The digital clinic: Implementing technology and augmenting care for mental health.
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ABSTRACT:
SUBMITTER: Rodriguez-Villa E
PROVIDER: S-EPMC7324929 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
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The digital clinic: Implementing technology and augmenting care for mental health.
Rodriguez-Villa Elena E Rauseo-Ricupero Natali N Camacho Erica E Wisniewski Hannah H Keshavan Matcheri M Torous John J
General hospital psychiatry 20200630
Increasing both access to and quality of mental healthcare is a global priority. One solution is to integrate technologies such as smartphone apps and sensors directly into care. Acknowledging many prior attempts and barriers, we introduce the Digital Clinic which is an already functioning clinic using smartphone apps to augment and extend care today at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts. In this piece, we outline the theoretical foundation of the Digital Clini ...[more]
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Project description:BackgroundThe World Economic Forum has recently highlighted substantial problems in mental health service provision and called for the rapid deployment of smarter, digitally-enhanced health services as a means to facilitate effective care coordination and address issues of demand. In mental health, the biggest enabler of digital solutions is the implementation of an effective model of care that is facilitated by integrated health information technologies (HITs); the latter ensuring the solution is easily accessible, scalable and sustainable. The University of Sydney's Brain and Mind Centre (BMC) has developed an innovative digital health solution - delivered through the Youth Mental Health and Technology Program - which incorporates two components: 1) a highly personalised and measurement-based (data-driven) model of youth mental health care; and 2) an industrial grade HIT registered on the Australian Register of Therapeutic Goods. This paper describes a research protocol to evaluate the impact of implementing the BMC's digital health solution into youth mental health services (i.e. headspace - a highly accessible, youth-friendly integrated service that responds to the mental health, physical health, alcohol or other substance use, and vocational concerns of young people aged 12 to 25 years) within urban and regional areas of Australia.MethodsThe digital health solution will be implemented into participating headspace centres using a naturalistic research design. Quantitative and qualitative data will be collected from headspace health professionals, service managers and administrators, as well as from lead agency and local Primary Health Network (PHN) staff, via service audits, Implementation Officer logs, online surveys, and semi-structured interviews, at baseline and then three-monthly intervals over the course of 12 months.DiscussionAt the time of publication, six headspace centres had been recruited to this study and had commenced implementation and impact evaluation. The first results are expected to be submitted for publication in 2021. This study will focus on the impact of implementing a digital health solution at both a service and staff level, and will evaluate digital readiness of service and staff adoption; quality, usability and acceptability of the solution by staff; staff self-reported clinical competency; overall impact on headspace centres as well as their lead agencies and local PHNs; and social return on investment.
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Project description:BACKGROUND:Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. OBJECTIVE:This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. METHODS:We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. RESULTS:Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. CONCLUSIONS:Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.
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| S-EPMC7118546 | biostudies-literature
Project description:IntroductionAs digital technologies become an integral part of mental health care delivery, concerns have risen regarding how this technology may detract from health professionals' ability to provide compassionate care. To maintain and improve the quality of care for people with mental illness, there is a need to understand how to effectively incorporate technologies into the delivery of compassionate mental health care. The objectives of this scoping review are to: (1) identify the digital technologies currently being used among patients and health professionals in the delivery of mental health care; (2) determine how these digital technologies are being used in the context of the delivery of compassionate care and (3) uncover the barriers to, and facilitators of, digital technology-driven delivery of compassionate mental health care.Methods and analysisSearches were conducted of five databases, consisting of relevant articles published in English between 1990 and 2019. Identified articles will be independently screened for eligibility by two reviewers, first at a title and abstract stage, and then at a full-text level. Data will be extracted and compiled from eligible articles into a data extraction chart. Information collected will include a basic overview of the publication including the article title, authors, year of publication, country of origin, research design and research question addressed. On completion of data synthesis, the authors will conduct a consultation phase with relevant experts in the field.Ethics and disseminationEthical approval is not required for this scoping review. With regards to the dissemination plan, principles identified from the relevant articles may be presented at conferences and an article will be published in an academic journal with study results. The authors also intend to engage interested mental health professionals, health professional educators and patients in a discussion about the study findings and implications for the future.
| S-EPMC6661656 | biostudies-literature
Project description:BackgroundThe World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice.ObjectiveThis study aimed to explore health care professionals' perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS).MethodsHealth care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made.ResultsEighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone.ConclusionsThis study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity.
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Project description:U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
| S-EPMC7709140 | biostudies-literature
Project description:BackgroundImplementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources.MethodsThirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants' accounts.ResultsSix major themes were identified. Three themes (Intervention characteristics; Carers' involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention's implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists' time constrains.ConclusionsThis study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe - a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research.
| S-EPMC8466399 | biostudies-literature
Project description:BackgroundIn the United States, millions of adolescents report poor mental health, where 1 in 5 teenagers considers suicide. Reducing stigma and fostering peer support remains critical for positive mental health interventions and programs. Increasingly, digital mental health tools have emerged with great promise, leveraging social networks. Despite the potential, limited understanding of such comprehensive programs and their implementation exist.ObjectiveThe objective of this study investigates a piloted digital mental health training program (Be Present) for youth, specifically describing the impact on youth behavioral outcomes and user engagement and identifying high-risk youth in the early phases of prevention.MethodsEligibility included Ohio residents (aged 14 to 22 years) to be enrolled as either a Friend or a Peer Advocate. From May 1 to June 1, 2019, participants completed the Advocate training course, taking pretest and posttest surveys. Single-arm descriptive analyses measured youth outcomes (self-efficacy, intentions, behaviors, social support, knowledge, and sources of strength) and engagement and assessed risk based on survey responses.ResultsA total of 65 adolescents participated, with 54 completing both pretest and posttest surveys. The majority of participants included non-Hispanic White females. Findings illustrated a significant increase in self-report of referrals for mental health services as well as in perceptions that youth had of experiencing social support; however, no significant differences were found for measures of self-efficacy, knowledge, and sources of strength between pretest and posttest surveys. Roughly two-thirds of the participants completed all of the Advocate training modules, and we observed a gradual decline in engagement. Most respondents who received escalated high-risk response messages identified as female.ConclusionsThe pilot presented promise for implementing a digital mental health program focused on peer support, specifically observing reported youth behavioral outcomes and user engagement and identifying high-risk youth. Various limitations exist given the small nonrepresentative sample and lack of control group. All findings should be considered preliminary to a larger trial and underscore the feasibility of delivering online training programs to bolster adolescent mental health. Such formative evaluation proved critical for future implementation and research, offering opportunity for substantial improvements for real-world digital mental health programs.
| S-EPMC8105753 | biostudies-literature