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Dimitropoulos G, Bassi EM, Bright KS, Gondziola J, Bradley J, Fersovitch M, Stamp L, LaMonica HM, Iorfino F, Gaskell T, Tomlinson S, Johnson DW. Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders. JMIR Ment Health 2024; 11:e49099. [PMID: 38231558 PMCID: PMC10831665 DOI: 10.2196/49099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. OBJECTIVE The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. METHODS Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. RESULTS Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. CONCLUSIONS Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Emilie M Bassi
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Katherine S Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, AB, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jason Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Jessica Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Melanie Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Leanne Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | | | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Tanya Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Sara Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - David Wyatt Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Capon W, Hickie IB, Fetanat M, Varidel M, LaMonica HM, Prodan A, Piper S, Davenport TA, Mughal S, Shah JL, Scott EM, Iorfino F. A multidimensional approach for differentiating the clinical needs of young people presenting for primary mental health care. Compr Psychiatry 2023; 126:152404. [PMID: 37524044 DOI: 10.1016/j.comppsych.2023.152404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES There is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care. METHODS 1284 people aged 12-25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality. RESULTS A three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder. CONCLUSIONS A large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Masoud Fetanat
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Australia.
| | | | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Australia; Translational Health Research Institute, Western Sydney University, Australia; School of Computer, Data and Mathematical Sciences, Western Sydney University, Australia.
| | - Sarah Piper
- Brain and Mind Centre, The University of Sydney, Australia.
| | | | - Sarah Mughal
- McGill University, Department of Psychiatry, Montreal, Canada.
| | - Jai L Shah
- McGill University, Department of Psychiatry, Montreal, Canada.
| | | | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Australia.
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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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McKenna S, Piper S, Capon W, Crowley A, Lira L, LaMonica HM, Chong MK, Scott E, Hickie I, Iorfino F. The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study. JMIR Hum Factors 2023; 10:e42993. [PMID: 37490321 PMCID: PMC10410532 DOI: 10.2196/42993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. OBJECTIVE This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. METHODS An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. RESULTS After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). CONCLUSIONS This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician's underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question.
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Affiliation(s)
- Sarah McKenna
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Sarah Piper
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - William Capon
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Lucas Lira
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Haley M LaMonica
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Min Kyung Chong
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Elizabeth Scott
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Ian Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Frank Iorfino
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
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Hampton-Anderson JN, Novacek DM, Zhen-Duan J, Latimer S, Perry T, Renard D. Redefining the Role of Public Health Professionals Serving Black Youths Seeking Mental Health Care: Implications for Training and Mentoring. Am J Public Health 2023; 113:S140-S148. [PMID: 37339410 PMCID: PMC10282850 DOI: 10.2105/ajph.2022.307194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 06/22/2023]
Abstract
Attrition rates for Black youths in mental health treatment settings are high, and the extant literature suggests this may be because treatment is not meeting their unique needs. Public health professionals, defined here as all individuals who work to increase the well-being of youths, can play a major role in changing these outcomes. The purpose of this article is to suggest a broader scope of practice, or a redefined role, for public health professionals who work with Black youths seeking outpatient mental health care and to explicate ways in which training and mentoring can help accomplish this goal. Bolstered by a socioecological conceptual model, we suggest 3 standards of practice that we believe must be satisfied to meet the requirement for this redefined public health professional role: using a sociocultural framework, exercising flexibility in one's assigned role, and understanding and incorporating culturally specific strengths and protective factors into care. (Am J Public Health. 2023;113(S2):S140-S148. https://doi.org/10.2105/AJPH.2022.307194).
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Affiliation(s)
- Joya N Hampton-Anderson
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Derek M Novacek
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Jenny Zhen-Duan
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Saundra Latimer
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Tyler Perry
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
| | - Destini Renard
- Joya N. Hampton-Anderson is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Derek M. Novacek is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. Jenny Zhen-Duan is with the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA. Saundra Latimer is with the Emory University School of Public Health, Atlanta. Tyler Perry is with the Emory University School of Medicine, Atlanta. Destini Renard is with the College of Arts and Sciences, Emory University, Atlanta
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Eapen V, Stylianakis A, Scott E, Milroy H, Bowden M, Haslam R, Stathis S. Stemming the tide of mental health problems in young people: Challenges and potential solutions. Aust N Z J Psychiatry 2023; 57:482-488. [PMID: 36377648 DOI: 10.1177/00048674221136037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One in five people experience clinically relevant mental health problems before the age of 25 years. Furthermore, in Australia, one in seven children are reported to experience a mental health disorder. Consequently, there has been a steady increase in demand for mental health services for children and young people, and this has been compounded by the COVID-19 pandemic. Unfortunately, currently many children and young people with mental health difficulties are not accessing appropriate and/or timely care, with individuals and families finding it increasingly difficult to access and navigate suitable services. In part, this is related to the fragmented and isolated manner in which child mental health services are operating. To address the current issues in access to appropriate child and adolescent mental health care in Australia, a novel Integrated Continuum of Connect and Care model is proposed to integrate relevant services along a tiered care pathway. The aim of this model is to facilitate timely access to mental health services that meet the specific needs of each child/young person and their family. This model will function within co-located service hubs that integrate health care through a comprehensive assessment followed by a link up to relevant services. The Integrated Continuum of Connect and Care has the potential to pave the way for unifying the fragmented child and youth mental health system in Australia.
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Affiliation(s)
- Valsamma Eapen
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, Australia, Sydney, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Academic Unit of Infant Child and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthea Stylianakis
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, Australia, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Academic Unit of Infant Child and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Elizabeth Scott
- Faculty of Medicine and Health, Brain and Mind Centre, Sydney University, Sydney, NSW, Australia
| | - Helen Milroy
- Perth Children's Hospital, Nedlands, WA, Australia
- Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Michael Bowden
- Perinatal, Child and Youth, Mental Health Branch, NSW Health, St Leonards, NSW, Australia
- Department of Psychiatry, Faculty of Medicine and Health, Western Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Ric Haslam
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Stephen Stathis
- Mental Health, Alcohol and Other Drugs Branch, Queensland Health, Brisbane, QLD, Australia
- Department of Psychiatry, Child and Youth Mental Health Services, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
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Capon W, Hickie IB, Varidel M, Prodan A, Crouse JJ, Carpenter JS, Cross SP, Nichles A, Zmicerevska N, Guastella AJ, Scott EM, Scott J, Shah J, Iorfino F. Clinical staging and the differential risks for clinical and functional outcomes in young people presenting for youth mental health care. BMC Med 2022; 20:479. [PMID: 36514113 PMCID: PMC9749194 DOI: 10.1186/s12916-022-02666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical staging proposes that youth-onset mental disorders develop progressively, and that active treatment of earlier stages should prevent progression to more severe disorders. This retrospective cohort study examined the longitudinal relationships between clinical stages and multiple clinical and functional outcomes within the first 12 months of care. METHODS Demographic and clinical information of 2901 young people who accessed mental health care at age 12-25 years was collected at predetermined timepoints (baseline, 3 months, 6 months, 12 months). Initial clinical stage was used to define three fixed groups for analyses (stage 1a: 'non-specific anxious or depressive symptoms', 1b: 'attenuated mood or psychotic syndromes', 2+: 'full-threshold mood or psychotic syndromes'). Logistic regression models, which controlled for age and follow-up time, were used to compare clinical and functional outcomes (role and social function, suicidal ideation, alcohol and substance misuse, physical health comorbidity, circadian disturbances) between staging groups within the initial 12 months of care. RESULTS Of the entire cohort, 2093 young people aged 12-25 years were followed up at least once over the first 12 months of care, with 60.4% female and a baseline mean age of 18.16 years. Longitudinally, young people at stage 2+ were more likely to develop circadian disturbances (odds ratio [OR]=2.58; CI 1.60-4.17), compared with individuals at stage 1b. Additionally, stage 1b individuals were more likely to become disengaged from education/employment (OR=2.11, CI 1.36-3.28), develop suicidal ideations (OR=1.92; CI 1.30-2.84) and circadian disturbances (OR=1.94, CI 1.31-2.86), compared to stage 1a. By contrast, we found no relationship between clinical stage and the emergence of alcohol or substance misuse and physical comorbidity. CONCLUSIONS The differential rates of emergence of poor clinical and functional outcomes between early versus late clinical stages support the clinical staging model's assumptions about illness trajectories for mood and psychotic syndromes. The greater risk of progression to poor outcomes in those who present with more severe syndromes may be used to guide specific intervention packages.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, 2751, Australia.,School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, 2751, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Shane P Cross
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | | | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, H3A 0G4, Canada
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.
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Abstract
Human-computer interaction (HCI) has contributed to the design and development of some efficient, user-friendly, cost-effective, and adaptable digital mental health solutions. But HCI has not been well-combined into technological developments resulting in quality and safety concerns. Digital platforms and artificial intelligence (AI) have a good potential to improve prediction, identification, coordination, and treatment by mental health care and suicide prevention services. AI is driving web-based and smartphone apps; mostly it is used for self-help and guided cognitive behavioral therapy (CBT) for anxiety and depression. Interactive AI may help real-time screening and treatment in outdated, strained or lacking mental healthcare systems. The barriers for using AI in mental healthcare include accessibility, efficacy, reliability, usability, safety, security, ethics, suitable education and training, and socio-cultural adaptability. Apps, real-time machine learning algorithms, immersive technologies, and digital phenotyping are notable prospects. Generally, there is a need for faster and better human factors in combination with machine interaction and automation, higher levels of effectiveness evaluation and the application of blended, hybrid or stepped care in an adjunct approach. HCI modeling may assist in the design and development of usable applications, and to effectively recognize, acknowledge, and address the inequities of mental health care and suicide prevention and assist in the digital therapeutic alliance.
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