S T I
Symptom Targeted Intervention
O u r C l i n i c a l P r o g r a m
Symptom Targeted Intervention (STI)
Our clinical program is called STI. It is a focused, active, individualized approach that teaches patients brief, effective ways to cope with difficult thoughts, feelings and behaviors using evidence-based interventions. STI’s nuanced, individualized engagement process employs techniques from solution-focused therapy using a Rogerian, patient-centered philosophy. This unique engagement process ensures that even challenging, at-risk patients are able to participate.
First developed in 2009 by Melissa McCool, LCSW, STI has been used in thousands of clinics to help patients who struggle with negative clinical outcomes such as missed and shortened treatments and problems with depression, anxiety and medication adherence.
STI has evolved and been creatively adapted for a number of clinical settings and medical disorders to assist vulnerable, disengaged patients.
Created for the Medical Setting
STI’s coping tools are cognitive-behavioral, dialectical behavioral, and mindfulness interventions that have been condensed and modified to make them user friendly and effective in brief sessions. After meeting with the clinician, the patient takes charge, performing interventions at home through assignments that extend and reinforce learning.
A defining aspect of STI is the focus on only one element of a problem. When Ms. McCool tried to use cognitive-behavioral therapy (CBT) with her patients in the clinic, she found that there wasn’t enough time for the 50-minute sessions that CBT requires—there were simply too many patients to see and too many interruptions in the busy medical setting. She began focusing on one symptom at a time out of necessity, but discovered that her patients started doing better once they successfully resolved that one symptom.
With a narrow focus on just one element of a problem, STI sessions are short and directed, which decreases feelings, for patient and clinician alike, of being overwhelmed by the myriad of psychosocial and psychological problems. By reducing this pressure, the patient and the clinician can focus and work productively on resolving the targeted issue.
STI'S Patient Engagement Styles
Benefits of a tailored content & approach
In the last five years, after working with health care providers to implement STI into thousands of clinics around the country, we discovered four distinct patient engagement styles.
As a result, we developed unique clinical processes to ensure that every patient can benefit from STI—from those who are pleasant and cooperative patients to those who are more guarded. In a recent internal study of nearly 1,000 patients, the engagement rate for patients with the poorest clinical outcomes, including missed treatments and treatment non-adherence, increased from 11% to more than 82%.
Once a patient engages in the STI process, the clinician can help them with a number of specific concerns, from sleep and stress to pain management, relationships and mood management. Yet, STI is always patient centered and patient driven, ensuring that the patient is invested in the process and outcome.
As the targeted issue or symptom improves, a domino effect helps other symptoms improve as well, possibly because, when the patient sees improvement in the targeted symptom, their internal narrative (i.e., thoughts about themselves and their situation) starts to change and they become more empowered and hopeful.
Since STI focuses heavily on psycho-education, the patient learns the connection between their thoughts, moods and behaviors. STI’s interventions teach the patient how to work with and relate to their moods, thoughts, and behaviors in a more effective and positive manner. They become less reactive and impulsive. In addition, they learn new coping skills that can be used in other areas of life.
STI also gives health care workers ways to uncover their clinical strengths and tools to continue to work with even the most resistant or challenging patients. With STI training, clinicians learn a nuanced approach to all patients, even those who resist help—since often those are the individuals who need help most. Interestingly, after learning STI, clinicians report they are more likely to approach rather than avoid difficult patient situation.