Participants
During the 8 months of the study, 129 patients received psychological consultations. Of these, 12,4% were children and adolescents and therefore, not included in the study. As for 7,9% of adult patients presenting for SSI, the psychologist delivering the intervention judged that their needs exceeded what could be offered within a single intervention. They were not included in the study, but still received psychological services. Another 7,7% of adult patients were excluded from the study because of their mental state when they consulted (perceptible cognitive impairment, active suicidal crisis or domestic violence that had to be reported to the Youth Protection Department). A total of 33 patients were excluded from the study but all benefited from psychological services.
Therefore, 96 patients were eligible for the study and 75% agreed to participate. A total of 72 participants were enrolled. Data from 3 participants were removed from the study since they came back each and every week. They were offered traditional psychotherapy by the on-site psychologist.
Study data is thus based on 69 enrolled participants. Table 3 presents their characteristics.
As shown in Table 3, patients with very different characteristics accessed the SSI. For example, whereas a consultation rate of 12–17% is generally expected among men [59], it was 27% in the present study. Diversity was also observed in age groups, education, and family income.
Accessibility
One objective of this study was to assess whether implementation of the model increased accessibility of psychological services. To evaluate this, we look at how many different patients had access to psychological consultations in the UFMG.
In the years 2016 and 2017, only 17 and 16 patients (respectively) benefited from psychological consultations. The year 2018 was particular, given the preparation for the SSI project. From January to September, a traditional model of service delivery in psychology was in place and 10 patients received psychological consultations. From the beginning of October, and until the end of December, there was a running-in period to assess the feasibility of the SSI. This service delivery model allowed 44 patients to access psychological consultations during this period.
As for 2019, the data show that during the 8-month period of the study, a total of 129 patients accessed psychological consultations through the SSI. These data confirmed that accessibility to psychological consultation, in terms of the number of patients benefiting from the service has indeed increased. Implementation of SSI allowed about 7 times more patients to access psychology consultations, when compared to previous years using traditional service model.
Access in a timely manner
Another specific objective of the study was to verify whether AA principles of timely access would work with the SSI.
The new model of services allowed 91% of participants to obtain an appointment in fewer than 7 working days, and only 1% waited for more than 10 days. It is noteworthy that 22% received an appointment in less than one day, or on the same day as their consultation request.
Impact on missed appointments/late cancellations
We also wanted to assess if the SSI would impact the no-show/late cancellation rate, which monopolize available clinical time and thus reduce access for potential new patients.
The no-show/late cancellation rate in previous years (2016 to 2018), with traditional service model, was about 22%. Implementation of SSI in 2019 seemed to have reduced this rate since it was at 10,4% during the study period.
Sufficiency of a single session
We wanted to know if participants felt that a single session was enough for them to help solve their problem.
When asked, 51% of participants said that it was. Of those who visited more than once, 50% came twice, and another 50% came thrice, usually for the same problem stated during the first SSI. In the 8-month study period, only 19% of participants came more than once.
Clinical outcomes of SSI
Although the study was observational in nature and the design did not include a control group, we were still interested in gathering data on clinical outcomes. These data should be interpreted with caution, as the study design is not powerful enough to ensure observed changes were attributable to the intervention.
Regarding the objectives related to the clinical effects of the SSI on the participants, the data suggested positive effects of the intervention (see Table 4).
For the first clinical outcome, we measured the participants perceived intensity (PPI) of their problem, by self-rating from 1 to 10, 10 being the “worst problem of their live”. When comparing T0 (before SSI) with T1 (immediately after SSI), results showed a significant reduction in PPI (7.8 vs 6.7, F = 32.32, df = 67, Cohen’s d = 0.89, p < 0.0001). To assess if the effect was sustained over time, we compare scores at T0 (before SSI) and at T2 (follow-up). We can see there is still a significant reduction in PPI at follow-up (7.8 vs 6.9, F = 11.89, df = 60, Cohen’s d = 0.58, p = 0.0003).
For the second clinical outcome, we measured participants’ psychological distress, with the K6. Compared to pre-SSI (T0), the distress scores also significantly decreased (13.6 vs 8.8, F = 94.17, df = 67, Cohen’s d = 1.51, p < 0.0001) after the intervention (T1). This reduction seemed to have been maintained at follow-up, when compared to pre-SSI (T0—T2) (13.6 vs 8.7, F = 72.15, df = 60, Cohen’s d = 1.42, p < 0.0001). Furthermore, before the intervention (T0), 49% of participants reached the K6 cut-off score (≥ 13 pts) indicating the probability of a serious mental illness [48]. After the SSI (T1), only 18% remained in this category.
As for the third clinical outcome, the well-being of participants was measured by the WHO-5 index. The results indicate a significant increase in well-being scores from before to after the SSI (T0—T1) (39.3 vs 57.9, F = 73.91, df = 67, Cohen’s d = 1.34, p < 0.0001). At follow-up, the increased well-being also seemed to be maintained, when compared to pre-SSI (T0 – T2) (39.9 vs 49.4, F = 23.23, df = 60, Cohen’s d = 0.80, p < 0.0001).
Interestingly, presumed effect sizes of the SSI, as measured by Cohen’s d [60], varies from moderate to large (0.58 to 1.81). Table 4 presents results in more details.
Satisfaction with the SSI
Assessing the satisfaction of participants with the intervention was also an objective of the study. This was measured immediately after the intervention using the Consulting Experience Questionnaire, in which participants had to endorse a statement describing their opinion, with 1 being the least positive statement and 5 being the most positive.
As shown in Table 5, participants seemed to be mostly satisfied with their SSI experience, feeling they were understood, helped, and successful in solving their problems. Overall satisfaction with the consultation experience was 92.9%.
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