57 Score on items STANDARD_DEVIATION 1.14 |
| Brief Services Evaluation Knowledge of community resources available to help | 3.43 Score on items STANDARD_DEVIATION 1.14 |
| Brief Services Evaluation Knowledge of social supports available to help | 3.93 Score on items STANDARD_DEVIATION 1.46 |
| Brief Services Evaluation Skills needed to solve the problem | 3.25 Score on items STANDARD_DEVIATION 1.35 |
| Brief Services Evaluation Understanding of the problem | 4.71 Score on items STANDARD_DEVIATION 1.01 |
| Generalized Anxiety Disorder- 7 (GAD-7) | 6.5 Score on a scale |
| Patient Health Questionnaire-9 (PHQ-9) | 8.50 Score on a scale |
| Race/Ethnicity, Customized American Indian or Alaskan Native | 1 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants |
| Race/Ethnicity, Customized Black or African American | 12 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 8 Participants |
| Race/Ethnicity, Customized More than one race | 5 Participants |
| Race/Ethnicity, Customized Not Hispanic or Latino | 32 Participants |
| Race/Ethnicity, Customized Pacific Islander | 1 Participants |
| Race/Ethnicity, Customized Unknown or not reported | 6 Participants |
| Race/Ethnicity, Customized Unknown or Not Reported | 2 Participants |
| Race/Ethnicity, Customized White | 17 Participants |
| Remoralization Scale | 29.33 Score on a scale STANDARD_DEVIATION 7.88 |
| Sex/Gender, Customized Demiboy | 0 Participants |
| Sex/Gender, Customized Female | 8 Participants |
| Sex/Gender, Customized Gender queer | 2 Participants |
| Sex/Gender, Customized Male | 28 Participants |
| Sex/Gender, Customized Nonbinary | 2 Participants |
| Sex/Gender, Customized Unknown or Not Reported | 2 Participants |
| Social Connectedness Scale-Original (SCS-Original) | 30.62 Score on a scale STANDARD_DEVIATION 11.36 |
| State-Trait Assessment of Resilience Scale (Trait sub-scale only) | 21.79 Score on a scale STANDARD_DEVIATION 4.16 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 42 | 0 / 0 |
| other Total, other adverse events | 0 / 42 | 0 / 0 |
| serious Total, serious adverse events | 0 / 42 | 0 / 0 |
Outcome results
None listed