Supported self management: Step 1: Assess
The first step of SSM is to evaluate the patient's suitability for this intervention. It involves making a clinical judgment about the patient's readiness for self-management and determining the severity of symptomatology.
A primary care provider who wants to determine whether SSM is appropriate for a patient with depression, for example, could rely on clinical judgment, but might also find it helpful to administer brief scales such as the Patient Health Questionnaire (PHQ-9). The PHQ-9 categorizes depressive symptomatology as mild, moderate or severe. The severity determines the treatment choice:
- If the depression falls in the mild or low-moderate range, then SSM is appropriate as a stand-alone intervention.
- If the depression falls in the high-moderate to severe range, then SSM may be appropriate as an adjunctive intervention, along with treatments such as antidepressant medication or CBT.
Even when treatment involves CBT or medication, it can be helpful to engage the patient in active recovery by teaching self-management skills. Certain patients may be so depressed at a particular time that they are unable to focus on learning or applying these skills. However, it is important not to automatically accept a patient's pessimistic self-evaluation, but rather to encourage the patient to read a small section of the recommended workbook.
If a patient has achieved a significant degree of recovery through treatment, SSM may be useful in maintaining recovery and planning relapse prevention.