Evolving Role of Technology In Behavioral Health and Developmental Disabilities March 12, 2014 Melissa D. Pinto, Emory University eSMART-MH Technology Real Life I m plications Where technology Prepares Americans to Improves well-being of and behavioral health address behavioral Americans research intersect health needs
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 or 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 outcomes BH Technology • Changing role of the therapeutic relationship Client BH Tech/Program Therapist/Provider 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 of 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 outcomes • 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 o with health providers Practice self- o management skills in realistic environment Increase confidence o and self-efficacy Overcomes stigma o and traditional barriers
How can eSMART I m prove Behavioral Health? • Uses Cognitive Behavioral Strategy: SBAR3 o S: Share your story o B: Bring your background o A: Ask for what you want and/or need o R: Review the plan o R: Reflect on whether it is “right for m e?” o R: Repeat the plan
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
W hat are the im plem entation considerations? • Consistent access to Internet • Transition to a mobile platform • Complete independently
eSMART ‐ MH participants show fewer depressive symptoms.
Potential Reach • 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 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
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