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Opportunities for and Tensions Surrounding the Use of Technology-Enabled Mental Health Services in Community Mental Health Care

Administration and Policy in Mental Health and Mental Health Services Research volume 47, pages 138–149 (2020)Cite this article

Abstract

Technology-enabled mental health services have the potential to expand the reach of care and reduce clinician demand. While the efficacy of technology-enabled mental health services is well established, there have been few successful implementations of such services into community care settings. Using mixed methods, 89 clinicians and supervisors at a mental health service organization shared attitudes toward and interest in using a variety of technologies in their work. Participants discussed several challenges and opportunities for technology-enabled mental health services. Whilst clinicians saw potential for technology to engage individuals both in and outside the clinical environment, the range of therapeutic techniques used by clinicians presented a challenge in implementing a tool to meet their needs. Client technology access was a concern, and although text messaging would facilitate communication, current HIPAA and payment structures restrict this ability. With these considerations, we offer recommendations for implementing technological services in community mental health organizations.

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References

  • Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014). The implementation leadership scale (ILS): Development of a brief measure of unit level implementation leadership. Implementation Science,9(1), 45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy In Mental Health. https://doi.org/10.1007/s10488-010-0327-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Albright, K., Gechter, K., & Kempe, A. (2013). Importance of mixed methods in pragmatic trials and dissemination and implementation research. Academic Pediatrics,13(5), 400–407. https://doi.org/10.1016/j.acap.2013.06.010.

    Article  PubMed  Google Scholar 

  • Alegría, M., Alvarez, K., Ishikawa, R. Z., DiMarzio, K., & McPeck, S. (2016). Removing obstacles to eliminating racial and ethnic disparities in behavioral health care. Health Affairs,35(6), 991–999. https://doi.org/10.1377/hlthaff.2016.0029.

    Article  PubMed  Google Scholar 

  • American Psychological Association. (2015). 2005–13: Demographics of the US Psychology Workforce. Washington, DC.

  • Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS ONE,5(10), e13196. https://doi.org/10.1371/journal.pone.0013196.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Aref-Adib, G., McCloud, T., Ross, J., O’Hanlon, P., Appleton, V., Rowe, S., et al. (2018). Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: A systematic review. The Lancet Psychiatry,6(3), 257–266. https://doi.org/10.1016/S2215-0366(18)30302-X.

    Article  PubMed  Google Scholar 

  • Becker-Haimes, E., Okamura, K., Baldwin, C., Wahesh, E., Schmidt, C., & Beidas, R. (2019). Understanding the landscape of behavioral health pre-service training to inform evidence-based intervention implementation. Psychiatric Services,70(1), 68.

    Article  PubMed  Google Scholar 

  • Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., et al. (2015). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics,169(4), 374–382. https://doi.org/10.1001/jamapediatrics.2014.3736.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bender, M. S., Choi, J., Arai, S., Paul, S. M., Gonzalez, P., & Fukuoka, Y. (2014). Digital technology ownership, usage, and factors predicting downloading health apps among Caucasian, Filipino, Korean, and Latino Americans: The Digital Link to Health Survey. JMIR Mhealth Uhealth,2(4), e43. https://doi.org/10.2196/mhealth.3710.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bertagnolli, A. (2018). Digital mental health: Challenges in Implementation. New York: Paper presented at the American Psychiatric Association Annual Meeting.

    Google Scholar 

  • Bertagnolli, A., Trangle, M., Marx, L., Lacoutture, E., Rukanonchai, D., & Schuster J. (2015). Behavioral health. Paper presented at the annual meeting of the alliance of community health plans, Washington, DC.

  • Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic analysis. In P. Liamputtong (Eds.), Handbook of research methods in health social sciences (pp. 843–860). Singapore: Springer.

    Chapter  Google Scholar 

  • Cook, J. M., Biyanova, T., & Coyne, J. C. (2009). Barriers to adoption of new treatments: An internet study of practicing community psychotherapists. Administration and Policy in Mental Health and Mental Health Services Research,36(2), 83–90. https://doi.org/10.1007/s10488-008-0198-3.

    Article  PubMed  Google Scholar 

  • Creed, T. A., Wolk, C. B., Feinberg, B., Evans, A. C., & Beck, A. T. (2016). Beyond the label: Relationship between community therapists’ self-report of a cognitive behavioral therapy orientation and observed skills. Administration and Policy in Mental Health and Mental Health Services Research,43(1), 36–43. https://doi.org/10.1007/s10488-014-0618-5.

    Article  PubMed  Google Scholar 

  • Cunningham, C. T., Quan, H., Hemmelgarn, B., Noseworthy, T., Beck, C. A., Dixon, E., et al. (2015). Exploring physician specialist response rates to web-based surveys. BMC Medical Research Methodology,15(1), 32. https://doi.org/10.1186/s12874-015-0016-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Donker, T., Blankers, M., Hedman, E., Ljótsson, B., Petrie, K., & Christensen, H. (2015). Economic evaluations of internet interventions for mental health: A systematic review. Psychological Medicine,45(16), 3357–3376. https://doi.org/10.1017/S0033291715001427.

    CAS  Article  PubMed  Google Scholar 

  • Dragovic, M., Davison, S., Morgan, V. A., Chiu, V. W., Richards, N., Vatskalis, T., et al. (2018). ‘Validated, easy to use and free’: Top three requests for mobile device applications (‘apps’) from mental health consumers and clinicians. Advances in Mental Health. https://doi.org/10.1080/18387357.2018.1557014.

    Article  Google Scholar 

  • Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World psychiatry: Official journal of the World Psychiatric Association (WPA),11(1), 47–51.

    Article  Google Scholar 

  • Ehrhart, M. G., Aarons, G. A., & Farahnak, L. R. (2014). Assessing the organizational context for EBP implementation: The development and validity testing of the implementation climate scale (ICS). Implementation Science,9(1), 157.

    Article  PubMed  PubMed Central  Google Scholar 

  • Firth, J., Torous, J., Nicholas, J., Carney, R., Rosenbaum, S., & Sarris, J. (2017). Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders,218, 15–22. https://doi.org/10.1016/j.jad.2017.04.046.

    Article  PubMed  Google Scholar 

  • Freundlich, R. E., Freundlich, K. L., & Drolet, B. C. (2017). Pagers, Smartphones, and HIPAA: Finding the best solution for electronic communication of protected health information. Journal of Medical Systems,42(1), 9. https://doi.org/10.1007/s10916-017-0870-9.

    Article  PubMed  Google Scholar 

  • Frisbee, K. L. (2016). Variations in the use of mHealth tools: The VA Mobile Health Study. JMIR mHealth and uHealth,4(3), e89. https://doi.org/10.2196/mhealth.3726.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gallo, K. P., & Barlow, D. H. (2012). Factors involved in clinician adoption and nonadoption of evidence-based interventions in mental health. Clinical Psychology: Science and Practice,19(1), 93–106. https://doi.org/10.1111/j.1468-2850.2012.01276.x.

    Article  Google Scholar 

  • Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R., et al. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): Large scale pragmatic randomised controlled trial. BMJ,351, h5627.

    Article  PubMed  PubMed Central  Google Scholar 

  • Granja, C., Janssen, W., & Johansen, M. A. (2018). Factors determining the success and failure of eHealth Interventions: Systematic review of the literature. Journal of Medical Internet Research,20(5), e10235. https://doi.org/10.2196/10235.

    Article  PubMed  PubMed Central  Google Scholar 

  • Karyotaki, E., Riper, H., Twisk, J., et al. (2017). Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: A meta-analysis of individual participant data. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2017.0044.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2017). Addressing the treatment gap: A key challenge for extending evidence-based psychosocial interventions. Behaviour Research and Therapy,88, 7–18. https://doi.org/10.1016/j.brat.2016.06.004.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine,352(24), 2515–2523.

    CAS  Article  Google Scholar 

  • Lattie, E. G., Schueller, S. M., Sargent, E., Stiles-Shields, C., Tomasino, K. N., Corden, M. E., et al. (2016). Uptake and usage of intellicare: A publicly available suite of mental health and well-being apps. Internet Interventions,4, 153–158. https://doi.org/10.1016/j.invent.2016.06.003.

    Article  Google Scholar 

  • Lehman, W. E. K., Greener, J. M., & Simpson, D. D. (2002). Assessing organizational readiness for change. Journal of Substance Abuse Treatment,22(4), 197–209. https://doi.org/10.1016/S0740-5472(02)00233-7.

    Article  PubMed  Google Scholar 

  • Lyon, A. R., & Bruns, E. J. (2019). User-centered redesign of evidence-based psychosocial interventions to enhance implementation—Hospitable soil or better seeds? JAMA Psychiatry,76(1), 3–4. https://doi.org/10.1001/jamapsychiatry.2018.3060.

    Article  PubMed  Google Scholar 

  • Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. General Hospital Psychiatry,35(4), 332–338. https://doi.org/10.1016/j.genhosppsych.2013.03.008.

    Article  PubMed  Google Scholar 

  • Mohr, D. C., Lyon, A. R., Lattie, E. G., Reddy, M., & Schueller, S. M. (2017a). Accelerating digital mental health research from early design and creation to successful implementation and sustainment. Journal of Medical Internet Research,19(5), e153. https://doi.org/10.2196/jmir.7725.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mohr, D.C., Schueller, S.M., Tomasino, K.N., Kaiser, S.M., Alam, N., Karr, C.J., Vergara, J., Gray, E., Kwasny, M.J., & Lattie, E.G. (in press). Randomized trial comparing the effects of coaching and receipt of app recommendations on depression, anxiety, and app use in the IntelliCare platform. Journal of Medical Internet Research.

  • Mohr, D. C., Tomasino, K. N., Lattie, E. G., Palac, H. L., Kwasny, M. J., Weingardt, K., et al. (2017b). IntelliCare: An eclectic, skills-based app suite for the treatment of depression and anxiety. Journal of Medical Internet Research,19(1), e10. https://doi.org/10.2196/jmir.6645.

    Article  PubMed  PubMed Central  Google Scholar 

  • Proctor, E. K., Knudsen, K. J., Fedoravicius, N., Hovmand, P., Rosen, A., & Perron, B. (2007). Implementation of evidence-based practice in community behavioral health: Agency director perspectives. Administration and Policy in Mental Health and Mental Health Services Research,34(5), 479–488.

    Article  PubMed  Google Scholar 

  • Schueller, S. M., Glover, A. C., Rufa, A. K., Dowdle, C. L., Gross, G. D., Karnik, N. S., et al. (2019). A mobile phone-based intervention to improve mental health among homeless young adults: Pilot feasibility trial. JMIR Mhealth Uhealth,7(7), e12347. https://doi.org/10.2196/12347.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schueller, S. M., Neary, M., O’Loughlin, K., & Adkins, E. C. (2018). Discovery of and interest in health apps among those with mental health needs: Survey and focus group study. Journal of Medical Internet Research,20(6), e10141–e10141. https://doi.org/10.2196/10141.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sebo, P., Maisonneuve, H., Cerutti, B., Fournier, J. P., Senn, N., & Haller, D. M. (2017). Rates, delays, and completeness of general practitioners’ responses to a postal versus web-based survey: A randomized trial. Journal of Medical Internet Research,19(3), e83.

    Article  PubMed  PubMed Central  Google Scholar 

  • So, M., Yamaguchi, S., Hashimoto, S., Sado, M., Furukawa, T. A., & McCrone, P. (2013). Is computerised CBT really helpful for adult depression?—A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity. BMC Psychiatry,13(1), 113. https://doi.org/10.1186/1471-244x-13-113.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services (Washington, D. C.),60(10), 1323–1328. https://doi.org/10.1176/appi.ps.60.10.1323.

    Article  Google Scholar 

  • Titov, N., Dear, B., Nielssen, O., Staples, L., Hadjistavropoulos, H., Nugent, M., et al. (2018). ICBT in routine care: A descriptive analysis of successful clinics in five countries. Internet Interventions,13, 108–115. https://doi.org/10.1016/j.invent.2018.07.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Torous, J., Andersson, G., Bertagnoli, A., Christensen, H., Cuijpers, P., Firth, J., et al. (2019). Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry: Official Journal of the World Psychiatric Association (WPA),18(1), 97–98. https://doi.org/10.1002/wps.20592.

    Article  Google Scholar 

  • Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry,62(6), 629–640. https://doi.org/10.1001/archpsyc.62.6.629.

    Article  PubMed  Google Scholar 

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Funding

Funding were provided by National Institute of Mental Health (Grant No. K08 MH112878) and National Center for Advancing Translational Sciences (Grant No. UL1TR001422).

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Authors and Affiliations

  1. Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA

    Emily G. Lattie

  2. Department of Preventive Medicine, Northwestern University, Chicago, IL, USA

    Jennifer Nicholas, Ashley A. Knapp, Susan M. Kaiser & David C. Mohr

  3. OhioGuidestone, Cleveland, OH, USA

    Joshua J. Skerl

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  1. Emily G. Lattie
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  2. Jennifer Nicholas
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  3. Ashley A. Knapp
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  4. Joshua J. Skerl
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  5. Susan M. Kaiser
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  6. David C. Mohr
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Corresponding author

Correspondence to Emily G. Lattie.

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Conflict of interest

Disclosure of potential conflicts of interest: David C. Mohr has accepted honoraria from Apple Inc. and has an ownership interest in Actualize Therapy, which has a license from Northwestern University for IntelliCare. Emily G. Lattie has received consulting fees from Actualize Therapy, LLC. Joshua J. Skerl is employed by OhioGuidestone.

Research Involving Human Participants and/or Animals

All procedures performed were in accordance with the ethical standards of Northwestern University’s IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Lattie, E.G., Nicholas, J., Knapp, A.A. et al. Opportunities for and Tensions Surrounding the Use of Technology-Enabled Mental Health Services in Community Mental Health Care. Adm Policy Ment Health 47, 138–149 (2020). https://doi.org/10.1007/s10488-019-00979-2

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  • DOI: https://doi.org/10.1007/s10488-019-00979-2

Keywords

  • mHealth
  • eHealth
  • Community mental health
  • Evidence-based treatments