Psychology service model redesign: direct to psychology and stepped care in the multidisciplinary sleep service

Abstract

ABSTRACTThis commentary outlines a rationale for Model of Care redesign using implementation science methodology in an example service (Sleep Psychology within a Public Hospital multidisciplinary service) incorporating Stepped Care and “Direct to” Psychology pathways. Sleep disorders are common and costly to society, with insomnia being the most common sleep disorder. We can improve access to Psychological care for this highly prevalent condition within existing resources through strategic service model redesign. In our service, model of care redesign was necessitated by the escalating demand for Psychology services in the context of finite resourcing in our public hospital context (Queensland Health). However, redesign of Psychology models of care is necessary across the public and private sector Nationally, particularly with the ongoing impacts and aftermath of the COVID-19 pandemic. These pressures have necessitated rapid changes in Psychology service delivery, with implementation of systematised models of care, practicing at full scope, delegation to junior staff, and utilisation of time efficient (e.g., group delivery) and technological solutions designed to improve service efficiencies, effectiveness of care, and to maintain or improve patient reported experience and outcomes. Given the evidence-base for direct access and stepped care models, appropriately tailored to the individual service context, it is imperative that we disseminate and share processes and skills for service model redesign with our colleagues across service areas and service delivery contexts. Implementation of similar/comparable service models to improve efficient and effective Psychology service delivery is a matter of priority Nationwide.KEY POINTSWhat is already known about this topic: Insomnia is a common condition with serious mental health and economic impacts for which Psychological intervention is the evidence-based treatment.Access to Psychology assessment and treatment nationally is increasingly impacted by high demand and under resourcing, further compounded by the COVID-19 pandemic.There is precedent for service model redesign in other health contexts and disciplines incorporating “Direct to” Allied Health and “Stepped Care” service delivery models to optimise care within existing resources.What this topic adds: Psychology services can utilise learnings from other services and disciplines to inform model of care redesign with the aim of improving service efficiencies – this commentary outlines a rationale and process for this in an example context (Sleep Psychology).“Direct to Psychology” pathways leverage Psychologist skill and training as first contact for mental health and appropriate physical health conditions, thus reducing burden on Medical and Psychiatric specialists, reducing wait times and improving access to appropriate care.“Stepped Care” pathways can improve access to care within existing resources by implementation of systematised models of care, delegation to junior staff, and utilisation of time efficient (e.g., group delivery) and digital therapies as first-line.KEYWORDS: Sleep psychologyservice redesignstepped carefull scope of practicedigital therapies AcknowledgementsThank you for the collaborators on this service model redesign project including Dr Irene Szollosi, Dr Deanne Curtin, Dr Tricia Rolls, Dr Jessica Haratsis, and Dr Tamlyn Rautenberg.Disclosure statementNo potential conflict of interest was reported by the author(s).Data availability statementData sharing is not applicable to this article as no new data were created or analysed for this purpose of this commentary.Open scholarshipThis article has earned the Center for Open Science badge for Preregistered. The materials are openly accessible at https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12622001086752.Additional informationFundingThis project is currently in the pre-implementation phase, with stakeholder and consumer consultation currently underway. Implementation of the service model changes are planned for 1 July 2023. This project has received ethics approval via the LNR pathway with waiver of informed consent (HREC 2022 QTDD 88,350). The Protocol is listed with the Australian and New Zealand Clinical Trials Registry (ACTRN12622001086752) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 384368&isReview=true. This project is supported by funding from a Metro North Allied Health AH-TRIP (Allied Health Translating Research Into Practice) start-up grant and the Chief Allied Health Officer (OCAHO) Health Practitioner Research Scheme; Queensland Health.