Telephone delivery of psychological interventions: Balancing protocol with patient-centred care.

Common mental health problems of anxiety and depression affect significant proportions of the global population. Within the UK, and increasingly across western countries, a key policy response has been the introduction of high volume, low intensity psychological assessment and treatment services, such as the NHS's Improving Access to Psychological Therapies (IAPT) service, the largest service delivery model yet to be implemented at a national level (England). IAPT may be delivered in face-to-face meetings or over the telephone, as well as through other media. In order to increase access and achieve wide reach with efficient use of resources, IAPT's service models utilise relatively structured and standardised protocols, whilst aiming simultaneously to deliver a tailored and personalised experience for patients. Previous research has revealed that this can be a challenging balance for front-line practitioners to strike. Here we report research into the telephone delivery of guided self-help, low intensity interventions within IAPT, examining the challenges faced in remote delivery when combining structure with personalisation during assessment and treatment sessions. We show the ways in which the lack of flexibility in adhering to a system-driven structure can displace, defer or disrupt the emergence of the patient's story, thereby compromising the personalisation and responsiveness of the service. Our study contributes new insights to our understanding of the association between personalisation, engagement and patient experience within high volume, low-intensity psychological treatment services. Our research on the telephone delivery of IAPT is particularly timely in view of the current global Covid-19 health crisis, as a result of which face-to-face delivery of IAPT has had to be (temporarily) suspended.

Comparison of growth of masking functions and speech discrimination abilities in younger and older adults.

This study examined the possibility that age-related differences in speech discrimination abilities may reflect individual differences in the amount of masking and in the rate of growth of on- and off-frequency masking. Young (mean age = 26 years) and older (mean age = 60 years) adult listeners were selected, all of whom had hearing thresholds equal to or better than 30 dB HL at audiometric frequencies < or = 2000 Hz and equal or better than 40 dB HL at audiometric frequencies from 3000 to 6000 Hz. Listeners were tested on a consonant identification task in which nonsense words were presented in quiet, high-pass-filtered, low-pass-filtered and in wide-band noise. Despite their good hearing thresholds, the older listeners made significantly more errors in all four test conditions. Masked thresholds and growth of masking functions were obtained for all listeners at signal frequencies of 750, 1000, and 1500 Hz, in the presence of a one-third-octave band of noise centred at 1000 Hz, with four noise levels from 50 to 80 dB SPL. The older listeners had higher masked thresholds overall, when compared to younger listeners, even though their audiometric thresholds at these frequencies were within normal limits. However, the slope of the growth of masking functions at and above the masker frequency did not differ with age. These results show that older listeners show reduced speech discrimination abilities both in difficult listening conditions and in quiet, even when their pure-tone thresholds are within normal limits. Moreover, these effects cannot be attributed to differences in masked thresholds or in the rate of growth of masking.