March 12 2014 Melissa D Pinto Emory University eSMARTMH Where technology and behavioral health research intersect Technology Prepares Americans to address behavioral health needs Real Life Implications ID: 510353
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Evolving Role of Technology In Behavioral Health and Developmental DisabilitiesMarch 12, 2014Melissa D. Pinto, Emory University
eSMART-MH
Where technology and behavioral health research intersect
TechnologyPrepares Americans to address behavioral health needs
Real Life ImplicationsImproves well-being of AmericansSlide2
ObjectivesEvolving role of technology based interventions in Behavioral Health Technology (BHT)Benefits and concerns about use of BHTHow BHT impacts the clinical relationship and care
State of science of BHTeSMART technologySlide3
Who suffers from “Technophobia”?Slide4
What is Behavioral Health Technology (BHT)?
Application of interventions through use of technology to address behavioral, cognitive, and affective targets that support physical and mental health Slide5
Types of BHTRemote delivery-real-time, time-boundVideoconference and telephoneReduced contactInternet CBT, email-therapy, automated or personal text messages
Online chatSlide6
How are BHTs Delivered?Web-based intervention (internet intervention)Mobile devices (mHealth)
LaboratoryGamingSlide7
Importance of BHT TodayGrowing need Workforce development alone cannot fully meet needExpand capacity and extend reach
Critical shortage of providers, especially child and adolescentSlide8
Importance of BHT Today75% patients identify 1+ structural or psychological barriers to careAccess more difficult for minority groups and individuals in rural areas
Potential for totally new interventionsSlide9
Strengths and Benefits of BHTImproved AccessBrings service to people (rural)Overcomes psychological and structural barriers to careConvenience and private
Reduce costs-preliminary findingsSlide10
Strengths and Benefits of BH TechFlexibilityHigh fidelity and individualized tailoringDesigned for many conditionsInteractivity and consumer engagementIncorporates multimedia
Consumer empowermentImprove continuity and integration of careSlide11
Concerns & Barriers of BHTWill it replace important and needed services?Will it divert attention from funding for conventional services?Will it be costly to develop, implement, and evaluate?Slide12
Concerns & Barriers of BHTWhat will happen to the important therapeutic relationship? How can this happen?
Will people not get the correct level of service or delay seeking appropriate services?Can it be reimbursed? How will this work?Slide13
Does BHT Work?Early Findings
Clinical outcomes similar to face-to-face in adultsTherapy outcomes diminished in some BHT studies compared to traditional therapiesSelf-guided, self-help just as effective as some traditional approachesSlide14
Early FindingsTherapeutic relationship robust to distance, asynchrony, and limited contact.BHT offer both traditional therapies on or new therapies all together?Mechanism for clinical improvement could be different in BHT?
Hope, self-efficacy, learned resourcefulness, self-determination, empowerment.Slide15
How does BHT impact therapeutic relationship?Therapeutic relationship critical for improved outcomesChanging role of the therapeutic relationshipSlide16
Four Types of BHT Interventions(1) Therapist administered
Clients sees therapistTechnology augments and adjunctive(2) Minimal-Contact
Therapist actively involved, lesser degree typical therapy (≤1.5 hrs
)Therapist assists client with application of techniquesSlide17
Four Types of Interventions(3) Client predominantly independent self-careTherapist checks-in, teaches how to use tool(4) Self-administered
therapyPure self-helpTherapist may do assessment onlyFully automated system no therapist contactSlide18
State of Science: delivery of BHT (ALSO APPLICABLE TO Developmental Disabilities)Slide19
Extending Therapist Reach: Psychotherapy via videoconference,
telephone, and Instant Message
May be equally effective as face-to-faceAcceptable to patientsIncreased access to careSlide20
Concerns and NeedsManaging emergencies and crisesRisk for privacyDiminish therapeutic relationshipLimited pool of providersEvaluate cost-effective modelSlide21
Mobile TechnologyReal-world, “in the moment” useFindings mixed, but some positive for depression, anxiety, bipolar and schizophreniaSuccessful adherence of medicationCollect/track data by sensors and infer patient state and location for intervention Slide22
Concern and NeedsHow interventions can be integrated with existing care seamlesslyTransition into the medical record if desiredDissemination and safety of interventionsProtection of data on mobile devicesBlending social media, sensor, and self-report healthSlide23
Simulated Places and PeopleImmersive virtual reality and exposure therapyAnxiety disorders Avatars
High on empathy and allianceDeliver health information in nonthreatening mannerSlide24
Concerns and Needs Cost-effective methods of delivering virtual reality therapyAvatars beginning Slide25
GamingVideo, web, & mobileRole play and support explorationIncrease therapeutic alliance and motivationFun! Serious games for healthMost games for childrenMay increase cognitive benefits and change neural circuitrySlide26
Needs and ConcernsEfficacy for games on clinical outcomes in early stagesReasonable for adults and older adultsExamine how games may work to improve clinical outcomes Is it content or delivery or both?Slide27
Developmental DisabilitiesMost studies using iPod Touch, Pad are beginningLittle evidence base3 popular applicationsProloquo2GoPick a Word PixtalkMost studies among young adultsSlide28
Autism Spectrum DisorderMost research in this areaUse robotics, interactive video, handheld and touch device, internet virtual environmentInterventions address: Initiate, maintain, and terminate behaviorRecognize faces and emotion
Improve spatial planning, functional activities of daily living, safety skills, vocabulary, and reading skills, and social participationMore rigorous research and evidence neededSlide29
eSMART-MHSlide30
Demonstration of esmarthttp://www.youtube.com/watch?v=zcjYYX_GS38Slide31
Overview of eSMART-MH Technology
Co-created with community members
Starts at the experience of the participantObjective: Improve depressive symptoms by self-management in young adultsSlide32
Overview of eSMART-MH Technology
How can e-SMART help?
Simulates interaction with health providers Practice self-management skills in realistic environment
Increase confidence and self-efficacy
Overcomes stigma and traditional barriers Slide33
Uses Cognitive Behavioral Strategy: SBAR3
S: Share your
story B: Bring your
background A: Ask
for what you want and/or need R:
Review the plan
R: Reflect on whether it is “right for me?”
R:
Repeat
the plan
How can eSMART Improve Behavioral Health?Slide34
How can eSMART Improve Behavioral Health?Promotes self-managementMental health educationEmpower patientsValidates feelings and thoughts: They Realize They Are Not AloneSlide35
Consistent access to Internet Transition to a mobile platform
Complete independently
What are the implementation considerations?Slide36
eSMART-MH participants show fewer depressive symptoms.Slide37
30 million young adults between the ages of 18-24 1 in 4 of them have a diagnosable mental illness
Digitally connected: Spend 25 hours per week online
75% use social media 95% have a cell phone 70% have a laptop
74% have an mp3 player Usage Spans all SES levels
Potential Reach
Sources: U.S. Census Bureau, National Alliance on Mental Health, Pew Internet Research, and WSL /Strategic Retail Slide38
Special AcknowledgementsJohn M. Clochesy, PhD, RN, CS, FAAN, FCCM
ProfessorUniversity of South Florida
eSMART-HD National Institute on Minority Health
and Health Disparities (RC2 MD004760)Slide39
Special Acknowledgements
L30MH09173
KL2TR00440Slide40
Questions?Slide41
Melissa Pinto, PhD, RNEmail: mdpinto@emory.eduPhone: 404.727.0126
@md_pinto