Comer Jonathan S, Barlow David H
Center for Anxiety and Related Disorders.
Am Psychol. 2014 Jan;69(1):1-18. doi: 10.1037/a0033582. Epub 2013 Aug 5.
Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.
精神疾病给美国带来了惊人的公共卫生负担。尽管在过去40年里，心理治疗中循证实践（EBPs）的识别取得了巨大进展，但实验环境中的治疗与社区可获得的服务之间仍存在差距。作为回应，近年来，大量的关注和资金投入集中在广泛传播和实施工作上，旨在提高各类全科医生在不同实践环境中提供的心理服务质量。在《患者保护与平价医疗法案》的影响下，越来越多地设想这些全科医生将在综合初级保健环境中执业。这些进展具有巨大潜力，然而，鉴于心理健康问题和人类痛苦的巨大多样性，仅向全科医生进行广泛传播和实施工作可能不足以充分应对精神疾病的负担。一些循证实践可能被证明过于复杂而无法普遍传播，高质量传播和实施所需的时间和费用排除了对低发病率疾病治疗的大规模培训。随着传播和实施工作努力确保有一支高质量的全科心理健康护理队伍，在此我们强调在提供心理治疗时提供专科护理的迫切需求。鉴于妨碍获得专科护理的传统障碍，我们提出了专科行为远程医疗护理队伍的变革潜力，与全科医生队伍合作，共同确保为受影响的个人提供最高质量和及时的所需治疗。
