However, this process of discovery is somewhat hampered bythe lack of a common language for describing elements across differenttheoretical models and interventions. Examination of fidelity measuresfrom different theoretical models indicates that different terms areused to describe the same element. For example, “using thoughtrecords” in cognitive-behavioral therapy is likely to representthe same element as “mood rating” in interpersonalpsychotherapy. This chapter addresses the elements—therapeutic activities, techniques, orstrategies—that make up psychosocial interventions. Most if not allevidence-based, manualized psychosocial interventions are packages of multipleelements (see Figure 3-1).
Types of Therapeutic Interventions
Other environmental interventions tackle indoor oroutdoor air pollution or involve the disposal of contaminants suchas pesticides or heavy metals. They are alsointerventions that typically have to be applied to wholecommunities, rather than to individuals in a community, so that, intrials, the unit of randomization is the community or, in someinstances, the household. Although interventions are often staged for individuals, they are also organized for people who reside in institutional settings and for communities at large. For instance, the practice of distributing free and readily available condoms is a common form of behavioral intervention with the goal of preventing sexually transmitted diseases. The goal of any type of intervention is to take action that will make a positive change in the way someone thinks or behaves and to modify or prevent self-destructive behavior. Therapeutic intervention also gives friends or family members an opportunity to directly approach their loved one in a safe and structured manner.
1. Preventive interventions
In addition,different levels of abstraction may characterize elements from differenttheoretical models (e.g., structural elements in assertive communitytreatment versus content elements in cognitive-behavioral therapy). Theresult is a large research agenda, given the number of elements fordifferent disorders/problems. Mechanisms of action could be investigated for each element or sequenceof elements across multiple units of analysis (from genes to behavior),consistent with NIMH’s Research Domain Criteria Initiative (Insel et al., 2010) and itsStrategic Plan for Research, which calls for mechanistic research forpsychological treatments. For example, an aim of the Strategic Plan isto “develop objective surrogate measures of outcome and clinicalchange that extend beyond symptoms, to assess if target mechanismsunderlying function, general health, and quality of life have beenmodified by treatments” (NIMH, 2015).
ADVANTAGES OF AN ELEMENTS APPROACH
- This chapter addresses the elements—therapeutic activities, techniques, orstrategies—that make up psychosocial interventions.
- In conclusion, the types of interventions and treatments can be vast and varied, depending largely on the field in which they are implemented.
- First, any newintervention could be examined in the context of existing elements thatcan be applied to new populations or contexts.
- For example, a treatment for diabetes might have a high impact if it successfully lowers blood sugar levels, and it would be considered effective if it helps maintain those levels in the long term.
- Obviously, the further apart the theoretical orientations, the lesslikely it is that shared elements function in the same way across twointerventions.
- Some major communicable diseases in developing countries depend onvector and intermediate hosts for their transmission.
There are a wide variety ofcontrol measures to reduce transmission of these infections throughattacking the vectors or the reservoirs of infection. Mostinterventions require a good understanding of the vector orintermediate host, its life cycle, and the environmental conditionsthat it requires to propagate infections. Residual insecticide on the walls ofhouses offers relatively little direct protection to those in thetreated household, as the mosquitoes take up the insecticide whileresting after a blood meal.
For some formsof surgery, ‘sham’ operations have been used in clinical studies andperhaps could be considered in field trials. In general, however,randomized trials of these procedures will have to be conductedwithout blinding. Strategies for the use of such interventions include the masstreatment of entire populations or the targeted treatment ofidentifiable subgroups (such as school-age children) in areas wherethe infection is highly prevalent. Generally, such treatment isapplied for the benefit of the individuals treated, but theobjective may also be to reduce the transmission of the agent in thecommunity more generally. When the prevalence is very high and thetreatment is cheap, treating all those in a defined population maybe more cost-effective than screening the whole population and thentreating only those found infected. A mother’s health and well-being during pregnancy and around the timeof delivery, including access to appropriate care, are criticaldeterminants of maternal mortality and neonatal and child health inthe early years of life, and possibly for much longer.
Mostdrugs employed against infectious disease are used to kill orinhibit the replication or spread of the pathogen in the host.Strategies for disease control that use such agents may involve casedetection (which requires an appropriate case definition and adiagnostic method), followed by treatment that is designed to reducemorbidity and mortality. Often, the public health success of thisapproach depends critically upon case finding, and, for diseasessuch as TB and leprosy, it depends also on case holding, i.e. beingable to follow and treat each patient at regular intervals oversufficient time to eliminate the agent from the individual. Casefinding and treatment may also reduce transmission of an agent ifcases are the main reservoirs of infection, if case detectionmethods locate a high proportion of prevalent cases, and if thetreatment is sufficiently effective. In terms of implementation, the matrix of elements (ranked by frequencyfor different patient characteristics) functioned as a guide forcommunity practitioners, who chose the elements that matched theirsample. Whereas Chorpita andcolleagues (2005) do not address nonspecific elements (i.e.,common factors), an elements approach could encourage practitioners toselect nonspecific elements as the foundation of their intervention, andto select specific elements from among those occurring most frequentlythat have an evidence base for their population (i.e., a personalizedapproach). With the accrual of evidence, the personalized selection ofelements could increasingly be based on research demonstrating whichelements, or sequence of elements, are most effective for specificclinical profiles.
Anecdotally, many interventionists say that they have up to a 95% success rate at convincing the subject of their interventions to enter a treatment program, but these claims have not been substantiated. Box 2.1 is reproduced from the guidelines and summarizes thesteps in developing and evaluating trials involving complexinterventions. If you choose to pursue an intervention, thorough preparation is key, including understanding what to expect. Interventions directed to the neonate are also important, such asexclusive breastfeeding and care practices, such as ‘kangaroo mothercare’, a method of care of preterm infants, involving infants beingcarried, usually by the mother, with skin-to-skin contact. In other instances, an intervention could take the simpler form of bringing music into an institutional setting, such as a hospital, to help reduce patients’ stress and regulate other negative emotions.
The Johnson Intervention
The main focus of the book will be on large-scale Phase III trialsconducted ‘in the field’ (i.e. outside clinical facilities), but thereis also a specific chapter on Phase IV studies (see Chapter 22). An intervention effort is often made to try to prevent people with known problems who cannot or will not help themselves from engaging in self-injurious behavior, or relapsing into substance abuse. Crisis intervention is used when someone is experiencing an immediate crisis, such as a suicide threat or attempt. While some interventionists will prescribe to one of the above models over the others, many are able to blend the three models based on what will be most effective for the addict and their family.
Treatment, however, is often a more reactive approach, following a diagnosis with the individual’s consent. The impact of treatment usually refers to how it improves the overall health or wellbeing of an individual, and its effectiveness is often gauged by the degree of recovery or the extent of symptom management. For example, a treatment for diabetes might have a high impact if it successfully lowers blood sugar levels, and it would be considered effective if it helps maintain those levels in the long term.
- The Distillation and Matching Model of Implementationhas been tested, albeit only in youth samples and only by oneinvestigative team.
- Intervention refers to the strategies or actions taken to prevent, manage, or address a problem, especially in relation to social and health issues.
- Most ofthese efforts have been introduced on a system-wide basis, withlittle thought about the value of rigorous assessment.
- These terms are widely used in different fields, such as medicine, psychology, education, and social work, and carry different connotations in each.
- Cognitive-behavioral therapy for substance use disorders includeselements of exploring the positive and negative consequences ofcontinued drug use, self-monitoring to recognize cravings early andidentify situations that might put one at risk for use, and developingstrategies for coping with cravings and avoiding those high-risksituations (e.g., Carroll andOnken, 2005).
Field Trials of Health Interventions: A Toolbox. 3rd edition.
These actions are usually proactive and are implemented with the aim of preventing the issue from becoming worse, or to disrupt a potentially harmful situation. In a medical context, an intervention could be a program or therapy designed to prevent the onset of a specific disease or health condition. In a social context, it could refer to programs aimed at preventing drug abuse, or initiatives to improve educational outcomes.
1.2. Nutritional interventions
For example, massadministration of anti-helminthic treatment to schoolchildren issometimes administered in this way. Whether requiring specificdiagnosis or not, therapeutic or preventive agents are usually takenon an individual basis, though sometimes agents can be distributedto everyone in a community through the water supply (for example,fluoride against dental caries) or in food (for example,historically, diethylcarbamazine for filariasis and chloroquine formalaria in medicated salt). Mass treatment of school-age children inareas highly endemic for the infection with an anti-schistosomaldrug every year or two may be sufficient to virtually eliminateserious disease consequences of infection with Schistosomamansoni. Alterations to the environment directed at reducing the transmissionof infections are central to the control of many infectiousdiseases, particularly those that are transmitted through water,such as cholera, or through the faecal–oral route such as manygastrointestinal infections. Environmental interventions to reducehuman faecal and urine contamination include latrine construction,provision of sewage systems, clean water supplies, and protectedfood storage.
Interventions and treatments are two key strategies used to manage and mitigate various health-related issues, behavioral disorders, and other life challenges. This article aims to demystify the difference between intervention and treatment, delving into their definitions, types, implementation, impact, and ethical and legal considerations. Obviously, the further apart the theoretical orientations, the lesslikely it is that shared elements function in the same way across twointerventions. For example, exploration of attempts to avoid distressingthoughts and feelings within psychodynamic therapy functions to sober house identifyunresolved conflicts, whereas exploration of avoidance of unwantedthoughts or images in cognitive-behavioral therapy provides therationale for exposure therapy to reduce discomfort and improvefunctioning.
Field trials are required to assess how interventions,both old and new, may be best applied in populations and to determine theirimpact on improving the health of the population. Some major communicable diseases in developing countries depend onvector and intermediate hosts for their transmission. For differentinfections, the vectors include mosquitoes, tsetse flies, triatominebugs, sandflies, ticks, and snails.