false
Catalog
Implementation of Digital Mental Health for SMI: O ...
Lecture Presentation
Lecture Presentation
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
Hello and welcome. I'm John Torres, the Director of Digital Psychiatry at Beth Israel Deaconess Medical Center and a member of the SMI Advisor Clinical Expert Team. I'm pleased that you're joining us for today's SMI Advisor webinar, Implementation of Digital Mental Health for SMI Opportunities and Barriers. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Now, I'm very excited to introduce you to the faculty for today's webinar, Dr. Stephen Schuller. Dr. Stephen Schuller is an Associate Professor of Psychological Sciences and Informatics at the University of California, Irvine and Adjunct Assistant Professor of Preventative Medicine at Northwestern University in the Chicago area. Dr. Schuller is a clinical psychologist and mental health service researcher whose research focuses on using technology to expand the accessibility and availability of mental health services. This includes the development, evaluation, and implementation of both web and mobile-based interventions for common mental health issues like depression, anxiety, and many more. He also serves as Executive Director of the One Mind Cyberguide Project, a project aimed to empower consumers to make informed choices about digital mental health products. Dr. Schuller is a Fellow of the NIMH NIDA, VA-funded Implementation Research Institute, IRI, at Washington University in St. Louis. He's received a Rising Star Award from the American Association for Psychological Science and the International Society for Research on Internet Interventions and truly is one of the world's experts in digital mental health. Stephen, thank you so much for leading today's webinar on this very important topic of implementing this work. Thank you, Dr. Toros, for the great introduction and it's a pleasure to be introduced by another internationally recognized leader in digital mental health. I really appreciate your moderating this webinar and really look forward to sharing this information with the SMI advisor community. Just as a couple disclosures to start, I receive research funding from the National Institute of Mental Health, from One Mind, and from Pivotal Ventures, and I serve as the Executive Director of One Mind Cyberguide with research funding from One Mind. I'm also part of an evaluation team that's contracted through the California Mental Health Service Authority, or CalMESA, to conduct a formative evaluation of California's Health at Hand project. I want to talk about the learning objectives for today's webinar, but I also want to sort of note in thinking about these learning objectives, I can't talk about digital mental health without talking about the current challenges and situations that's facing all clinicians and consumers, individuals experiencing mental health issues that are going on with results in relation to COVID-19. I was first asked to give this webinar about six months ago, and of course, at that time, digital mental health was a topic that was of strong interest, but no one could have predicted what would have been coming in the coming months in terms of the increased necessity to deliver psychological services and psychological interventions to individuals with SMI remotely, and to be able to meet people truly where they're at through technology. And so, I think that this is not a transition that was made, you know, this was not a transition that was made voluntarily. This was a transition that was made very quickly, but I think a lot of the challenges that we've noticed through the past years of doing research here in terms of the implementation of these tools are going to remain. And so, I think, although we're all trying to figure this out right now, understanding really the barriers and facilitators to implementation of digital mental health intervention to improve the lives of individuals with SMI is a very important and timely topic. So, in today's webinar, I'm going to help identify some of the common barriers and facilitators to the uptake of digital mental health interventions that we see, to explain some of the different factors to consider and to assess when considering the adoption of digital mental health interventions, and to describe some of the various ways in which digital mental health interventions can be integrated into traditional pathways of care, including thinking about considerations of clinical settings, peer support, as well as self-management. So, I wanted to start with a little bit of a primer into what is implementation science, and what do we think about when we think about the study of the implementation of evidence-based practices broadly, and also specifically, evidence-based practices through technology or evidence-based digital mental health interventions. So, this slide is borrowed from a recent paper that came out from Jeff Curran, which I think is a really great primer into understanding what implementation research is about, and what do we mean when we talk about the implementation of different evidence-based practices. So, typical research often looks at the clinical effectiveness or understanding, does the thing work? Does the intervention, does the evidence-based practice have the outcome that we want that intervention to achieve? Implementation research, on the other hand, tries to understand how can we help people or places do the thing? So, when we have an evidence-based practice, when we have a digital mental health intervention, what do we need to do to make sure that people can actually use this, that settings can integrate that tool into the places that that tool is wanting to be used? And so, in this case, the thing, the intervention or practice is a digital mental health intervention, or the practice of using digital mental health in traditional clinical pathways. Related to this, we often talk about implementation strategies, which are not the intervention itself, but the stuff that we do to try to get people in places to do the thing. So, the strategies and the things that we do to try to help people integrate digital mental health interventions into their work. In light of this, when we think about implementation strategies, we often then look at implementation outcomes, which relates to how much and how well are people or places doing the thing. Even the best digital mental health intervention that has good efficacy, good effectiveness data, is going to be useless if people actually don't use it. And by people, I mean both consumers or individuals with SMI, as well as clinicians. So, we really need to think about what are the barriers and what are the facilitators in order to make sure we can help people or settings incorporate these digital mental health interventions into their lives, into their clinical workflow. So, one of the ways that we often organize some of these outcomes or some of these considerations in the field of implementation science is using models. And one of the most popular models is what's known as the Consolidated Framework for Implementation Research, or the CFER. The CFER model breaks down different aspects of the implementation into five domains. There's characteristics of the intervention. There's the inner setting, which is the specific clinical setting in which that intervention or the thing is trying to be implemented in. There's the outer setting, which is the sort of environment, the culture, the policy, the regulation in which all of these different inner settings are existing in. There's characteristics of the individuals involved. And so, those include both the clinicians, as well as consumers who are being expected to either try to use these interventions or these evidence-based practices in their workflow, or to adopt those evidence-based practices, or to use a digital mental health intervention in their life. And then there's aspects of the implementation process, things like planning, and engaging, and executing, and reflecting, and evaluating. And I think it's really important to think about these different domains because it helps us understand the different places that we need to assess, to plan for, and to look at different barriers and facilitators as we try to implement digital mental health intervention to benefit individuals with SMI. And so, throughout the webinar today, I'm going to talk about some different aspects of digital mental health interventions and some different barriers and facilitators that lie within each of these domains. I'd like to note that the conversation that I'm going to be having in this webinar is not exhaustive. There are definitely going to be barriers and facilitators that I'm not going to have an opportunity to talk about during my presentation. And so, that's not to say that if you know everything in terms of the barriers and facilitators that I mentioned, that you're going to be able to successfully design an implementation or successfully understand the implementation of a digital mental health intervention. But I think this is a really useful starting off point, and we'll touch on some of the key topics that sort of overlie considerations when considering the adoption of such tools. And definitely, if you have further questions, I think this is a great place to drill down to in the Q&A. We can talk more about specific questions related to barriers or facilitators that might come up in these various domains. This is another way just to visualize the CFER. I'm a very visual person, and so I always like to see sort of demonstrations or illustrations of what this actually looks like. And so, I think a few things I want to sort of note here. One thing that's worth pointing out is that these different domains of implementation are not clean boxes with clean boundaries. You can see on the top of the slide here that the outer setting, the way it's depicted, sort of comes just in and out of the inner setting. And so, I think for different organizations, there might be more than one inner setting or outer setting. So, you might work in a clinic that is part of a broader health system, and that health system might live in a broader treatment context. And so, there are maybe multiple layers of inner and outer settings. There are also places where outer setting variables are more dependent or related to inner setting variables. If you look at the sides of this figure, you'll see that the intervention has both the core components as well as what's known as the adaptable periphery. And I think that this is an important reminder that there is no implementation without adaptation, that when we take an intervention, even a digital mental health intervention, and move it into different settings, there's going to have to be some sort of adaptations or adjustments that's made to that intervention to be able to make it fit into work in that setting. With digital mental health interventions, those adaptations might be adaptations to the intervention itself. And so, there might need to be some programming changes, some content changes, some small adjustments to the product that is being deployed or being implemented. But it also might refer to service changes or human services that kind of wrap around that intervention and adaptations that are able to make it work. I think that it's really useful to kind of think about this with regards to other technologies is that we do these adaptations or these workarounds all the time. If your computer monitor is anything like mine, you have multiple Post-its posted around it with reminders, different numbers or different ways, login information that you might need to log into different things. And this is an example of a way that we work around or we adapt a technology to meet the needs of our workflow. And so, I think there's a lot of perceptions that because digital mental health interventions are technologies that they can be plug-and-play solutions, that we can purchase a digital mental health intervention and deploy it to the individuals that we work with or deploy it in the setting. And I think I'd really like to sort of note that there's adaptation that needs to happen at sort of all levels, even with digital mental health interventions, that the perception of these things being off-the-shelf products is usually a misconception and a misconstrual of how these things are actually going to work. And then lastly, I want to sort of note on this figure the implementation process. And you see these sort of series of different circular arrows. And I'd just like to note here that the implementation process is something that is ongoing, it's dynamic, it's changing, and should hopefully be adaptive in responding to aspects that occur earlier in the implementation to understand how we actually move to maintenance and sustainment of the rollout of these tools and settings over time. So, when we think about a digital mental health intervention, there's a lot of different aspects that go into understanding what those implementation strategies might be. You have to think about aspects of planning or training. How are you going to teach people to use these tools? I was not trained as a clinical psychologist all that long ago, and I was given zero training about how to use a digital intervention in my clinical practice. And I think that the state of affairs is that although there's useful webinars like this one, as well as other trainings and workshops that focus on the delivery or the use of digital technologies in clinical practice, there still is not a core competency or a core aspect of training in a lot of people's training as a mental health service provider. And so, I think that that's an important thing to realize is that there's a lot of training that goes into not just the specific use of the technology, but also the general use of technology and the evidence-based use of technologies in mental health service delivery. There's questions of financing. Who's going to pay for these things? We think about adaptation. So, at the bottom of the slide here, you see different types of adaptations that might occur, tailoring or adding, removing or shortening, lengthening, substituting, reordering, integrating, and departing. And so, I think I really share this slide as an overview of all the different things that do need to be thought about as we think about the implementation strategy. How are we getting people to do the thing? The implementation outcome, how do we know if our attempts to get people to do the thing is working, as well as making sure that we're tracking and evaluating these adaptations? What changes had to be made, both to the technology, as well as our workflows over time, to be able to make these tools more useful for the people that we serve and for the clinical practices and the clinical settings that we're working? So, I want to talk now about some of the common barriers and facilitators for individuals, specifically with SMI. And again, these are organized in the CIFR domain. So, what you see in this table here is, on the left side of the table, the five different CIFR domains. So, if you remember, those are characteristics of the intervention, characteristics of the individuals involved, aspects of the inner setting, aspects of the outer setting, and aspects of the process. And the other columns on this table are common barriers and facilitators that have been noted across studies and evaluations of implementation of digital mental health interventions for individuals with SMI. So, what I'm going to do right now is give a broad overview of some of these barriers and facilitators. And then for each domain, I'm going to walk through and give a more specific and concrete example, such that you guys will see some illustrations of how these barriers and facilitators might play out, as well as get some real-world understanding of some examples of the different digital mental health interventions that have been attempted to be implemented to improve the lives of individuals living with SMI. So, when we look at the intervention, there are multiple barriers that might occur. There's aspects of privacy and security. And I think that some of the greatest work that's been done in this area, in terms of illustrating some of the challenges here, has actually been done by our moderator, John Toros, who's done a great job of sort of categorizing and characterizing some of the privacy and security concerns that are pervasive in the space of digital mental health interventions. There's aspects of interoperability. So, how does the technology actually communicate with other technologies that are being used in the system? There's a lot of short-term costs that go into adopting digital mental health interventions sometimes. There's also complexity. In terms of facilitators, there's lots of reasons why people like these interventions. They're broadly accessible. They can be accessed 24-7, sometimes without the need for human support. They can improve communication between a clinician and an individual with SMI. Some people really like these tools. I think that it makes people think that the evidence-based practices that we're delivering are more legitimate sometimes when there's an app or a technology behind that. It's like, oh, cool, there's an app that does this thing. That must mean this is a real thing, which is a little disconcerting to me as a clinical psychologist. We've always been doing real things, but definitely the app provides some sort of social proofing. When we look at characteristics of the individuals involved, it's really important to understand the demographics and aspects of digital health literacy so that not all tools are going to be usable by all people, and definitely aspects of a person's cultural background, socioeconomic background, their access to different technologies, and their use of those different technologies play the role in people's ability to implement or adopt these tools. Facilitators, experience with technologies, knowledge and beliefs, self-efficacy towards using technology are all very useful facilitators to increase the implementation of these tools. When we look at the inner setting, there's different aspects of the infrastructure, resources. Turnover is always a problem. Once we train people to use these tools, are they there and are they staying long enough to actually be able to put these into practice? I think one important facilitator that I'll talk about a little bit later in the webinar is the importance of having a clear clinical champion. In the outer setting, aspects of regulation, which again, I'll touch on in more detail later, that there is very little regulation out there. Then facilitators are often policies or procedures that are existing to put these things into place. Then in process, I think we have to think about the ways in which workflow or non-use can be a barrier and how we might be able to overcome those with education, training, and engagement. Talking about intervention complexity, to give you a real world example or a demonstration of this, I'm going to talk about an app that's named PE Coach or Prolonged Exposure Coach. This is a really great app. It was developed by the National Center for PTSD to be able to facilitate treatment or enhance the treatment of prolonged exposure. PE Coach is a free mobile application. It's meant to be used as a companion app or in conjunction with traditional treatment for post-traumatic stress disorder. Prolonged Exposure is an evidence-based treatment for post-traumatic stress disorder. It really is a nice app. It has homework reminders. It has different didactic or psychoeducational content in the app. It can help people record their therapy sessions. It can set reminders for these different things. It's a really great tool that helps facilitate and help a clinician who's doing prolonged exposure therapy organize and coordinate all the different things that they would be doing to help promote the treatment of prolonged exposure therapy. I think one thing that's been really interesting in looking at some of the studies is that, although it looks like there's been some successes in the implementation of PE Coach, clinicians like it, consumers like it, it really can support the use and the delivery of prolonged exposure. It's a very feature-rich app. There's a lot of different content in here. One thing that was found in some initial studies of PE Coach is that the main feature that the therapists and the consumers were using was the ability to record their sessions. Again, this is an app that was developed by the VA. In the VA, there's a lot of regulation or challenges around recording sessions. When you give them this app that is safe and secure, it doesn't transmit data anywhere, it was like, great, we can record sessions on this app and we can use this for this purposes. There's all these other features or all these other aspects of the technology that are not being used. I think that one thing that this really points out is that these apps are often very feature-rich and people are going to pick the features that they like the most or most useful for them, especially when individuals have differences in their knowledge or use of technology generally as well as the technologies specifically. There's a disparity of technology skills needed to use interventions often between providers and consumers and we can't assume that everyone is equally facile or equally able to use these technologies and I think it's worth noting that all digital interventions make some assumptions about the level of knowledge that a person has. Interventions, digital interventions, they're not able to be as adaptive or responsive as a clinician or a provider. They don't do assessments of a person's level of literacy and then adapt that intervention accordingly. Individuals with SMI have various levels of technological literacy, level of knowledge, and we have to make sure that we adapt our delivery of these interventions to be able to match what a consumer or what a client is able to do. I think this is just one good illustration that feature-rich apps can be really nice in terms of having a lot of stuff that looks good for a clinician or looks good for us as experts, but it's really important to understand what a person's level of understanding of that app might be and what are the features and what are the components that they want to use. Now, I want to talk about an aspect or some aspects thinking about barriers and facilitators related to the individuals involved and I want to talk about digital health literacy. Again, I think that we're really lucky here to have such a fantastically skilled and knowledgeable moderator who's done a lot of good work here. I want to call out specifically the DOORS manual that was developed as part of Dr. Toros' digital psychiatry program at Beth Israel Deaconess as a good example of great work around the area of understanding and building digital health literacy to address this aspect of the characteristics of the individuals involved. I think a lot of the, to me, the way I sort of see the rationale behind this DOORS manual is that individuals with SMI, many of them may own a smartphone, but many of them may not know how to use those smartphones to support their own health and so there's varying levels of technology literacy as well as digital health literacy as well as aspects of trying to understand how people can access health through technology. I'll say I have a better appreciation of this recently with regards to all of the, everything going on with the response to COVID-19. I've done a little bit of sheltering in place with my parents out in Riverside, California, which is not far from where I typically live and in my parents' house they have no Wi-Fi internet connection. They get zero cell service. They have a computer that is hardwired to broadband internet, so that's even a huge accomplishment or a huge capacity, but that computer has no microphone or no webcam and so I spent a week on all of my conference calls watching video but calling in on a landline phone to stay connected and so I really do appreciate that even in places where it seems like technology access should be widely available, it's not, and there's lots of places where technology access is not as prevalent as we would want it to be in the current day and age. I think it's also useful to sort of know that individuals from different cultural backgrounds might have more propensity to use different tools and so one thing that I've seen in my own work and then some work with some colleagues around working with individuals, Latinx individuals, is a huge interest and a huge use of WhatsApp to connect to family members and using WhatsApp and connecting to family members is ways to support their health, social support, and well-being and so I think one thing that's really worth understanding is to do thorough assessments of individuals' tech literacy and digital health literacy and then pursuing training programs like the DOORS program that's meant to sort of promote that. Another really important aspect as I move to a different domain, and this is something I referred to earlier, is really understanding who are the clinical champions who are supporting this intervention. A key aspect that we've learned is that these champions are often people who have some similarities between what they're doing in their role and I think one thing that is not on this slide, and it's not on this slide because this is not the case, is we don't see that those champions have to be a person of a certain title or training background or degree level, so it's not necessarily that these are clinical psychologists or psychiatrists. In some places, we've seen the champions be nurses, be other administrative staff, but what we see consistently as an important aspect is that there is most successful implementation where these champions exist. Champions are people who have high availability, that they are accessible to providers or individuals with SMI, that they're able to answer questions, to troubleshoot problems as they come up, to figure out what's going on, to be able to address those things. They are often focused on consumer satisfaction and so really the main question that drives successful champions is how to improve the experience of people with SMI. How do we make sure that the person at the end of the day who this tool is meant to benefit is getting the experience and the benefit that we're expecting and that they start to create protocols and procedures or processes such that these aspects can be standardized, can be formalized, and spread and scaled throughout an organization or throughout a treatment setting. I think one thing that we see successful clinical champions do who are responsible for the implementation of these tools is setting up processes and procedures for other providers to follow. I want to move on and talk about the outer setting and the thing I want to talk about here is regulation. I think that this is something that's really important to think about because what I get asked a lot about these digital mental health interventions is how do we know these interventions are working? How do we know these interventions are good? How do we know these interventions are efficacious? I think a lot of people think that the FDA or FDA approval is going to be the pathway to ensure that that's the case. I say this a little bit as an aspect of suggesting that that could be a pathway but I don't think it's efficient. As of now, we have what I say are two and a half FDA approved digital mental health products. I say two and a half because we have RESET, which is a digital mental health intervention that's focused on substance use treatment. We have RESET-O, which is an offshoot of RESET, which is focused on opioid treatment specifically. That's my one and a half. These are very similar interventions. One is focused more specifically on opioids. Then we just recently had THOMREST, which is a digital therapeutic that's focused on the treatment of insomnia. All of these products are released by Pear Therapeutics. There is a single company that has gone the FDA approval route successfully and released these products. The 2.5 is far fewer than the vast number of digital mental health interventions that are out there. I think there is a big discrepancy between the number of FDA approved products and number of available products. Just recently, and this is another reason to note why FDA approval alone is not going to solve this problem of regulation to support the implementation of digital mental health intervention. Just a couple of weeks ago, the FDA released guidance that actually reduced the regulation of digital devices for psychiatric disorders during COVID-19. That FDA guidance came out and said that in light of the need for more services due to COVID-19, that they were no longer going to regulate digital devices for psychiatric disorders that fell under some specific categories, including devices that use principles of cognitive behavioral therapy. We've already actually seen a couple of products come to market in the past couple of weeks to be available to consumers based on this guidance and this reduced regulation from the FDA with regards to digital devices for psychiatric disorders. I think that it's just really important to note that regulation in this space is evolving. It's ongoing and it's a constantly shifting, especially in light of COVID-19 area that will continue to evolve over time. Even if products are FDA approved, payment is another important aspect of the outer setting and few payment pathways exist for digital mental health treatment. There was a paper that was actually released by Adam Powell last year that was showing that there are very few billing codes that are related to digital mental health treatments or could be used for digital mental health treatments. A lot of our billing codes are based off of the provision of services by a service provider. Interventions that look to reduce the time that a provider is providing service or create efficiencies like these digital mental health interventions often do, have a hard time thinking about where they fit in the payment pathways. I think it's useful to note as we think about implementation barriers, that regulation by itself does not guarantee payment and that ultimately someone's going to have to pay for these technologies to be able to put them into practice. When we talk about processes, one of the processes that I've found is most critical is understanding aspects of training. I don't have time during today's webinar to go into every aspect of training that's important to understand in terms of using a digital mental health tool in a clinical practice or clinical workflow. I would like to call out and note that there's been great work in this area done by the U.S. Department of Defense and their Connected Health Group led by Dr. Christy Armstrong. These are five steps that draw from their mobile health practice guidelines which talk about key steps for mobile health clinical integration including understanding the workflow, how that app fits in their workflow, how you introduce an app to a client and an individual with SMI in the clinical care pathway, how to prescribe an app to a patient to support a treatment plan. Really, I think I want to emphasize that these tools should be consistent with the treatment plan and the treatment modality that a provider is considering for a particular patient or individual with SMI. How you review the data and how you talk about the data collected on that app with the patient. Lastly, documentation. It's really key to ensure that all of the efforts you do in digital mental health is documented in the traditional clinical record. I think there are some individuals who seem to assume that because it's a technology, the technology is tracking things and that it's going to be sufficient for documentation. I think I'd really like to note that that's not the case in that considering documentation and ensuring documentation is an important part of the role of a provider. So, when we think then about factors to assess when considering adoption, what are some of the different aspects that you want to think about when considering implementing or considering using a digital mental health tool? These questions draw from the American Psychiatric Association framework and the group there that's chaired by John Toros that's really focused on understanding the potential use of digital health tools in clinical psychodiastric practice. They have this triangle model here, this pyramid model that looks at five levels. It starts with background information and goes all the way up to data integration. I'm going to paraphrase and summarize some of these questions, but I think that some of the key things that we see that individuals are often considering when looking at the adoption of these tools is understanding first, is it useful? What does this app say it can do and how will you know if it works? What value does this tool provide to the life of an individual with SMI as well as the role of a provider trying to provide treatment in this area? Is the app easy to use? Is it customizable? Would you use it long-term? Most of these apps that we see have very high attrition rates, which means that most people download it and never open it up. Of those who open it up, many people only open it up once. Even a very cursory review through these applications can often show you some features that might relate to long-term use. Can you share information? If so, how is that information shared? Can it be printed, exported, or shared directly to others? If so, is it done in a way that conforms with HIPAA regulations or other regulations? This might be an especially useful consideration for providers if they want to review the data entered with clients. Is the app safe? This is a really tricky thing to figure out. Our recommendation through the work that I've done is really to only download apps from a trusted source, but I think it's important to note that trusted sources may vary between people or cultures. In my own research, we found that many individuals are likely to be willing to download an app if recommended by their provider, but that actually more people are willing to download an app if it's been recommended by people on their social media or friends or family members. I think that it's worth considering the information that we provide to people along with the adoption of an application to make sure we walk them through important considerations of security, privacy, effectiveness, usefulness, and user experience. As I noted earlier, there was some work that John Toros did recently that looked at what apps were actually doing in terms of sharing data with other folks. They found that a lot of these apps were actually sending data to third parties, even if that wasn't included in their data security and privacy policy. Also in my own work, we do evaluations of security and privacy policies in the scope of the work I do at One Mind Cyberguide. We did a review of about 120 different digital mental health apps that were focused on depression. We found that of those apps, about half of them or 50% did not even have a data security and privacy policy, so they tell you nothing about what they do with their data. Of the ones that did have a policy, about half of those were deemed as unacceptable based on our review. There were many reasons on why those different policies were deemed as unacceptable. One of the most egregious, it seemed like to me, was that there was a lot of apps that would only provide you their privacy policy after you had already entered information about yourself, had provided your email, maybe some demographics. After you give this app company all of that data, they then tell you what they're able to do or what they will do with those data. I think one really simple check that we can do as providers or that an individual can do as a consumer is to first check if there is a privacy policy. I think as I mentioned in these depression apps, that would rule out about half of the products that we reviewed. That's at least one step you can see to be able to at least look at the information that's provided. I think another thing that as a provider you can do is if you're using these tools with your patients or with individuals with SMI, to encourage those patients to protect their phones, apps, and stored data with a password. To put a password on your phone as well as to look at apps that if they do have passwords or logins to encourage strong passwords. It's just best practices to make sure that if someone does ever get your phone, that that data would not be able to be accessed from the phone. I want to just start to close up here and just talk a little bit about where these tools might fit into traditional care pathways. This figure draws from some work that I did with some colleagues, Eric Hermes, Aaron Lyon, and Joe Glass that we had published on last year. They really noted that digital technologies fit into a continuum of different provisions. Some including self-help tools, which means that the technology is providing all of the intervention itself and there's no human involved. All the way back to a tool that is used in conjunction with traditional care. A tool like I mentioned, Prolonged Exposure Coach, or PE Coach, that's really meant to facilitate or enhance the treatment of prolonged exposure from a provider. A simplification of this figure, and the way that I usually think about these is three main buckets. We see these standalone apps, which are fully automated, self-guided apps. I'll say that the research literature generally shows that these things can be somewhat effective. We usually see small to moderate effect sizes or benefits that come from the use of fully automated and self-guided apps. One of the key reasons why these apps are not as effective is because people have a harder time keeping up sustained use. I think that engagement and maintenance of these tools is a challenge to standalone apps. We then see this next category, which is guided apps. This is an app provided along with a professional coach, a therapist, et cetera. Sometimes this supporter is someone who's meant to provide what I call engagement support, which is to keep people engaged or using the tool, whereas other times they're a trained therapist who's meant to provide some interventional support, so to clarify the concept and provide additional intervention. Lastly, we see adjunctive apps, so apps that are used in the context of traditional face-to-face therapy or in light of COVID-19, Zoom-to-Zoom therapy or video therapy, but an app that's really meant to enhance or extend the efficacy of a traditional treatment by making it more efficacious, more efficient, or more integrated into a patient's daily life. So, I want to wrap up and conclude just here with just a couple of concluding thoughts. I'd just like to note that a lot of the considerations for implementation are not technological. We need to consider the human and service components that intersect with technology. You might note that as I talked about the different barriers and facilitators to implementation, very few of these barriers and facilitators are related to the technology itself. That's not to say that they're not existent, and definitely some of the barriers we hear around access is consistent access to a phone, a phone that's capable of running these devices, that has enough memory and storage to download these apps, that has consistent access to Wi-Fi or an internet connection, but many more of these implementation barriers or potential facilitators are things that are related to human components. So, actually, in my own work and in my work with some of my colleagues, we've started to refer to these digital mental health resources thinking about these more as technology-enabled services as opposed to products itself. I think this is a major important reconceptualization so that people understand the key critical aspect of the human service components in these digital tools. We need to consider multiple aspects of technologies to understand how people might perceive and use these tools. I think, again, the APA model is a great model to illustrate that considerations can happen on multiple levels. There's aspects related to the evidence supporting the tool, the user experience of the tool, the data security and privacy of this tool. In any of our considerations of adoption and in efforts to implement these tools, if we don't look at multiple levels, we're going to miss important things to understand what might come up in the implementation. Then, lastly, I'd like to note there is lots of evidence that shows that these tools can be effective. We've done research over the past 20 years to show that digital mental health interventions can work. Individuals with SMI can use these tools effectively for recovery, but we need strategies to help people in settings use them effectively. I think this is an important thing to remember, especially in that framing I gave at the beginning of today's presentation around thinking about what implementation research is, is that we know that these things can work. Now we need to think about how do we help people and help settings use them and use them effectively to get the most benefit out of them. With that, I'd just like to say thank you, everyone, for your attention. I really enjoyed sharing this information with you, and I think we have a good amount of time left for some questions and discussion based on this.
Video Summary
The video is a webinar titled "Implementation of Digital Mental Health for SMI: Opportunities and Barriers" featuring Dr. Stephen Schueller. The webinar is part of the SMI Advisor series, an initiative aimed at implementing evidence-based care for those with serious mental illness. Dr. Schueller is an associate professor at the University of California, Irvine, and a leading expert in digital mental health. <br /><br />Dr. Schueller begins by discussing the current challenges faced by clinicians and individuals with mental health issues due to COVID-19, which has increased the need for remote therapy and accessibility to mental health services. He highlights the importance of understanding the barriers and facilitators to implementing digital mental health interventions and integrating them into traditional care pathways.<br /><br />The webinar covers various aspects related to implementation, including the characteristics of the intervention itself, the digital health literacy of individuals involved, the infrastructure and resources of the healthcare setting, external factors such as regulation and payment, and the implementation process itself. Dr. Schueller emphasizes the need for adaptability and customization of digital mental health interventions to ensure they fit the needs and preferences of both clinicians and patients.<br /><br />He also discusses the importance of clinical champions to drive the adoption and successful implementation of digital mental health interventions. Clinical champions are individuals who support the use of these tools and provide guidance and support to other providers. The role of regulation and the lack of payment pathways for digital mental health treatment is also highlighted.<br /><br />Dr. Schueller concludes by discussing the different types of digital mental health interventions, including standalone apps, guided apps with professional support, and adjunctive apps used alongside traditional therapy. He emphasizes the need for a holistic approach that considers both the technological and human components of digital mental health interventions.<br /><br />Overall, the webinar provides a comprehensive overview of the challenges and opportunities in implementing digital mental health interventions for individuals with serious mental illness.
Keywords
Implementation
Digital Mental Health
SMI
Opportunities
Barriers
Remote Therapy
Accessibility
Evidence-based Care
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
×
Please select your language
1
English