Evolving Role of Technology In Behavioral Health and Develo

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 Americans

Objectives

Evolving role of technology based interventions in Behavioral Health Technology (BHT)

B

enefits and concerns about use of BHT

H

ow BHT impacts the clinical relationship and care

S

tate of science of BHT

eSMART

technology

Who suffers from “Technophobia”?

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

Types of BHT

Remote delivery-real-time, time-bound

Videoconference and telephone

Reduced contact

Internet CBT, email-therapy, automated or personal text messages

Online chat

How are BHTs Delivered?

Web-based intervention (internet intervention)Mobile devices (mHealth)LaboratoryGaming

Importance of BHT Today

Growing need

Workforce development alone cannot fully meet need

Expand capacity and extend reach

Critical shortage of providers, especially child and adolescent

Importance of BHT Today

75% patients identify 1+ structural or psychological barriers to care

Access more difficult for minority groups and individuals in rural areas

Potential for totally new interventions

Strengths and Benefits of BHT

Improved Access

Brings service to people (rural)

Overcomes psychological and structural barriers to care

Convenience and private

Reduce costs-preliminary findings

Strengths and Benefits of BH Tech

Flexibility

High fidelity and individualized

tailoring

Designed for many conditions

Interactivity and consumer engagement

Incorporates multimedia

Consumer empowerment

Improve continuity and integration of care

Concerns & Barriers of BHT

Will it replace important and needed services?

Will it divert attention from funding for conventional services?

Will it be costly to develop, implement, and evaluate?

Concerns & Barriers of BHT

What 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?

Does BHT Work?Early Findings

Clinical outcomes similar to face-to-face in adults

Therapy outcomes diminished in some

BHT studies

compared to traditional

therapies

Self-guided, self-help just as effective as some traditional approaches

Early Findings

Therapeutic relationship robust to distance, asynchrony, and limited contact.

BHT offer both traditional therapies on or new therapies all together?

M

echanism for clinical improvement could be different in BHT?

Hope, self-efficacy, learned resourcefulness, self-determination, empowerment.

How does BHT impact therapeutic relationship?

Therapeutic relationship critical for improved outcomesChanging role of the therapeutic relationship

Four Types of BHT Interventions

(1) Therapist administered

Clients sees therapist

Technology augments and adjunctive

(2) Minimal-Contact

Therapist actively involved, lesser degree typical therapy (≤1.5

hrs

)

Therapist assists client with application of techniques

Four Types of Interventions

(3) Client predominantly independent self-care

Therapist checks-in, teaches how to use tool

(4) Self-administered

t

herapy

Pure self-help

Therapist may do assessment only

Fully automated system no therapist contact

State of Science: delivery of BHT (ALSO APPLICABLE TO Developmental Disabilities)

Extending Therapist Reach: Psychotherapy via videoconference, telephone, and Instant Message

May be equally effective as face-to-faceAcceptable to patientsIncreased access to care

Concerns and Needs

Managing emergencies and crises

Risk for privacy

Diminish therapeutic relationship

Limited pool of providers

Evaluate cost-effective model

Mobile Technology

Real-world, “in the moment” use

Findings mixed, but some positive for depression, anxiety, bipolar and schizophrenia

Successful adherence of medication

Collect/track data by sensors and infer patient state and location for intervention

Concern and Needs

How interventions can be integrated with existing care seamlessly

Transition into the medical record if desired

Dissemination and safety of interventions

Protection of data on mobile devices

Blending social media, sensor, and self-report health

Simulated Places and People

Immersive virtual reality and exposure therapy

Anxiety disorders

Avatars

High on empathy and alliance

Deliver health information in nonthreatening manner

Concerns and Needs

Cost-effective methods of delivering virtual reality therapy

Avatars beginning

Gaming

Video, web, & mobileRole play and support explorationIncrease therapeutic alliance and motivationFun! Serious games for healthMost games for childrenMay increase cognitive benefits and change neural circuitry

Needs and Concerns

Efficacy for games on clinical outcomes in early stages

Reasonable for adults and older adults

Examine how games may work to improve clinical outcomes

Is it content or delivery or both?

Developmental Disabilities

Most studies using iPod Touch, Pad are beginning

Little evidence base

3 popular applications

Proloquo2Go

Pick a Word

Pixtalk

Most studies among young adults

Autism Spectrum Disorder

Most research in this area

Use robotics, interactive video, handheld and touch device, internet virtual environment

Interventions address:

I

nitiate, maintain, and terminate behavior

Recognize faces and emotion

Improve spatial planning, functional activities of daily living, safety skills, vocabulary, and reading skills, and social participation

More rigorous research and evidence needed

eSMART-MH

Demonstration of esmart

http://

www.youtube.com

/

watch?v

=zcjYYX_GS38

Overview of eSMART-MH Technology

Co-created with community membersStarts at the experience of the participantObjective: Improve depressive symptoms by self-management in young adults

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

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?

How can eSMART Improve Behavioral Health?

Promotes self-management

Mental health education

Empower patients

Validates feelings and thoughts: They Realize They Are Not Alone

Consistent access to Internet Transition to a mobile platform Complete independently

What are the implementation considerations?

eSMART-MH

participants

show fewer

depressive symptoms.

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

Special Acknowledgements

John M. Clochesy, PhD, RN, CS, FAAN, FCCM ProfessorUniversity of South FloridaeSMART-HD National Institute on Minority Health and Health Disparities (RC2 MD004760)

Special Acknowledgements

L30MH09173

KL2TR00440

Questions?

Melissa Pinto, PhD, RNEmail: mdpinto@emory.eduPhone: 404.727.0126

@md_pinto