A comprehensive behavioral health system for identifying and treating nonadherence

Abstract

In this chapter we describe an innovative system designed to promote adherence, prevent nonadherence, and provide interventions for nonadherence based on level and type of risk. While there are many discrete interventions focused on adherence being implemented at institutions across the country, they tend to be highly focused in terms of method and target population. The model sketched out here provides a different approach, focused on improving the overall system in which treatment takes place, rather than placing the entire burden of treatment adherence on the patient (or patient and parent) alone. The system utilizes a web-based hub and incorporates universal screening for risk for nonadherence at disease diagnosis; triage to targeted interventions; and ongoing surveillance for newly emerging adherence problems or psychosocial concerns. In the model, interventions are based on level and type of assessed risk or need. At the Universal level (low risk patients), we provide examples of preventive educational materials and tools that can be given to patients and parents. At the Targeted (moderate risk) level, we delineate using outreach supports as efficient ways to mitigate risk by keeping at-risk patients and families connected to, and helping them navigate, the healthcare system. For children assessed to be at the Clinical (highest risk) level, we provide guidelines for referral for individualized intervention. We end the chapter with a summary of the key factors and guiding principles for developing an effective system-based approach to adherence.