Making Problem Solving Treatment (PST) Accessible
Evidence-based clinical interventions are often delivered with poor fidelity and abandoned by practitioners soon after training. Additionally, our research showed that the quality of PST delivery suffered during the pandemic because of the prevalence of remote sessions.
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In response to these findings, we have worked with practitioners and clients to co-design an automated decision support tool supporting Problem Solving Treatment (PST) for depression.
PST-Aid is a web-based app that promotes practitioner–client collaboration in the use of PST for goal setting and action planning, which we conceptualize as an educate and reorganize implementation strategy.
Team Included
UX Designer, Clinical Psychologist, PCP, and the Co-Director of UW ALACRITY Center
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My Role
User Research & Design Lead​​
Problem Solving Treatment (PST)
A brief, evidence-based approach that teaches and empowers patients to solve the here-and-now problems contributing to their depression and helps increase their self-efficacy.
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Effective with the majority of patient populations.
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Typically involves six to ten sessions.
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The purpose is to teach the problem-solving technique to the patient so that they may use it on their own.
Not to provide open-ended, ongoing therapy. -
​Uses a worksheet each session that contains 7 steps.
7 STEPS OF PST:
6 Steps of PST
Client Education
Case Formulation
Goal Setting
Action Planning
Engagement
& Avoidance Reduction
Follow-up Practice
Evaluation Problem-Solving
Our research showed that the quality of PST delivery suffered during the pandemic because of the prevalence of remote sessions.
Therapists were forced to fill out the worksheets on behalf of the patients during sessions:
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Despite the understood priority of having the patient take the lead in filling out the forms.
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This undermined the goal of preparing patients to continue using this problem solving method independently after they completed treatment.
Our online tool allows the worksheets to be filled out by multiple users in real time, regardless of their location.
DISCOVER PHASE
Understanding User Needs
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We observed 9 clinicians new to PST undergoing training-as-usual
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We interviewed 9 experienced PST clinicians, and 2 PST trainers to understand where both clinicians and clients could use support.
Affinity Diagram
We used Affinity diagramming to identify themes and support needs for PST.
Timeline of Support Opportunities
We were able to examine PST from various angles, looking for opportunities; mapping out what goes on when and where.
Design Phase
We analyzed our insights and began capturing design requirements and brainstorming possible solutions for our tool.
Remote Co-Design Sessions
We set up two co-design sessions each with three experienced therapists we had previously interviewed about using PST. We facilitated a series of activities over a 90 min session.
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This storyboard was shared to help explain the concept of a digital tool to support the successful delivery of PST.
Co-Design Sessions
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Because these were REMOTE co-design sessions, to make them more engaging we mailed the participants signs to hold up as we ran through a list of potential features.
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Besides being more fun, by having them vote at the same time we were able to reduce the likelihood of the participants influencing each other’s answers.
​(Alex Lopez, our UX Designer (top left), and I (center) in Co-design sessions)
Build Phase
We built high fidelity working prototypes of both the desktop and mobile versions using Figma so that we could put it in front of both patients and therapists for their feedback and to refine the details
User Testing
We randomized 5 clinicians to PST Aid and 3 to PST training-as-usual, then evaluated and observed their therapy sessions.
We assessed:
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PST usability and appropriateness for clinicians and their patients.
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Adoption of PST by clinicians.
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Depression severity after 9 weeks of treatment.
(PHQ-9 and GAD-7 assessments)
Study Results
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Usability
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PST was found to be acceptable to both clinicians and patients, with adequate usability (no significant differences between groups).
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Treatment Fidelity
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4/5 clinicians in the PST Aid group certified in 2 sessions (fastest possible);
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only 1/3 PST-as-usual clinician was able to certify.
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9/10 post-certification PST Aid sessions met adequate fidelity standards.
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Patient Outcomes
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75% of PST-Aid clients (n=6) scored <10 on the PHQ-9 at 9-week follow-up compared with 0% of PST-as-usual clients (n=4) (p = .061).
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Patients in the PST-Aid condition reported reduction in PHQ-9 scores from baseline (mean = 15.78) to 9 weeks (mean = 10.33).
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Patients in PST-as-usual also reported reductions from baseline (mean = 17.25) to 9 weeks (mean = 13.75).
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Or, perhaps just this:
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PST Aid was found to be acceptable, with adequate usability.
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More practitioners in the PST-Aid group adopted PST after their certification, than those without the tool,
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And patients from both groups showed reductions in their depression scores.
Positive Feedback
“I like that everything is there that you would want or need. I wish I had that!”
- Patient
“I really liked it. It had helpful reminders of what to do next, helpful prompts to be more thorough in each step… A lot easier to use than having to organize paper copies.”
- Therapist
“I think this is especially great for beginning therapist and patients being able to do it on their own. ”
- PST Trainer
Next Steps
To further redesign PST Aid by working with stakeholder groups from our partnering OCHIN health informatics network, we will:
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Train 60 practitioners from 20–30 OCHIN clinics in PST, and then randomly assign them training in PSTAid vs PST as Usual.
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Recruit up to 350 clients with elevated depressive symptoms (PHQ-9>10)
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Conduct a hybrid type III effectiveness-implementation randomized clinical trial