As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the ...world today must "flatten the curve" of spread of the virus, we argue that now is the time to "accelerate and bend the curve" on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further.
The following case series provides several examples from the Digital Clinic, an outpatient mental health program which uses smartphone technology to augment traditional mental health care. The themes ...highlighted in this piece, expanding emotional-awareness, symptom tracking, and medication management, provide real-clinical examples of how the Digital Clinic offered remote mental health care to a diverse group of people. Furthermore, the following piece demonstrates to practicing clinicians how digital technologies, like smartphone apps, can diversify methods of clinical engagement, assist with collecting health metrics in a safe and ethical manner, and promote person centred care. With the COVID-19 pandemic forcing re-evaluation of how mental health services are provided, it is critical to ensure that digitally infused systems of care, like the Digital Clinic, are effective, accessible, and scalable.
Objective: This study assessed the feasibility of capturing smartphone based digital phenotyping data in college students during the COVID-19 pandemic with the goal of understanding how digital ...biomarkers of behavior correlate with mental health. Participants: Participants were 100 students enrolled in 4-year universities. Methods: Each participant attended a virtual visit to complete a series of gold-standard mental health assessments, and then used a mobile app for 28 days to complete mood assessments and allow for passive collection of GPS, accelerometer, phone call, and screen time data. Students completed another virtual visit at the end of the study to collect a second round of mental health assessments. Results: In-app daily mood assessments were strongly correlated with their corresponding gold standard clinical assessment. Sleep variance among students was correlated to depression scores (ρ = .28) and stress scores (ρ = .27). Conclusions: Digital Phenotyping among college students is feasible on both an individual and a sample level. Studies with larger sample sizes are necessary to understand population trends, but there are practical applications of the data today.
Despite the emergence of app evaluation tools, there remains no well-defined process receptive to diverse local needs, rigorous standards, and current content. The need for such a process to assist ...in the implementation of app evaluation across all medical fields is evident. Such a process has the potential to increase stakeholder engagement and catalyze interest and engagement with present-day app evaluation models.
This study aimed to develop and pilot test the Technology Evaluation and Assessment Criteria for Health apps (TEACH-apps).
Tailoring a well-known implementation framework, Replicating Effective Programs, we present a new process to approach the challenges faced in implementing app evaluation tools today. As a culmination of our experience implementing this process and feedback from stakeholders, we present the four-part process to aid the implementation of mobile health technology. This paper outlines the theory, evidence, and initial versions of the process.
The TEACH-apps process is designed to be broadly usable and widely applicable across all fields of health. The process comprises four parts: (1) preconditions (eg, gathering apps and considering local needs), (2) preimplementation (eg, customizing criteria and offering digital skills training), (3) implementation (eg, evaluating apps and creating educational handouts), and (4) maintenance and evolution (eg, repeating the process every 90 days and updating content). TEACH-apps has been tested internally at our hospital, and there is growing interest in partnering health care facilities to test the system at their sites.
This implementation framework introduces a process that equips stakeholders, clinicians, and users with the foundational tools to make informed decisions around app use and increase app evaluation engagement. The application of this process may lead to the selection of more culturally appropriate and clinically relevant tools in health care.
As the role of technology expands in healthcare, so does the need to support its implementation and integration into the clinic. The concept of a new team member, the digital navigator, able to ...assume this role is introduced as a solution. With a digital navigator, any clinic today can take advantage of digital health and smartphone tools to augment and expand existing telehealth and face to face care. The role of a digital navigator is suitable as an entry level healthcare role, additional training for an experienced clinician, and well suited to peer specialists. To facilitate the training of digital navigators, we draw upon our experience in creating the role and across health education to introduce a 10-h curriculum designed to train digital navigators across 5 domains: (1) core smartphone skills, (2) basic technology troubleshooting, (3) app evaluation, (4) clinical terminology and data, and (5) engagement techniques. This paper outlines the curricular content, skills, and modules for this training and features a rich online supplementary Appendix with step by step instructions and resources.
Background
Despite a recent proliferation in web-based and digital resources that are designed to assist users in finding appropriate mental health treatment and supportive services, it can be ...overwhelming, confusing, and difficult for an individual or family member to access and use an appropriate navigation tool. As digital resources are increasingly sought after, there is an urgent need for a clearer understanding of digital navigation tools in order to help link individuals with the tool that is best suited to their needs.
Objective
The objective of this study was to determine the needs of individuals seeking mental health treatment and supportive services and to quantify their experiences and satisfaction with available digital navigation tools.
Methods
A survey was offered via an email newsletter and social media posting throughout the extended membership of the National Alliance on Mental Illness, which includes both individuals with a mental health condition and their family members and support networks. A 13-item anonymous survey, which consisted of multiple-choice and open response options, was developed to measure participants’ past use of and experiences with web-based, mobile, and phone-based navigation tools. The survey was available from April 9 through May 21, 2020.
Results
A total of 478 respondents completed the survey; the majority of respondents were female (397/478, 83.1%) and aged ≥35 years (411/478, 86%). Younger respondents were more likely to report seeking mental health services for themselves, while older respondents were more likely to be searching for such services on behalf of a family member. The majority of respondents seeking such services on behalf of a family member (113/194, 58.2%) required a combination of mental health treatment and supportive services. Furthermore, two-thirds of respondents (322/478, 67.4%) used a navigation tool to find treatment or services. The majority of respondents who provided feedback about their experiences with navigation tools (224/280, 80%) reported difficulties, with data availability and accuracy being the most commonly reported issues.
Conclusions
The survey results suggest that issues with data availability and accuracy in available navigation tools remain a major barrier for locating timely and appropriate mental health treatment and supportive services within the population of individuals seeking such services. Particularly for individuals seeking care on behalf of a family member, improving the accuracy of and users’ experiences with navigation tools could have a major impact on effectively connecting people to treatment and support services.
Increasing both access to and quality of mental healthcare is a global priority. One solution is to integrate technologies such as smartphone apps and sensors directly into care. Acknowledging many ...prior attempts and barriers, we introduce the Digital Clinic which is an already functioning clinic using smartphone apps to augment and extend care today at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts. In this piece, we outline the theoretical foundation of the Digital Clinic and its emphasis on the therapeutic alliance, measurement-based care, and shared decision making. We explore both workflow and engagement challenges as well as solutions including a new care team member, the Digital Navigator, and the customization of technology. Acknowledging that the Digital Clinic is an evolving program, we offer details on our implementation in order to allow others to replicate, expand on, and improve these initial efforts.
Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision-Technology Enabled ...Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP.
TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design.
The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations.
The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction.
TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations.
PRR1-10.2196/23771.
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