So, to start with some of the questions, Stephen, this one is a little, I don't know if it's possible to answer, but is there any easy way you've seen to get people's smartphones or technology now during this crisis or clients we want to kind of get connected that don't have devices? Yeah, I mean, that's a good question. I don't think there's an easy answer. I will say, I think device access is such an important piece. When I was in Chicago, actually, I did a lot of work on trying to think about the implementation of these tools for homeless youth, both sheltered and unsheltered homeless youth. And what we ended up having to do for that project is we had to buy phones and we had to pay for data plans and service plans. And it wasn't because the homeless youth, the youth we were working with, it wasn't because they didn't have phones, but often their phones were broken or old or, you know, they really, I think the service plans was sort of the more important piece. But I think that there's this assumption a lot of places that, you know, everyone has a smartphone and I've, you know, I've heard this a lot of talks I've been to, there's more smartphones on the planet than toothbrushes. And so, you know, we just need to get these, get the apps out there and everyone's going to be able to use them. And I think that's, that's not the case. I think that there are, you know, I talked a lot about apps, but I think there's a lot of other technology resources that are out there, crisis text line, you know, so like text message based, warm lines and hotlines put on by, you know, individual counties, cities or states. So I think also spreading, you know, those as effective technology resources is really useful. But I think, you know, some of this is also just we as, you know, individuals in the mental health field, I think, and also try to advocate the importance of technology access as a basic right. And I think that some of this might be, you know, lobbying and other things that we need to do as providers is trying to educate, you know, and get more, try to get more resources out there for people. But yeah, it's a very complicated question, but I think it's, it's a really important one because I've seen that come up in a lot of my work. So a different, a question is about half, this is where half our homeless population have phones. This is a barrier to universally dispel of the strategy and pop, sorry, I'm going to be about half of our homeless population have phones. This is the barrier to universal dispersal of the strategy in the populations that really need it. So I think that's actually just a comment kind of agreeing that people do have phones, but again, sometimes the phones aren't the correct ones. The different question is, you were mentioning earlier kind of portents of kind of buy-in or kind of getting, having a clinical champion, but how have you kind of seen of different organizations? How do you go about and create buy-ins of your clinician or peer support? You want to begin getting your organization kind of implementing these, what is the best approach to kind of begin to get buy-in from leadership for the, for using these digital tools? Yeah, I think that one of the things that we've seen to be a really important aspect of implementation of these is just experience that when people really use and know the products and can speak to them thoughtfully, I think that that's really important to be able to get buy-in from sort of all levels. And so where I've seen a lot of challenges with the implementation of such tools come up is when, you know, the people trying to sort of advocate for the tool, don't really know what the tool does and doesn't really know how it works. And I think that in some of those cases, I've seen people paint overly optimistic or Pollyanna ish views on whatever tool it is that they're, you know, trying to get implemented. So I think that, you know, if you know a tool well, you can, you know what it does. You also know what its limitations are. And so that way you can not oversell it because I think that there's a lot of challenges to rolling something out and then seeing the challenges and the problems come up as it's been deployed. And I think that that can poison the well and reduce sort of an initial enthusiasm. So just, you know, experience and realism, I think are two of the things that I found to be sort of really important to be able to get people buy-in and to be able to maintain that people maintain people's buy-in. That makes a lot of sense. This is a more technical question, but saying your points about integration with EHR are spot on. Is there any effort to develop standardized kind of APIs for the eHealth community so that kind of these apps can kind of talk to electronic medical records and vice versa? That's a great question. I'd actually, I'd be curious if you have thoughts on that, John, as well. If you've noticed that, I have not, I mean, I have seen some initiatives to make more consistent APIs in health and make sort of open, you know, open kits to be able to start to do this, but I haven't seen any standards really catch on. And so I think that that's, it's a really, in my view, needed aspect in this area. I know you and I had talked about this before and, you know, we see some areas where a lot of people are just rebuilding, you know, rebuilding similar tools. And I know you've done a really great job in terms of sharing at least your LAMP tool to other individuals who are interested, but I haven't, I personally have not seen strong efforts to try to create more open APIs to ease the aspects of clinical integration and EHR. No, I, I agree there's, the government has kind of put its weight behind something called FHIR, F-H-I-R, which is meant to be a standard, but no one's actually practically kind of using FHIR as this kind of standard on apps. So I agree, it's a necessary thing to kind of have data flowing between these different devices and systems, but it doesn't really seem to be happening right now. So, a related question is, on a peer support level, do you have any thoughts on using Zoom for one-on-one and face-to-face interactions? It's a good question. I have lots of thoughts on using Zoom. I will say, as someone who, as also an instructor, has been moved to Zoom for all of my, my sort of teaching purposes, I mean, I think, you know, there, there are lots of questions and concerns around Zoom, and I think that Zoom is, you know, the product of the, the moment, it seems like, with COVID-19. I do think that there are lots of nice features in Zoom, aspects like breakout rooms and passwords and waiting rooms, and so I think, again, you know, it's going to be a very similar comment, first comment that I said, you know, earlier on, which is, like, know the product, know the features, be able to speak to it and know what it can do and know what its limitations are. It is a challenge to interact with people entirely remotely, and I think that that actually was something that interestingly came up in, again, the work that I did with Homeless Youth when I was in Chicago. We did some, a lot of remote outreaches with them, and this was all, you know, a couple years ago, so this was before the necessity of the current time, and what we heard from the youth, like, over and over again was, like, we're fine to talk with people over the phone and to text and, you know, to be online, but I want to sit down with the person before that happens, and I do think that there is aspects of connection and relationship which are harder to build online, and so I think that, you know, that's something that we're going to continue to see and struggle with as remote interactions become more a part of the work that we do is it's one thing to take a relationship online, it's another thing to start a relationship online and to do the assessments and the information gathering that we typically do, so I don't know, that's probably not a great, satisfying answer to that question, but just some of my thoughts with regards to that is I think that there's a lot of potential there. I think there's also things that we need to think about, and I think forming relationships and doing adequate assessments are two places where I think that there's still some questions and work to be figured out. That makes sense, and I think we can maybe fit this question quickly. Are there graduate training programs that kind of offer e-health kind of usage or kind of information on e-health in their curriculum that you know of or recommend? Yeah, so I do know that Palo Alto University does do a lot of training on e-health tools in their program. They have a lot of faculty who have expertise in that area, Joe Ruzick, Ricardo Munoz, Jan Laken, Lynn Barrera, Eduardo Bunke, and they have two groups that are focused on that, the M2 Health as well as the I4 Health group, and the M2 Health group I know has done a variety of other trainings that are available for webinars and the like, so I think that they're one group where they're, I don't think they're, I think their uniqueness is they probably have more consolidated faculty who are focused on that area. I think other than that, I think a lot of the places to get good training in this area is to go to the people who are doing this work, so you know your digital psychiatry group I think is a great example of people with expertise and starting to bring people together. McLean has their Institute of Technology in Psychiatry, which means that there are folks interested in that area, but I do think the advice I usually give to people looking to get specific training on this in graduate programs is right now, look to the people doing research and work and training in this area and go to the place where they're going or where they're at, because I think although there's not formal training programs yet, there's more likelihood to be able to pick up some of the skills from those people. No, it still is an evolving field, you're right, it's kind of the knowledge is transforming so quickly in it, so I think in the last minutes I'll wrap up.

smartphones

technology access

homeless youth

crisis text lines

e-health