Investigators at CTBH and The National Council for Community Behavioral Healthcare (The National Council) recently completed a study to assess community behavioral health agencies’ readiness to implement technology-delivered care approaches. The study, led by CTBH Director of Dissemination and Implementation Core Sarah Lord, Ph.D. and National Council Vice President of Health Information Technology and Strategic Development Michael Lardiere, LCSW, examined correlates of technology readiness attitudes and current treatment-related use of health information technology in community behavioral health agencies.

Evidence for technology-facilitated behavioral health screening, assessment, prevention, and treatment is rapidly growing. The Internet and mobile devices offer the potential to expand the reach of effective care to a broader client base, and beyond the walls of traditional service. Examples include web-based CBT and skills training, and mobile symptom management and recovery support. Health care reform under the Accountable Care Act will increase demand for behavioral health services at community agencies with already-strapped provider systems, creating a pressing need for innovative care approaches. As such, it is critically important to understand barriers and facilitators to implementation of technology-based approaches in behavioral health care settings.

The Dartmouth CTBH – National Council online survey study tapped a network of community behavioral health agencies across the country to explore individual and organization characteristics associated with readiness intentions to utilize technology-based therapeutic approaches. Over 400 valid responses were obtained, representing agencies across 44 states. Approximately 65% of respondents were clinical directors or supervisors, 24% administrators and 11% clinicians or providers. Respondents reported a range of services provided at their respective agencies (i.e., mental health, drug treatment, alcohol treatment, primary care). Seventeen percent identified agencies as Federally Qualified Health Centers.

The online survey included closed-ended questions to measure individual characteristics and perceived organization structure and climate. A qualitative question at the end of the survey tapped perceived barriers to use of technology-based therapeutic tools to enhance care delivery. Technology Readiness was measured with nine items that tapped supportiveness for use of technology (i.e., “Leadership at this agency supports the use of technology to improve care delivery”), perceived value of technology (i.e., “I can see how technology-based therapeutic tools could improve care delivery here”), and commitment to use (“I am strongly committed to pursuing the integration of technology-based therapeutic tools into care delivery at this agency”).

Overall, readiness attitudes for use of technologies to support behavioral health care was relatively high (mean = 4.03; SD=.58 on 5-point scale). Organization administrators reported higher levels of readiness to use technology than those in director, supervisor or provider positions. Other factors associated with readiness attitudes included high internal (clients, staff, management) and external (funders, policies) pressures for change, a flexible organization climate that is open to innovations, and current use of technologies in client care (i.e., EHR, electronic health assessments, informational websites, communication via email, text messaging or teleconferencing). Not surprisingly, a concern about privacy with use of technologies was associated with lower technology readiness over and above all other associated factors.

A majority of respondents indicated that their agencies used an Electronic Health Record system (83%), reported use of technology (i.e., computer, laptop, tablet) for conducting client assessments (88%), and the existence of an organization website with health information for clients (87%). Fewer respondents indicated Internet access for clients at agencies (45%), and communication with clients via organization email (31%), text messaging (29%), and tele- or video-conferencing (21%). The top three areas in which respondents reported they would most likely use technology-based tools were training for clinicians/providers (94%), illness education (81%), and wellness intervention and tracking (80%). The three least frequently endorsed areas for likely technology use were brief intervention (40%), treatment (39%), and crisis intervention (26%). Perceived cost, privacy and security concerns, and lack of knowledge and training for using technology-delivered tools emerged as key barriers to implementation at agencies.

Results indicate that readiness attitudes for use of technology in delivery of care in community behavioral health settings are relatively high. There are a number of factors associated with facilitating readiness and supporting the translation to actual implementation of technology-based care approaches in these settings. Strategies to educate administrators, clinical directors and providers about the potential for technology-based approaches to facilitate workflow and client outcomes are needed. These strategies should address privacy and security issues associated with technology use in delivery of behavioral health care, and realistic consideration of cost efficiencies associated with these care approaches. Clear implementation guidelines for technology-based therapeutic tools can foster confidence in trial testing these approaches in a system of care. Finally, efforts by organization leadership to foster flexible work climates that are receptive to innovations can pave the way for readiness to embrace technology in the delivery of care.

Results of this study will be presented at the upcoming annual conference of The National Council for Community Behavioral Healthcare in a session entitled, “The Future is in the Palm of Your Hand”, http://www.thenationalcouncil.org/cs/conference2013.