Melissa D. Pinto, Emory University eSMART-MH Technology Real Life - - PowerPoint PPT Presentation

Evolving Role of Technology In Behavioral Health and Developmental Disabilities 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 I m plications Improves well-being of Americans

Objectives

• Evolving role of technology based

interventions in Behavioral Health Technology (BHT)

• Benefits and concerns about use of BHT
• How BHT impacts the clinical relationship and

care

• State of science of BHT
• eSMART technology

Who suffers from “Technophobia”?

W hat 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)
• Laboratory
• Gaming

I m portance 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

I m portance 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
• r delay seeking appropriate services?
• Can it be reimbursed? How will this work?

Does BHT W ork? 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?

• Mechanism for clinical improvement could be

different in BHT?

– Hope, self‐efficacy, learned resourcefulness, self‐ determination, empowerment.

How does BHT im pact therapeutic relationship?

• Therapeutic relationship

critical for improved

• utcomes
• Changing role of the

therapeutic relationship

BH Technology Therapist/Provider Client BH Tech/Program Support

Four Types of BHT I nterventions

• (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

• f techniques

Four Types of I nterventions

• (3) Client predominantly independent self‐care

– Therapist checks‐in, teaches how to use tool

• (4) Self‐administered therapy

– Pure self‐help – Therapist may do assessment only – Fully automated system no therapist contact

STATE OF SCI ENCE: DELI VERY OF BHT ( ALSO APPLI CABLE TO DEVELOPMENTAL DI SABI LI TI ES)

Extending Therapist Reach: Psychotherapy via videoconference, telephone, and I nstant Message

– May be equally effective as face‐to‐face – Acceptable to patients – Increased 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

Sim ulated 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

Gam ing

• Video, web, & mobile

– Role play and support exploration – Increase therapeutic alliance and motivation – Fun! Serious games for health – Most games for children – May 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

• utcomes
• Is it content or delivery or both?

Developm ental 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:

• Initiate, 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 members

• Starts at the

experience of the participant

• Objective: 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 m e?”
• R: Repeat the plan

How can eSMART I m prove Behavioral Health?

How can eSMART I m prove 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

W hat are the im plem entation 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
• nline
• 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 Acknow ledgem ents

John M. Clochesy, PhD, RN, CS, FAAN, FCCM Professor University of South Florida

eSMART-HD National Institute on Minority Health and Health Disparities (RC2 MD004760)

Special Acknow ledgem ents

L30MH09173 KL2TR00440

Questions?

Melissa Pinto, PhD, RN Email: mdpinto@emory.edu Phone: 404.727.0126

@md_pinto