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Hilty DM, Stubbe D, McKean AJ, Hoffman PE, Zalpuri I, Myint MT, Joshi SV, Pakyurek M, Li STT. A scoping review of social media in child, adolescents and young adults: research findings in depression, anxiety and other clinical challenges. BJPsych Open 2023; 9:e152. [PMID: 37563766 PMCID: PMC10594088 DOI: 10.1192/bjo.2023.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Social media and other technologies are reshaping communication and health. AIMS This review addresses the relationship between social media use, behavioural health conditions and psychological well-being for youth aged <25 years. METHOD A scoping review of 11 literature databases from 2000 to 2020 explored research studies in youth in five areas: clinical depression and anxiety, quantitative use, social media mode, engagement and qualitative dimensions and health and well-being. RESULTS Out of 2820 potential literature references, 140 met the inclusion criteria. The foci were clinical depression and anxiety disorders (n = 78), clinical challenges (e.g. suicidal ideation, cyberbullying) (n = 34) and psychological well-being (n = 28). Most studies focused on Facebook, Twitter, Instagram and YouTube. Few studies are longitudinal in design (n = 26), had comparison groups (n = 27), were randomised controlled trials (n = 3) or used structured assessments (n = 4). Few focused on different youth and sociodemographic populations, particularly for low-income, equity-seeking and deserving populations. Studies examined association (n = 120; 85.7%), mediating (n = 16; 11.4%) and causal (n = 4; 2.9%) relationships. Prospective, longitudinal studies of depression and anxiety appear to indicate that shorter use (≤3 h/day) and purposeful engagement is associated with better mood and psychological well-being. Depression may predict social media use and reduce perception of support. Findings provide families, teachers and providers ways to engage youth. CONCLUSIONS Research opportunities include clinical outcomes from functional perspective on a health continuum, diverse youth and sociodemographic populations, methodology, intervention and privacy issues. More longitudinal studies, comparison designs and effectiveness approaches are also needed. Health systems face clinical, training and professional development challenges.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA; and Mental Health, Veterans Affairs Northern California Health Care System, California, USA
| | - Dorothy Stubbe
- Child Study Center, Yale School of Medicine, Connecticut, USA
| | | | - Pamela E. Hoffman
- Department of Psychiatry & Behavioral Science, Yale School of Medicine, Connecticut, USA
| | - Isheeta Zalpuri
- Department of Psychiatry & Behavioral Science, Stanford University Medical Center, California, USA
| | - Myo T. Myint
- Department of Psychiatry & Behavioral Science, Tulane University School of Medicine, Louisiana, USA
| | - Shashank V. Joshi
- Department of Psychiatry & Behavioral Science, Stanford University Medical Center, California, USA
| | - Murat Pakyurek
- Division of Child and Adolescent Psychiatry, University of California, Davis School of Medicine, California, USA
| | - Su-Ting T. Li
- Department of Pediatrics, University of California, Davis School of Medicine, California, USA
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Hilty DM, Groshong LW, Coleman M, Maheu MM, Armstrong CM, Smout SA, Crawford A, Drude KP, Krupinski EA. Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue. CLINICAL SOCIAL WORK JOURNAL 2023; 51:1-35. [PMID: 37360756 PMCID: PMC10233199 DOI: 10.1007/s10615-023-00865-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry & Behavioral Sciences, UC Davis, 2230 Stockton Boulevard, Sacramento, CA 95817 USA
| | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Marlene M. Maheu
- Coalition for Technology in Behavioral Sciences, Telebehavioral Health Institute, Inc, 5173 Waring Road #124, San Diego, CA 92120 USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, U.S., 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Shelby A. Smout
- Virginia Commonwealth University, 3110 Kensington Ave Apt 3, Richmond, VA 23221 USA
| | - Allison Crawford
- Ontario Mental Health at CAMH, Toronto, Canada
- University of Toronto, Toronto, Canada
- Suicide Prevention Service, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
| | - Kenneth P. Drude
- Coalition Technology in Behavioral Science, 680 E. Dayton Yellow Springs Rd, Fairborn, OH 45324 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
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Smith K, Torous J, Cipriani A. Teaching Telepsychiatry Skills: Building on the Lessons of the COVID-19 Pandemic to Enhance Mental Health Care in the Future. JMIR Ment Health 2022; 9:e37939. [PMID: 35358948 PMCID: PMC9617186 DOI: 10.2196/37939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19 has accelerated the use of telehealth and technology in mental health care, creating new avenues to increase both access to and quality of care. As video visits and synchronous telehealth become more routine, the field is now on the verge of embracing asynchronous telehealth, with the potential to radically transform mental health. However, sustaining the use of basic synchronous telehealth, let alone embracing asynchronous telehealth, requires new and immediate effort. Programs to increase digital literacy and competencies among both clinicians and patients are now critical to ensure all parties have the knowledge, confidence, and ability to equitably benefit from emerging innovations. This editorial outlines the immediate potential as well as concrete steps toward realizing the potential of a new, more personalized, scalable mental health system.
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Affiliation(s)
- Katharine Smith
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom.,Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom.,Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Mucic D, Shore JH, Hilty DM, Krysta K, Krzystanek M. Lessons Learned or Forgotten? Impacts of COVID-19 on the Future Direction of Global (e-)Mental Health Care. Curr Psychiatry Rep 2021; 23:86. [PMID: 34842979 PMCID: PMC8628486 DOI: 10.1007/s11920-021-01300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has impacted lives globally, posing unique challenges to mental health services exposing vulnerability and limitations within these systems. During the course of the pandemic, telecommunications technologies (e-mental health care) have served a critical role in psychiatric care. It is important to understand current lessons learned in e-mental health care and implications for global mental health systems for both emerging from the pandemic and after the pandemic has ended. RECENT FINDINGS There are significant regulatory, policy, and evaluation challenges for global e-mental health impacting patients, clinicians, health systems, and decision-makers. These include complex regulatory issues, difficulties of providing care across boundaries, and keeping pace with the implementation of new technologies in behavioral health. The collaborative development of global standards along with policies, appropriate regulations, and developing new models of research and development opens the possibility of improved access to care across national boundaries.
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Affiliation(s)
- D Mucic
- Little Prince Treatment Centre, Havneholmen 82, 5th, 1561, Copenhagen V, Denmark.
| | - J H Shore
- Office of Telehealth and Technology Implementation for Behavioral Health Practice and Science (TIPS), Department of Psychiatry, Aurora, USA
- Department of Psychiatry and Family Medicine, School of Medicine And Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D M Hilty
- VA Northern California Health Care, System & UC Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, CA, 95817, USA
| | - K Krysta
- Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Clinic of Psychiatric Rehabilitation, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland
| | - M Krzystanek
- Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Clinic of Psychiatric Rehabilitation, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland
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Hertlein KM, Drude K, Jordan SS. "What Next?": Toward telebehavioral health sustainability in couple and family therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:551-565. [PMID: 33818791 DOI: 10.1111/jmft.12510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.
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Zalpuri I, Domakonda M, Wrzosek M, DeJong S. Trainees on Technological Terrain: a Video Vignette-Based Tool to Teach E-Professionalism. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:224-230. [PMID: 33058052 DOI: 10.1007/s40596-020-01325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
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Cruz C, Orchard K, Shoemaker EZ, Hilty DM. A Survey of Residents/Fellows, Program Directors, and Faculty About Telepsychiatry: Clinical Experience, Interest, and Views/Concerns. ACTA ACUST UNITED AC 2021; 6:327-337. [PMID: 33585672 PMCID: PMC7870779 DOI: 10.1007/s41347-020-00164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
The effectiveness of telepsychiatry video for clinical care is well established, and clinician and psychiatry resident interest in it is growing—particularly in light of the COVID-19 impact. Still, few residency programs in the United States have core curricula, rotations/electives available, and competencies, and many faculty have no experience. A survey was sent via national organization listserves for residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience and interest, and views/concerns, using Likert-like and yes/no questions. Descriptive statistics and other analyses compared the groups to assess impact of clinical experience on interest and views/concerns. Respondents (N = 270) have limited clinical experience with telepsychiatry (46% none), with trainees having less than others, and yet, most were very interested or interested in it (68%). Trainees (N = 123) have concerns about being prepared for future practice. Clinical experience with video in the range of 6–20 h appears to dramatically increase interest and reduce concerns, though less time has a positive effect. Respondents have concerns about connectivity, medico-legal issues, and clinical effectiveness (e.g., diverse populations, psychosis, and emergencies) with telepsychiatry. More research is needed to assess current clinical and curricular experience, interest, and concerns. Additional curricular interventions during residency and fellowship training could build skills and confidence, if this is feasible, and the benefits outweigh the costs.
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Affiliation(s)
- Cesar Cruz
- Child and Adolescent Psychiatry, USC Institute of Psychiatry & Law, Los Angeles, CA USA
| | - Kali Orchard
- Yellowknife Adult and Child Psychiatry, Yellowknife, Canada
| | - Erica Z Shoemaker
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, USC and LAC+USC Medical Center, Los Angeles, CA USA
| | - Donald M Hilty
- Northern California Veterans Administration Health Care System, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Davis, CA USA
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A Survey Comparing Adult and Child Psychiatry Trainees, Faculty, and Program Directors' Perspectives About Telepsychiatry: Implications for Clinical Care and Training. ACTA ACUST UNITED AC 2021; 6:338-347. [PMID: 33501373 PMCID: PMC7820828 DOI: 10.1007/s41347-020-00187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
Telepsychiatry’s effectiveness is well established, and interest in it is growing, despite few residency/fellowship core curricula and rotations. A link to a cross-sectional survey was sent via national organization listservs for psychiatry residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience, and views/concerns about telepsychiatry. Descriptive statistics and other analyses compared groups to assess the impact of amount clinical experience and psychiatric specialty (general vs. child and adolescent psychiatry), on interest, and views/concerns about the practice of telepsychiatry. All respondents (N = 270; child psychiatry N = 89) have limited clinical experience with telepsychiatry (46% overall; 49% of non-child had none versus 40% child). Trainees (N = 123; child N = 43) expressed less interest than others. All respondents expressed worry about ability to do a physical exam, connectivity, medico-legal issues, and fit for diverse populations. Child respondents expressed less concern than others, but they reported more worry about loss of nonverbal cues. Clinical experience with telepsychiatry in the range of 6–20 h appears to build interest and allay concerns, though 1–5 h also may have a positive impact. More research is needed to assess clinical experience, interest, and concerns for adult and child psychiatry trainees and clinicians. Replicable, curricular interventions appear to be indicated.
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Hilty DM, Armstrong CM, Edwards-Stewart A, Gentry MT, Luxton DD, Krupinski EA. Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:252-277. [PMID: 33501372 PMCID: PMC7819828 DOI: 10.1007/s41347-020-00190-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023]
Abstract
Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.
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Affiliation(s)
- Donald M. Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, Washington, DC USA
| | | | - Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN US
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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Parish MB, Gonzalez A, Hilty D, Chan S, Xiong G, Scher L, Liu D, Sciolla A, Shore J, McCarron R, Kahn D, Iosif AM, Yellowlees P. Asynchronous Telepsychiatry Interviewer Training Recommendations: A Model for Interdisciplinary, Integrated Behavioral Health Care. Telemed J E Health 2021; 27:982-988. [PMID: 33434453 DOI: 10.1089/tmj.2020.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the development of a training model for ATP clinician skills. Methods: Clinical and procedural training for ATP clinicians (n = 5) was provided by master's-level, clinical mental health providers developed by three experienced telepsychiatrists (P.Y. D.H., and J.S) and supervised by a tele-psychiatrist (PY, GX, DL) through seminar, case supervision, and case discussions. A training manual and one-on-one sessions were employed for initial training. Unstructured expert discussion and feedback sessions were conducted in the training phase of the study in year 1 and annually thereafter over the remaining 4 years of the study. The notes gathered during those sessions were synthesized into themes to gain a summary of the study telepsychiatrist training recommendations for ATP interviewers. Results: Expert feedback and discussion revealed three overarching themes of recommended skill sets for ATP interviewers: (1) comprehensive skills in brief psychiatric interviewing, (2) adequate knowledge base of behavioral health conditions and therapeutic techniques, and (3) clinical documentation, integrated care/consultation practices, and e-competency skill sets. The model of training and skill requirements from expert feedback sessions included these three skill sets. Technology training recommendations were also identified and included: (1) awareness of privacy/confidentiality for electronic data gathering, storage, management, and sharing; (2) technology troubleshooting; and (3) video filming/retrieval. Conclusions: We describe and provide a suggested training model for the use of ATP integrated behavioral health. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians, and more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed. Clinical Trials number: NCT03538860.
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Affiliation(s)
- Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Alvaro Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Donald Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
- Northern California Veterans Administration, Sacramento, California, USA
| | - Steven Chan
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
- School of Medicine, Stanford University, Palo Alto, California, USA
- Addiction Treatment Services, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - David Liu
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Andres Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Jay Shore
- University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Robert McCarron
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Debra Kahn
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, Sacramento, California, USA
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
- Division of Clinical Affairs, University of California, Davis, Sacramento, California, USA
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Wright J, Dewan S, Hilty D, Dewan NA. Health Care Providers' Perceptions of Quality, Acceptance, and Satisfaction With Telebehavioral Health Services During the COVID-19 Pandemic: Survey-Based Study. JMIR Ment Health 2020; 7:e23245. [PMID: 33180740 PMCID: PMC7721630 DOI: 10.2196/23245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Due to rapidly increasing rates of COVID-19 across the country, system-wide changes were needed to protect the health and safety of health care providers and consumers alike. Technology-based care has received buy-in from all participants, and the need for technological assistance has been prioritized. OBJECTIVE The objective of this study was to determine the initial perceptions and experiences of interprofessional behavioral health providers about shifting from traditional face-to-face care to virtual technologies (telephonic and televideo) during the COVID-19 pandemic. METHODS A survey-based study was performed at a large, integrated medical health care system in West-Central Florida that rapidly implemented primary care provision via telephone and televideo as of March 18, 2020. A 23-item anonymous survey based on a 7-point Likert scale was developed to determine health care providers' perceptions about telephonic and televideo care. The survey took 10 minutes to complete and was administered to 280 professionals between April 27 and May 11, 2020. RESULTS In all, 170 respondents completed the survey in entirety, among which 78.8% (134/170) of the respondents were female and primarily aged 36-55 years (89/170, 52.4%). A majority of the respondents were outpatient-based providers (159/170, 93.5%), including psychiatrists, therapists, counselors, and advanced practice nurses. Most of them (144/170, 84.7%) had used televideo for less than 1 year; they felt comfortable and satisfied with either telephonic or televideo mode and that they were able to meet the patients' needs. CONCLUSIONS Our survey findings suggest that health care providers valued televideo visits equally or preferred them more than telephonic visits in the domains of quality of care, technology performance, satisfaction of technology, and user acceptance.
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Affiliation(s)
- Jesse Wright
- BayCare Health System, Clearwater, FL, United States
| | - Shyam Dewan
- Emory University, Atlanta, GA, United States
| | - Donald Hilty
- University of Southern California, Los Angeles, CA, United States
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Wisniewski H, Gorrindo T, Rauseo-Ricupero N, Hilty D, Torous J. The Role of Digital Navigators in Promoting Clinical Care and Technology Integration into Practice. Digit Biomark 2020; 4:119-135. [PMID: 33442585 PMCID: PMC7768140 DOI: 10.1159/000510144] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Hannah Wisniewski
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tristan Gorrindo
- American Psychiatric Association, Washington, District of Columbia, USA
| | - Natali Rauseo-Ricupero
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Don Hilty
- Department of Psychiatry and Behavioral Sciences, Northern California Veterans Administration Health Care System, University of California Davis, Mather, California, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Jamal AA, Aldawsari ST, Almufawez KA, Barri RM, Zakaria N, Tharkar S. Twitter as a promising microblogging application for psychiatric consultation - Understanding the predictors of use, satisfaction and e-health literacy. Int J Med Inform 2020; 141:104202. [PMID: 32506051 DOI: 10.1016/j.ijmedinf.2020.104202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The use of social media is widespread globally. It provides a quicker and faster means of efficient exchange of communications. The use of Twitter Applications to seek mental health advice is becoming popular. OBJECTIVES This study aims to identify the determinants associated with Twitter use in psychiatric consultations and to assess the level of satisfaction in using the microblogging platform. In addition, the level of e-health literacy is also assessed among users. METHODS The target population included Twitter users seeking psychiatric consultation. A leading psychiatrist's twitter account with 4.5 million followers was selected and consent obtained. A validated Patient Satisfaction Questionnaire was adopted to assess the level of satisfaction in Twitter use and e-health literacy. The questionnaire was tagged to the chosen Twitter account and reminders were sent until the sample size was reached. Data was analysed using SPSS version 22.0. The analysis included descriptive statistics tabulation, multi-response analysis, and cross-tabulation for satisfaction variables and the chi-square test was used to measure association between different variables. RESULTS The study obtained 155 completed response sheets, of which 52 were Twitter users seeking psychiatric advice while the rest sought general health advice. Most of the study participants were females (71.6 %). Women, single status and income range between 4000-9000 Saudi riyal were found to be significantly associated with Twitter use for psychiatric consultation. Generally, most of the participants were satisfied with Twitter in seeking psychiatric consultation that reduced financial disbursement. Furthermore, concerns were expressed regarding the waiting period, word limitations and issues of privacy. The e-health literacy was higher among the participants. CONCLUSION Psychiatric consultations via Twitter is more popular among women. By addressing privacy issues and reducing response time, Twitter may be used as a major platform to deliver mental health services to the population.
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Affiliation(s)
- Amr A Jamal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Evidence-Based Healthcare and Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia.
| | | | | | - Raghad M Barri
- College of Medicine at King Saud University in Riyadh, Saudi Arabia
| | - Nasriah Zakaria
- Medical Education Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Shabana Tharkar
- Prince Sattam Chair for Epidemiology and Public Health Research, King Saud University, Riyadh, Saudi Arabia
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Hilty DM, Torous J, Parish MB, Chan SR, Xiong G, Scher L, Yellowlees PM. A Literature Review Comparing Clinicians' Approaches and Skills to In-Person, Synchronous, and Asynchronous Care: Moving Toward Competencies to Ensure Quality Care. Telemed J E Health 2020; 27:356-373. [PMID: 32412882 DOI: 10.1089/tmj.2020.0054] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Research is increasing on asynchronous technologies used by specialist clinicians and primary care, including e-mail, text, e-consultation, and store-and-forward (asynchronous) options. Studies typically describe interventions and care outcomes rather than development of clinical skills for using technology. Methods: This article attempts to compare clinicians' approaches to, and skills for, asynchronous technologies versus in-person and synchronous (i.e., video) care. Literature from technology, health care, pedagogy, and business were searched from 2000 to 2019 for title words, including synchronous (e.g., video, telemental or behavioral health, telepsychiatry), asynchronous (e.g., app, e-consultation, e-mail, text, sensor in a wearable device), education, clinical, and consultation. Results: From a total of 4,812 potential references, two authors (D.M.H., J.T.) found 4,622 eligible for full text review and found 381 articles directly relevant to the concept areas in combination for full text review. However, exclusion criteria subtracted 305, leaving a total of 76 articles. While in-person and synchronous care are similar in many ways, the clinical approach to asynchronous care has many differences. As asynchronous technologies and models of care are feasible and effective, often for consultation, an outline of patient, primary care provider, and specialist clinician goals and skills are presented. Few studies specifically discuss skills or competencies for asynchronous care, but components from published clinical informatics, video, social media, and mobile health competencies were organized into Accreditation Council of Graduate Medical Education domains. Conclusions: Further implementation of science research is needed for asynchronous technology interventions, as well as clinician competencies using asynchronous technologies, to ensure optimal outcomes for patients in health care.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Burke Parish
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Steven R Chan
- Stanford University School of Medicine, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, UC Davis School of Medicine, Sacramento, California, USA
| | - Glen Xiong
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA.,Department of Internal Medicine, UC Davis School of Medicine, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Peter M Yellowlees
- Department of Psychiatry, UC Davis School of Medicine, Sacramento, California, USA
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15
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Hilty DM, Gentry MT, McKean AJ, Cowan KE, Lim RF, Lu FG. Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches. Mhealth 2020; 6:20. [PMID: 32270012 PMCID: PMC7136658 DOI: 10.21037/mhealth.2019.10.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 - July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and other databases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.
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Affiliation(s)
- Donald M. Hilty
- Northern California Veterans Administration Health Care System, Mather, CA 95655, USA
- Department of Psychiatry & Behavioral Sciences, UC Davis, Mather, CA 95655, USA
| | - Melanie T. Gentry
- Geriatric Psychiatry Fellowship, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Alastair J. McKean
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Kirsten E. Cowan
- Essentia Health and Child Psychiatrist Affiliated with Mayo Clinic Department of Psychiatry and Psychology, Hinckley, MN 55037, USA
| | - Russell F. Lim
- Emeritus Clinical Professor of Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Francis G. Lu
- Clinical Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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16
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Hilty D, Chan S, Torous J, Luo J, Boland R. A Framework for Competencies for the Use of Mobile Technologies in Psychiatry and Medicine: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e12229. [PMID: 32130153 PMCID: PMC7060500 DOI: 10.2196/12229] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/26/2019] [Accepted: 05/29/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. OBJECTIVE This paper sought out competencies for mobile technologies and/or an approach to define them. METHODS A scoping review was conducted to answer the following research question, "What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?" The review was conducted in accordance with the 6-stage scoping review process starting with a keyword search in PubMed/Medical Literature Analysis and Retrieval System Online, APA PsycNET, Cochrane, EMBASE, PsycINFO, Web of Science, and Scopus. The literature search focused on keywords in 4 concept areas: (1) competencies, (2) mobile technologies, (3) telemedicine mode, and (4) health. Moreover, 2 authors independently, in parallel, screened the search results for potentially relevant studies based on titles and abstracts. The authors reviewed the full-text articles for final inclusion based on inclusion/exclusion criteria. Inclusion criteria were keywords used from concept area 1 (competencies) and 2 (mobile technologies) and either 3 (telemedicine mode) or 4 (health). Exclusion criteria included, but were not limited to, keywords used from a concept area in isolation, discussion of skills abstractly, outline or listing of what clinicians need without detail, and listing immeasurable behaviors. RESULTS From a total of 1232 results, the authors found 78 papers eligible for a full-text review and found 14 papers directly relevant to the 4 key concepts. Although few studies specifically discussed skills, the majority were clinical studies, and the literature included no lists of measurable behaviors or competency sets for mobile technology. Therefore, a framework for mobile technology competencies was built according to the review, expert consensus, and recommendations of the Institute of Medicine's Health Professions Education Summit and Accreditation Council of Graduate Medical Education framework. This framework borrows from existing competency framework domains in telepsychiatry and social media (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication) and added domains of mHealth clinical decision support, device/technology assessment/selection, and information flow management across an electronic health record platform. mHealth Asynchronous components require additional traditional learning, teaching, supervisory and evaluation practices. Interactive curricula with case-, problem-, and system-based teaching may help faculty focus on decision making and shape skills and attitudes to complement clinical exposure. CONCLUSIONS Research is needed on how to customize implementation and evaluation of mHealth competencies and to ensure skill development is linked to the quality of care. This will require the management of organizational change with technology and the creation of a positive electronic culture in a complex policy and regulatory environment.
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Affiliation(s)
- Donald Hilty
- VA Northern California Health Care System, Mental Health & Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Mather, CA, United States
| | - Steven Chan
- Palo Alto VA Health Care System, Palo Alto, CA, United States
| | - John Torous
- Beth Israel Deaconess Medical Center, Psychiatry, Harvard School of Medicine, Boston, MA, United States
| | - John Luo
- Consultation-Liaison & Emergency Psychiatry, UC Irvine Department of Psychiatry, UCI Health, Irvine, CA, United States
| | - Robert Boland
- Harvard Longwood Psychiatry Residency Training Program, Brigham and Women's/Faulkner Hospitals, Harvard Medical School, Boston, MA, United States
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17
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A Review of Telepresence, Virtual Reality, and Augmented Reality Applied to Clinical Care. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s41347-020-00126-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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18
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Hilty DM, Unützer J, Ko DG, Luo J, Worley LLM, Yager J. Approaches for Departments, Schools, and Health Systems to Better Implement Technologies Used for Clinical Care and Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:611-616. [PMID: 31172384 DOI: 10.1007/s40596-019-01074-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Donald M Hilty
- University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Jürgen Unützer
- University of Washington School of Medicine, Seattle, WA, USA
| | - Dong-Gil Ko
- University of Cincinnati, Carl H. Lindner College of Business, Cincinnati, OH, USA
| | - John Luo
- University of California, Riverside Health, Riverside, CA, USA
| | - Linda L M Worley
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joel Yager
- University of Colorado at Denver School of Medicine, Denver, CO, USA
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19
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Miner AS, Shah N, Bullock KD, Arnow BA, Bailenson J, Hancock J. Key Considerations for Incorporating Conversational AI in Psychotherapy. Front Psychiatry 2019; 10:746. [PMID: 31681047 PMCID: PMC6813224 DOI: 10.3389/fpsyt.2019.00746] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/17/2019] [Indexed: 01/25/2023] Open
Abstract
Conversational artificial intelligence (AI) is changing the way mental health care is delivered. By gathering diagnostic information, facilitating treatment, and reviewing clinician behavior, conversational AI is poised to impact traditional approaches to delivering psychotherapy. While this transition is not disconnected from existing professional services, specific formulations of clinician-AI collaboration and migration paths between forms remain vague. In this viewpoint, we introduce four approaches to AI-human integration in mental health service delivery. To inform future research and policy, these four approaches are addressed through four dimensions of impact: access to care, quality, clinician-patient relationship, and patient self-disclosure and sharing. Although many research questions are yet to be investigated, we view safety, trust, and oversight as crucial first steps. If conversational AI isn't safe it should not be used, and if it isn't trusted, it won't be. In order to assess safety, trust, interfaces, procedures, and system level workflows, oversight and collaboration is needed between AI systems, patients, clinicians, and administrators.
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Affiliation(s)
- Adam S. Miner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
- Department of Communication, Stanford University, Stanford, CA, United States
| | - Nigam Shah
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Kim D. Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Bruce A. Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeremy Bailenson
- Department of Communication, Stanford University, Stanford, CA, United States
| | - Jeff Hancock
- Department of Communication, Stanford University, Stanford, CA, United States
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20
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Ho PA, Girgis C, Rustad JK, Noordsy D, Stern TA. Advancing the Mission of Consultation-Liaison Psychiatry Through Innovation in Teaching. PSYCHOSOMATICS 2019; 60:539-548. [PMID: 31493903 DOI: 10.1016/j.psym.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Consultation-liaison (C-L) psychiatry, similar to other medical specialties, relies on the education of students, residents, fellows, and life-long learners for growth of the field. C-L psychiatry is unique as it exists at the intersection of psychiatry with other medical subspecialties. Traditional teaching methods have been used in C-L psychiatry programs for more than 50 years, while technology has recently advanced as available resources and the learning styles of today's learners have evolved. A growing number of younger trainees are taking advantage of new ways to learn. OBJECTIVES We sought to examine both traditional and novel teaching methodologies and how each of these educational methodologies fits within adult learning theory and in the context of how digital natives learn about C-L psychiatry. METHODS In this narrative review, we drew upon the experiences of the authors as both life-long learners and educators. We then reviewed the literature pertaining to teaching methods that have been used in C-L psychiatry as well as emerging methods that could potentially be used in C-L psychiatry. RESULTS C-L psychiatry has used traditional teaching methods such as readings, didactic lectures, case-based rounds, and problem-based learning. Novel teaching methodologies such as teaching rotations, simulations, social media, podcasts, movie clubs, and the use of mobile tablet computers have been used in general psychiatry and other medical specialties, while literature specific to C-L psychiatry was sparse. CONCLUSIONS Opportunities abound to make use of new teaching methodologies and technologies to appeal to future generations of C-L psychiatrists.
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Affiliation(s)
- Patrick A Ho
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH; Dartmouth-Hitchcock Leadership Preventive Medicine Residency Program, Lebanon, NH; Dartmouth-Hitchcock Psychiatry Residency Program, Lebanon, NH.
| | - Christina Girgis
- Mental Health Service Line, Edward Hines Junior VA Hospital, Hines, IL; Department of Psychiatry, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - James K Rustad
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Mental Health and Behavioral Sciences, White River Junction VA Medical Center, White River Junction, VT
| | - Douglas Noordsy
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Mental Health and Behavioral Sciences, White River Junction VA Medical Center, White River Junction, VT
| | - Theodore A Stern
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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21
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Hilty DM, Chan S, Torous J, Luo J, Boland RJ. Mobile Health, Smartphone/Device, and Apps for Psychiatry and Medicine: Competencies, Training, and Faculty Development Issues. Psychiatr Clin North Am 2019; 42:513-534. [PMID: 31358129 DOI: 10.1016/j.psc.2019.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Faculty and trainees need clinical skills, knowledge, and attitudes to ensure quality care using technology. Clinical faculty teach, supervise, and role model skills for trainees and interprofessional team members. Mobile health, smartphone/device, and app competencies may be situated within the graduate medical education milestone domains. This article outlines these competencies and aligns them with clinical care, teaching methods, and evaluation. These competencies have similarities and differences from in-person and telepsychiatric care and additional dimensions like clinical decision support, technology selection, and information flow management across an e-platform. Health systems must integrate in-person and technology-based care, while maintaining the therapeutic relationship.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Steven Chan
- Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System, University of California, San Francisco, 3801 Miranda Avenue, Building 520F, Mail Code 116A, Palo Alto, CA 94304, USA
| | - John Torous
- Digital Psychiatry Division, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - John Luo
- UC Riverside Department of Psychiatry, UCR Health at Citrus Tower, 3390 University Avenue, Suite 115, Riverside, CA 92501, USA
| | - Robert J Boland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
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22
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Hilty DM, Liu HY, Stubbe D, Teshima J. Defining Professional Development in Medicine, Psychiatry, and Allied Fields. Psychiatr Clin North Am 2019; 42:337-356. [PMID: 31358116 DOI: 10.1016/j.psc.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Professional development refers to training, formal education, and/or advanced professional learning intended to help clinicians, teachers, researchers, and administrators improve their professional knowledge and effectiveness. Institutions have been trying to adapt to a rapidly changing internal and external environment, with resource constraints and competitive health care. Professional development may be contextualized using adult development, educational, and organizational perspectives, and most best practices overlap. Key partners are faculty, departments, institutions, and national organizations. Interprofessional, team-based and project-based longitudinal initiatives may ignite educational innovations, and serve as a method to learn authentically in the workplace, promote socialization, and change attitudes.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, Sacramento, CA 95655, USA.
| | - Howard Y Liu
- Department of Psychiatry, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA; Behavioral Health Education Center of Nebraska, Omaha, NE, USA
| | - Dorothy Stubbe
- Child Study Center, Child and Adolescent Psychiatry, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - John Teshima
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG-62, Toronto, Ontario M4N 3M5, Canada
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Liu HY, Beresin EV, Chisolm MS. Social Media Skills for Professional Development in Psychiatry and Medicine. Psychiatr Clin North Am 2019; 42:483-492. [PMID: 31358127 DOI: 10.1016/j.psc.2019.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Social media use is increasing in the United States. Because psychiatrists and physicians are becoming more active online, Twitter is emerging as a leading platform for professional development. Social media can enhance networking, serve as a tool for mentoring trainees and colleagues, introduce journal articles to new readers, and allow psychiatrists and physicians to advocate for health care issues. Psychiatrists and physicians should observe ethical standards for digital citizenship on Twitter and other social media platforms.
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Affiliation(s)
- Howard Y Liu
- Department of Psychiatry, University of Nebraska Medical Center, 985575 Nebraska Medical Center, Omaha, NE 68198-5575, USA.
| | - Eugene V Beresin
- Harvard Medical School, Massachusetts General Hospital One Bowdoin Square, 9th Floor, Boston, MA 02114, USA. https://twitter.com/GeneBeresinMD
| | - Margaret S Chisolm
- Johns Hopkins Medicine, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA. https://twitter.com/whole_patients
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Hilty DM, Chan S, Torous J, Luo J, Boland RJ. A Telehealth Framework for Mobile Health, Smartphones, and Apps: Competencies, Training, and Faculty Development. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00091-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hilty DM, DeJong S. Putting Technologies Used for Clinical Care and Education in Context. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:753-758. [PMID: 30350270 DOI: 10.1007/s40596-018-0996-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Sacramento, CA, USA.
| | - Sandra DeJong
- Harvard University School of Medicine, Cambridge, MA, USA
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26
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Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
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Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
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Hilty DM, Maheu MM, Drude KP, Hertlein KM. The Need to Implement and Evaluate Telehealth Competency Frameworks to Ensure Quality Care across Behavioral Health Professions. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:818-824. [PMID: 30426453 DOI: 10.1007/s40596-018-0992-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/16/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Donald M Hilty
- University of California Davis School of Medicine, Sacramento, CA, USA.
| | | | - Kenneth P Drude
- Coalition Technology in Behavioral Science, Fairborn, OH, USA
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