Complementary Medicine & Integrative Health Approaches to Trauma Therapy & Recovery

Research Paper Title

Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery.

Abstract

The popularity of complementary and integrative health (also complementary integrated health; CIH) approaches has significantly increased in recent years.

According to the National Centre for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, about 1 in 3 adults and 1 in 9 children used CIH approaches to healing.

Some reports estimate that the use of CIH approaches will continue to increase (Clarke et al., 2015) as these therapies are cost effective and also due to the difficulties in finding trained mental health professionals (Simon et al., 2020).

For the purpose of this special issue, the researchers use the NCCIH’s definition of CIH as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (Barnes et al., 2004, p. v). However, the integration of these therapies into the health system has not followed the same pattern despite the fact that patients report the need to discuss CIH therapies with their doctors or are actually using them (de Jonge et al., 2018; Jou & Johnson, 2016; Stapleton et al., 2015). This inability to keep up with the demand or patients’ preference is possibly due to providers’ lack of understanding and/or knowledge of these therapies, as well as scientific skepticism (Ali & Katz, 2015; Fletcher et al., 2017).

Using data from the 2012 National Health Interview Survey, Jou & Johnson (2016) identified patterns of CIH use in the United States and reasons for patients’ nondisclosure of the use of these therapies. Patients’ fear of disclosure due to perceived scepticism or disapproval from their provider was frequently attributed as a cause of patients’ nondisclosures to providers about the use of these therapies (Eisenberg et al., 2001; Jou & Johnson, 2016; Thomson et al., 2012).

The arrival of patient-centred care models is beginning to shift the ways we understand the patient’s role in treatment engagement. Patient-centred approaches often emphasize the use of preventative and holistic wellness models that go beyond the use of evidence-based treatments. This approach also seeks to be culturally responsive, which is a key factor in addressing health disparities in the United States (American Psychological Association [APA], 2019).

The Institute of Medicine, in its report on CIH therapies, highlighted the importance of engaging patients in their own care, including having a decision about therapeutic options (Bondurant et al., 2005). Likewise, the Race and Ethnicity Guidelines in Psychology (APA, 2019) recommend psychologists engage the patient’s cultural beliefs, or what Kleinman called the “explanatory belief model” (Kleinman, 1978)- for example, by “aim[ing] to understand and encourage indigenous/ ethnocultural sources of healing within professional practice” (APA, 2019, p. 24).

Reference

Mattar, S. & Frewenm P.A. (2020) Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery. Psychological Trauma. 12(8):821-824. doi: 10.1037/tra0000994.

Primary Mental Health Integration Requires Considerable Organisational Investments

Research Paper Title

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration.

Background

Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost.

The objective of this study was to examine the time and organisational cost of facilitating implementation of primary care mental health integration.

Methods

One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics.

Implementation facilitation tailored to the needs and resources of the setting and its stakeholders.

The researchers documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organisational cost.

Results

The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders).

The organisational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other.

Conclusions

Although facilitation can improve implementation of primary care mental health integration, it requires substantial organisational investments that may vary by site and implementation effort.

Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

Reference

Ritchie, M.J., Kirchner, J.E., Townsend, J.C. Pitcock. J.A., Dollar, K.M. & Liu, C.F. (2019) Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration. Journal of General Internal Medicine. doi: 10.1007/s11606-019-05537-y. [Epub ahead of print].