RE-AIM analysis of Internet-based psychotherapy

We live in an era where the Internet is expected to be available at the home, the workplace, schools, libraries, and even the corner café. Everyday, more and more of the world's population is connected to this growing minefield of information, many of whom use it to seek out services they need. Health services are amongst the many purchasable products currently available online. The Internet, thus, is a viable method of contacting populations that a provider would not traditionally be able to reach. A growing service in this area is the practice of Internet-based psychotherapy. This goes by many other names as well, such as e-counseling, telecounseling, web therapy, computer mediated counseling, Interapy, and many other variations. ^ This paper reviews the current available literature on the efficacy and associated concerns of Internet-based psychotherapy through the RE-AIM lens. After an evaluation of the selected studies, Internet-based psychotherapy may be able to reach a wider audience than with traditional means and also produces similar efficacy results to in-person therapy. However, providers are still reluctant to adopt Internet-based psychotherapy due to legal concerns, and long-term maintenance of these practices may be an issue. Further research into the effectiveness, cost, and legal issues surrounding Internet-based psychotherapy is recommended. ^

The impact of traditional psychiatric services and case management services on the functioning of people with schizophrenia: A cross-national study in Nova Scotia and Texas

The purpose of this study was to determine the impact of traditional psychiatric services with case management services on the functioning of people with schizophrenia. Traditional services were defined as routine clinic services consisting of medication follow-along, psychotherapy, and support services. Case management consisted of activities involved in linking, planning, and monitoring services for the outpatient client who has schizophrenia. The target population was adult schizophrenics who had been receiving outpatient clinic services for a minimum of six months. Structured interviews were conducted using standardized scales (e.g., Quality of Life, Self-Efficacy, and Brief Symptom Inventory) with 78 outpatient client volunteers from two sites: Nova Scotia (Canada) and Texas (USA). The researcher tested for differences in psychiatric symptomatology, recidivism, and quality of life for persons with schizophrenia receiving traditional psychiatric services in Nova Scotia and traditional plus case management services in Texas. Data were collected from the structured interviews and medical records review forms. Types of services were blocked into low and high levels of Intensity (frequency x minutes) and compared to determine the relative contribution of each. Finally, the role of clients' self-efficacy was tested as an intervening variable. Although the findings did not support the hypotheses in the direction anticipated, there were some interesting and useful results. From the Nova Scotia site, clients who received low levels of services were hospitalized less compared to the Texas site. The more psychotic a patient was the higher their involvement in medication follow-along and the more monitoring they received. The more psychotherapy received, the lower the reported satisfaction with social relationships. Of particular interest is the role that self-efficacy played in improved client outcomes. Although self-efficacy scores were related to improved functioning, the mechanism for this still needs to be clarified through subsequent research. ^