title: Stepped care for insomnia: an evaluation of implementation in routine practice.
abstract: OBJECTIVE
  Stepped care models for chronic insomnia are in their infancy. This study evaluated predictors of movement in a stepped care pathway using a sample of 50 adult outpatients with chronic insomnia.
  
  
  METHODS
  At assessment periods, participants completed daily sleep diaries, the Insomnia Severity Index, the Multi-Dimensional Fatigue Inventory (MFI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10). Following this, data were collected regarding whether the individual went on to receive more intensive services (i.e., individual consultation, group or individual therapy). Data were analyzed using multi-nomial logistic regression.
  
  
  RESULTS
  Results showed that age, employment status, and sleep (quality, latency) predicted use of more intensive services. Results showed that psychiatric and sleep comorbidity, sleep attitudes, and insomnia severity did not.
  
  
  CONCLUSIONS
  Implications of these findings are that stepped care resulted in a 69% improvement in efficiency, and that low-intensity treatment delivered in step 1 may have been particularly sufficient for the young and employed, and for those with better sleep.
authors.affiliation: Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada. Nvincent@exchange.hsc.mb.ca
authors.forename: Norah
authors.initials: N
authors.lastname: Vincent
authors.forename: Kate
authors.initials: K
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000379:methods*; D004651:Employment; D006801:Humans; D008297:Male; D008499:Medical Records; D010342:Patient Acceptance of Health Care; D011787:Quality of Health Care; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Stepped care; computerized treatment; insomnia