evolving role of technology in behavioral health and developmental disabilities march 12, 2014...
TRANSCRIPT
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Evolving Role of Technology In Behavioral Health and Developmental Disabilities
March 12, 2014
Melissa D. Pinto, Emory University
eSMART-MHWhere technology
and behavioral health research intersect
TechnologyPrepares Americans to
address behavioral health needs
Real Life ImplicationsImproves well-being of
Americans
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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
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Who suffers from “Technophobia”?
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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
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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
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How are BHTs Delivered?• Web-based intervention (internet intervention)• Mobile devices (mHealth)• Laboratory• Gaming
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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
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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
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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
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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
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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?
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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?
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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
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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.
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How does BHT impact therapeutic relationship?
• Therapeutic relationship critical for improved outcomes
• Changing role of the therapeutic relationship
BH Technology
Therapist/Provider
Client
BH Tech/Progr
am Support
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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
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Four Types of Interventions
• (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
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STATE OF SCIENCE: DELIVERY OF BHT (ALSO APPLICABLE TO DEVELOPMENTAL DISABILITIES)
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Extending Therapist Reach: Psychotherapy via videoconference,
telephone, and Instant Message
– May be equally effective as face-to-face
– Acceptable to patients– Increased access to care
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• Concerns and Needs– Managing emergencies and crises– Risk for privacy– Diminish therapeutic relationship– Limited pool of providers– Evaluate cost-effective model
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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
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• 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
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Simulated Places and People
• Immersive virtual reality and exposure therapy– Anxiety disorders
• Avatars – High on empathy and alliance– Deliver health information in nonthreatening
manner
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• Concerns and Needs– Cost-effective methods of delivering virtual reality
therapy– Avatars beginning
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Gaming• 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
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• 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?
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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
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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
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ESMART-MH
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DEMONSTRATION OF ESMART
http://www.youtube.com/watch?v=zcjYYX_GS38
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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
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Overview of eSMART-MH Technology
• How can e-SMART help?o Simulates interaction
with health providers
o Practice self-management skills in realistic environment
o Increase confidence and self-efficacy
o Overcomes stigma and traditional barriers
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• Uses Cognitive Behavioral Strategy: SBAR3
o S: Share your storyo B: Bring your backgroundo A: Ask for what you want and/or needo R: Review the plano R: Reflect on whether it is “right for me?”o R: Repeat the plan
How can eSMART Improve Behavioral Health?
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How can eSMART Improve Behavioral Health?
• Promotes self-management• Mental health education• Empower patients• Validates feelings and thoughts: They
Realize They Are Not Alone
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• Consistent access to Internet
• Transition to a mobile platform
• Complete independently
What are the implementation considerations?
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eSMART-MH participants show fewer depressive symptoms.
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• 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
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Special Acknowledgements
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)
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Special Acknowledgements
L30MH09173KL2TR00440
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Questions?