How mobile and internet technologies can disrupt and improve behavioral health services: Lessons from abroad
Innovative mobile and web applications designed to support evidence-based behavioral health practices are having a disruptive influence on mental health service delivery systems around the world. These technologies can provide a means of scaling up behavioral health services at the population level by shifting tasks related to monitoring and tracking patient progress from licensed providers to paraprofessionals, care managers or coaches. They also have the potential to improve the efficiency of traditional clinician-delivered services by automating some of the more routine aspects of psychotherapy, thereby allowing therapists to achieve similar client outcomes with less hours of direct client contact.
Although it is seldom cited by American companies working in this space, much of the innovative research on the use of these technologies to improve mental health services has been conducted in Europe and Australia. For example, The Improving Access to Psychological Therapies (IAPT) initiative in the UK National Health Service has embraced the use of web applications as a first line intervention for individuals with mild-to-moderate depression and anxiety. In the IAPT model “low-intensity workers” are trained to support clients who are working through “Computerized Cognitive Behavioral Therapy (CCBT) programs like Beating the Blues (http://www.beatingtheblues.co.uk/) and Fear Fighter (http://www.fearfighter.com/). Similarly, Australian researchers have demonstrated how clinicians, peer counselors, and even tech support personnel, can play a critical role in facilitating engagement with, and deriving benefit from, web and mobile mental health programs (e.g. https://thiswayup.org.au/; https://www.mycompass.org.au/; https://moodgym.anu.edu.au)
These British and Australian examples will be used to highlight some of the system issues that are likely to influence the rate of adoption of similar new models of mental health care in the U.S. On the technology side, barriers to widespread adoption of these technologies include the need for an IT infrastructure and data standards to support the secure exchange of Personal Health Information between patients and providers. On the people side of the equation, barriers to implementation include clinicians who perceive these technologies as threats to their professional identity, IT managers who are concerned about the security of their networks, and administrators of mental health systems who are concerned about the additional costs associated with adopting new technologies.
This presentation concludes with a brief review of the Implementation Science approach, such as is embodied in the Consolidated Framework for Implementation Research (CFIR http://cfirguide.org/), and a discussion of how Implementation Science can help us to understand the context in which novel behavioral technologies are being evaluated and adopted.
Dr. Weingardt is a Licensed Clinical Psychologist, and a Consulting Associate Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University. He also serves as the National Director for Mental Health Web Services in the U.S. Department of Veterans Affairs, where he provides strategic direction and coordination for all mental health web assets, including behavioral health programs for Veterans and their families. (e.g. www.veterantraining.va.gov)