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Evolving Role of Technology In Behavioral Health and Develo

March 12, 2014. Melissa D. Pinto, Emory University . eSMART-MH. Where technology and behavioral health research intersect. Technology. Prepares Americans to address behavioral health needs. Real Life Implications.

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Evolving Role of Technology In Behavioral Health and Develo

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Evolving Role of Technology In Behavioral Health and Developmental DisabilitiesMarch 12, 2014Melissa D. Pinto, Emory University


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)


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


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?”



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




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