scholarly journals Behavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health

2011 ◽  
pp. 87 ◽  
Author(s):  
Bruce Rybarczyk ◽  
Laurin Mack
Keyword(s):  
Public Health ◽  
Behavioral Treatment ◽  
Stepped Care ◽  
Care Approach

scholarly journals 658 Adjusting Fire - Piloting an Online Sleep Class in a U.S. Air Force Population in Response to COVID-19 Patient Care Restrictions

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A257-A257
Author(s):  
Marc Patience ◽  
Rosemary Estevez Burns ◽  
Daniel Cassidy
Keyword(s):  
Behavioral Treatment ◽  
Sleep Problems ◽  
Severity Index ◽  
Stepped Care ◽  
Service Members ◽  
Military Population ◽  
Sleep Difficulty ◽  
Related Services ◽  
Care Approach

Abstract Introduction Sleep problems remain problematically prevalent among U.S. service members. In 2015 over 60% of sampled service members reported getting less than 7 hours of sleep per night, 31.4% getting 5 hours or less, and nearly 50% reported subthreshold insomnia symptoms on the Pittsburgh Sleep Quality Index. Ongoing COVID-19 service delivery restrictions necessitate a rapid shift to virtual health solutions and illuminate barriers to the delivery of sleep interventions. This process improvement pilot was a proof-of-concept during uncertain times. Methods From September to January 2020, 10 weekly 1-time, 60-min virtual sleep classes were held over Microsoft Teams. Interventions were consistent with Motivational Interviewing and Brief Behavioral Treatment for Insomnia. Participants completed the STOP BANG and Insomnia Severity Index (ISI) before each class, and accomplished the ISI again at a 2-week contact during which they rated progress toward problem resolution and were offered additional clinical services as-needed. Results Forty-six participants attended the class. 67% responded to the post-class survey. 74% responded to the two-week follow-up. A majority (84%) indicated either agreement or strong agreement with the statement ’I plan to CHANGE a behavior or TRY an intervention I learned to better my sleep’, and many proceeded to establish a more consistent sleep schedule (n=14; 45%), remove electronics from the bedroom (n=13; 42%), and/or go to bed only when sleepy (n=11; 35%). 84% would recommend this class to others with similar concerns. Scaled from 1 (‘no change’) to 10 (‘full resolution’), participants reported having derived modest benefit from the intervention (M = 4.1, SD=1.7). Eleven (35%) denied need for additional sleep-related services, and 84% expressed intent to recommend the class to others with similar concerns. Conclusion Results suggest a military population is receptive to a 1-time, virtual sleep class consistent with social distancing strictures. This service provided patients rapid access to care while contemporaneously reducing demand for time-intensive one-to-one appointments. As hypothesized, receipt of the intervention was associated with intention to modify sleep-relevant behavior, and with meaningful progress toward resolution of sleep difficulty as assessed at 2-week follow-up. Broadly disseminated, this intervention could introduce an internet-based, stepped-care approach to management of sleep insufficiency across the DoD. Support (if any):

Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings

Addiction ◽  
1997 ◽  
Vol 92 (11) ◽  
pp. 1479-1490 ◽  
Author(s):  
F. Curtis Breslin ◽  
Mark B. Sobell ◽  
Linda C. Sobell ◽  
Giao Buchan ◽  
John A. Cunningham
Keyword(s):  
Stepped Care ◽  
Problem Drinkers ◽  
Predictive Utility ◽  
Care Approach

scholarly journals The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients

2021 ◽  
Author(s):  
J. W. H. Luites ◽  
P. P. F. M. Kuijer ◽  
C. T. J. Hulshof ◽  
R. Kok ◽  
M. W. Langendam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Prognostic Factors ◽  
Back Pain ◽  
Work Participation ◽  
Stepped Care ◽  
Low Back ◽  
Lumbosacral Radicular Syndrome ◽  
Care Approach ◽  
Radicular Syndrome

AbstractPurpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation “to advise”, low to very low in a recommendation “to consider”, unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines “lifting” and “whole body vibration”. The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.

scholarly journals Developing efficient and effective behavioral treatment for insomnia in cancer survivors: Results of a stepped care trial

Cancer ◽  
2019 ◽  
Vol 126 (1) ◽  
pp. 165-173 ◽  
Author(s):  
Eric S. Zhou ◽  
Alexis L. Michaud ◽  
Christopher J. Recklitis
Keyword(s):  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Stepped Care
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