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Tag: implementation
09/19/2023

Symposium Focuses on Digital Tech for Mental Health

Article Excerpt: Technology offers new avenues for mental health delivery. Digital record keeping, virtual consultations, wearables that monitor activity and well-being, mindfulness apps, and AI-based chatbots are just a few examples. But these advances have not been leveraged effectively enough, Cornell Tech Professor and HealthRhythms Co-Founder Tanzeem Choudhury said in a keynote talk Tuesday at the Digital Mental Health and AI Symposium organized by the Center for Technology and Behavioral Health. Choudhury explored the challenges that have forestalled digital mental health from delivering on some of its early promises and how to move the needle forward.

Full Article: https://tinyurl.com/ysvssb4s

Article Source: Dartmouth News

Posted in: Dissemination & Implementation // Tagged: ; ; ; ; ; ; ; ; ; ; ;
08/21/2023

As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance”: barriers and facilitators to digital peer support implementation into community mental health centers.

Fortuna KL, Divatia S, Neupane S, Geiger P and Bohm A (2023) “As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance”: barriers and facilitators to digital peer support implementation into community mental health centers. Front. Digit. Health 5:1130095. doi: 10.3389/fdgth.2023.1130095

This study aimed to identify barriers and facilitators to implementation of digital peer support based on perspectives of patients with serious mental illness (SMI) and certified peer support specialists. Semi-structured qualitative interviews were conducted with 27 participants (17 persons with SMI and 10 certified peer support specialists) at an urban community mental health center. Agency staff in a community mental health center shared information about the study with potential participants for recruitment. The interview guide included six broad questions to evaluate feasibility, acceptability, and effectiveness of a digital peer support intervention for patients with SMI. Patient participants were on average 51 years of age, mostly male, white and had varying mental health diagnoses. Peer support specialists were on average 40 years of age, all female and white. Nine barriers were identified: 1) adaptability to the needs of older patients, 2) technology complexity, 3) cost of implementation, 4) compatibility with patients’ real-world environment, 5) quality of communications, 6) availability of resources, 7) access to information, 8) lack of human interaction, and 9) patients’ personality and characteristics. Two facilitators were identified: 1) increased access to health care and 2) relative advantage of implementing digital peer support compared to in-person meetings. Overall, patients with SMI have unique needs regarding training and access to digital peer support. In-person interaction is preferred, but digital peer support can be a helpful augment to clinical treatment.  Identification of implementation barriers and facilitators can inform multilevel strategies to increase uptake of digital peer support in community mental health centers.

Posted in: Cutting Edge Literature // Tagged: ; ; ; ;
07/31/2023

Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth

Becker-Haimes EM, Wislocki K, Schriger SH, Kratz HE, Sanchez AL, Clapp D, Frank HE. Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth. Child Youth Care Forum (2023). https://doi.org/10.1007/s10566-023-09732-1

Exposure therapy is a cognitive-behavioral treatment tool for youth anxiety but is highly underutilized in routine clinical care. This study assessed usage and clinician perspectives of an online toolkit that supports the use of exposure therapy with anxious youth, called the Resource for Exposure for Anxiety Disordered Youth (READY). READY is hosted on a freely available website and has been disseminated to clinicians. Researchers extracted web analytics from the READY platform and conducted brief, anonymous electronic surveys of site users to assess READY adoption, utility, and the association with exposure therapy use. In its first three years, READY had 13,543 page views across 1731 unique users. READY clinician users (N=49, mean age=34 years, 82.9% female, 71% White) completed the survey. Survey data suggested variability in usage and perceived utility across toolkit components. READY was perceived positively overall by users and was most commonly used to prepare for exposure therapy sessions by reviewing tips or generating exposure ideas. Open-ended responses about perceived challenges in exposure delivery with youth found common barriers to be engagement by patients, difficulties with the family system, and difficulties with generating ideas for exposure practices. Although the study engaged only a small number of READY users (14%) to complete the survey, findings suggest the READY toolkit, a free online implementation resource, could be a promising tool to support clinicians delivering exposure therapy and may augment traditional training and consultation.

Posted in: Cutting Edge Literature // Tagged: ; ; ; ; ;
07/24/2023

A Mobile App to Promote Alcohol and Drug SBIRT Skill Translation Among Multi-Disciplinary Health Care Trainees: Results of a Randomized Controlled Trial

Curtis AC, Satre DD, Sarovar V, Wamsley M, Ly K & Satterfield J. (2022). A mobile app to promote alcohol and drug SBIRT skill translation among multi-disciplinary health care trainees: Results of a randomized controlled trial. Substance Abuse, 43(1), 13–22. https://doi.org/10.1080/08897077.2019.1686723

The aim of this study was to evaluate the effectiveness of an alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) mobile app to support healthcare trainees working in various clinical settings. A randomized controlled trial of a new mobile app was conducted among 131 participants who were health profession trainees, had completed SBIRT training in the past year, and had a personal mobile device. The app had three main functions: 1) review of SBIRT skills and substance use disorders, 2) application of SBIRT (including screeners, intervention strategies and tools), and 3) data collection on SBIRT delivery via brief surveys. Participants were randomized to either the SBIRT app or the control condition (no access to the app). Participants completed weekly self-report assessments on SBIRT delivery over the 10-week study duration. Seventy-eight percent of participants assigned to the SBIRT app downloaded it and logged in. There were no statistically significant differences between the groups in the percentage of patients screened, brief interventions delivered, or referrals made to treatment. Additionally, there were no differences between the two arms at baseline nor at the end of the study for attitudes, beliefs, confidence in ability to deliver SBIRT, or behavioral intent to deliver SBIRT. In the group that received the SBIRT app, the average system usability score was 62.00 (SD=12.01), which is considered below average. Participants spent an average of 8.81 minutes in the app. Based on these findings, despite good uptake of the SBIRT app, adherence was low. Authors noted that the effect of the classroom training prior to app access is unknown; it is possible that this training reduced the need for the SBIRT app, leading to non-significant differences between the two arms. The potential for use of digital apps to support the translation of best practices from classroom to clinic is promising; however, additional research is needed to improve engagement and adherence.

Posted in: Cutting Edge Literature // Tagged: ; ; ; ;
07/18/2023

The Role of Digital Health In Treating OUD

Article Excerpt: In a study recently published in the JAMA Network, researchers sought to investigate the use of patient-facing digital health technologies for OUD by organizations in the United States with ACO contracts. The search began as it was unclear whether these technologies serve as substitute or complements to traditional SUD treatment resources in health care organizations. According to researchers and authors of the study, medication and behavioral treatment for OUD is scarce. Many barriers make access to OUD treatment challenging, including transportation and limited numbers of mental health and SUD clinicians. Digital health technologies are suggested to have the potential to alleviate barriers and expand access to treatment for OUD patients.

Full Article: https://tinyurl.com/yjfu8ud2

Article Source: Managed Healthcare Executive

Posted in: Emerging Technologies, Methodologies & Analytics // Tagged: ; ; ; ; ; ; ; ;
07/17/2023

Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses

Zhao X, Stadnick N, Ceballos-Corro E, Castro Jr J, Mallard-Swanson K, Palomares K, Eikey E, Schneider M, Zheng K, Mukamel D, Schueller S, Sorkin D. Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses. JMIR Form Res 2023;7:e45718. DOI: 10.2196/45718

This article identified barriers, facilitators, and best practices for implementing digital mental health interventions (DMHIs) according to the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. This qualitative interview study is part of a larger state-funded project in which six county behavioral health departments in California explored the use of DMHIs as part of mental health services. Interviews were conducted with clinical staff, peer support specialists and leadership. The interview was structured using the EPIS domains of relevant inner context (i.e., individual and organizational characteristics), outer context (i.e., patient characteristics, policy, fiscal mandates), innovation factors (i.e., fit of the innovation), and bridging factors (i.e., community-academic partnerships). Sixty-nine interviews were included for analysis. Three main themes were identified: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Readiness of individuals included patients’ access to technology and digital literacy to participate in DMHIs. Innovation-level readiness pertained to accessibility, clinical usefulness, safety and fit of DMHIs. On the organization and system level, providers and leaders held positive views about DMHIs. Based on these findings, successful implementation of DHMIs requires readiness at the individual, innovation, and organizational levels. The authors recommend equitable device distribution and digital literacy training at the individual level. Adapting DMHIs to fit clients’ needs, as well as clinical workflow, is also recommended. To improve at the organization level, providers and local behavioral health departments should be supported with appropriate technology and training.

Posted in: Cutting Edge Literature // Tagged: ; ; ; ; ;
06/06/2023

Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study

Mogk JM, Matson TE, Caldeiro RM, Garza Mcwethy AM, Beatty T, Sevey BC, Hsu CW, Glass JE. Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study. Addict Sci Clin Pract. 2023 May 8;18(1):27. doi: 10.1186/s13722-023-00387-w.

This study aimed to identify implementation needs and strategy design considerations for integrating digital therapeutics for alcohol use disorders (AUD) into primary care. Qualitative interviews were conducted with clinicians, care delivery leaders, and implementation staff (N=16). All participants had experience implementing digital therapeutics for depression or substance use disorders in primary care in the United States. Participants were asked to share successes and challenges from implementation efforts and how these experiences could inform the implementation of digital therapeutics for AUD. Common themes were identified across health system staff roles. Participants were committed to digital therapeutics for AUD and anticipated high patient demand for such treatments. Reported facilitators of successful implementation included: 1) use implementation strategies that align with the needs of patients with varying AUD severity, 2) use strategies that minimize burden on clinicians, and 3) offer digital therapeutics as an adjunct to other treatments for AUD. Other helpful implementation strategies included clinician training and electronic health record support. Findings inform future efforts to implement digital interventions for AUD in primary care.

Posted in: Cutting Edge Literature // Tagged: ; ; ; ; ;
04/18/2023

Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department

Carter PM, Cunningham RM, Eisman AB, Resnicow K, Roche JS, Cole JT, Goldstick J, Kilbourne AM, & Walton MA. (2022). Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department. The Journal of Emergency Medicine, 62(1), 109–124. https://doi.org/10.1016/j.jemermed.2021.09.003

This study examined the translation of SafERteens, an evidence-based violence prevention program, into clinical care. Implementation of the program was piloted in an emergency department (ED) hospital setting with youth (14-18 years old) who screened positive for recent aggression during an ED visit. Youth participants were randomized to SafERteens (delivered remotely by study therapists or in-person by hospital staff) or enhanced usual care. The SafERteens intervention is a 30–45-minute brief behavioral intervention that integrates motivational interviewing for cognitive behavioral strategies. Participants also received an optional 2-month tailored text messaging program on self-efficacy, reminders on their goals, and tools to avoid violence. Data was collected from hospital staff on implementation facilitators and barriers using the RE-AIM framework. SafERteens completion rate was found to be 77.6% for remote delivery and 49.1% for in-person delivery. The SafERteens and tailored text messaging demonstrated high acceptability among youth; 84.9% of participants found it helpful. After the intervention, participants reported increased self-efficacy to avoid fighting and decreased pro-violence attitudes compared to baseline. Hospital staff reported a number of barriers to implementation such as limited staff availability and lack of reimbursement for staff time to conduct intervention delivery. Remote delivery of SafERteens can be a promising strategy to overcome resource limitations. Results demonstrate that policymakers should continue to expand reimbursement mechanisms in hospitals for violence screening and interventions.

Posted in: Cutting Edge Literature // Tagged: ; ; ; ; ; ;
04/03/2023

I-CARE: Feasibility, Acceptability, and Appropriateness of a Digital Health Intervention for Youth Experiencing Mental Health Boarding

Leyenaar JK, Arakelyan M, Acquilano SC, Gilbert TL, Craig JT, Lee CN, Kodak SG, Ignatova E, Mudge LA, House SA, Brady RE. I-CARE: Feasibility, Acceptability, and Appropriateness of a Digital Health Intervention for Youth Experiencing Mental Health Boarding. J Adolesc Health. 2023 Mar 2:S1054-139X(23)00062-9. doi: 10.1016/j.jadohealth.2023.01.015. Epub ahead of print. PMID: 36870901.

A modular digital intervention was developed to facilitate delivery of evidence-based psychosocial skills by non-mental health clinicians for youth with expressed suicidality. The paper describes pilot mixed method findings on the intervention’s effectiveness, feasibility, acceptability, and appropriateness. The intervention, I-CARE, consisted of seven modules grounded in cognitive behavior therapy and were delivered via a table computer with videos and practice activities. Licensed nursing assistants provided one-on-one supervision and facilitated the intervention. I-CARE was implemented in a pediatric hospital with 24 patients aged 12-17 years hospitalized due to suicidal ideation or attempt. Clinical outcomes were assessed by self-reported surveys at hospital admission and 24 hours before hospital discharge. Emotional distress significantly decreased after participation (6.3 points on 63-point scale). There were no significant changes in engagement readiness and illness severity. Majority of youth, caregivers and clinicians rated I-CARE as feasible (98%, N=39), acceptable (90%, N=36), and appropriate (78%, N=31). Overall, I-CARE was feasible to implement and acceptable to end-users and demonstrated preliminary positive impact on emotional distress for suicidal young people in psychiatric hospitalization.

 

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