JMIR Publications

ABSTRACT

Background:

During COVID-19 in Canada, mental-health issues worsened while face-to-face and distance mental-health services were rarely operational. Trials of computer-assisted, telephone, and videoconferencing interventions document mental health improvements especially using cognitive behavior therapy (CBT). However, fewer trials offer strong or real-world evidence for treating a broad spectrum of disorders including trauma in a clinical service.

Objective:

This study explored a telephone/videoconferencing mental health intervention, Carepath Mental Health Program (CMHP), using non-random assignment to lower (navigation) or higher (psychotherapy) distress groups. Researchers documented proof-of-concept questions—feasibility, acceptability, and usefulness—for a future randomized clinical trial (RCT).

Methods:

In this unblinded, closed-user-group study in teacher’s-union members, seven mental health clinicians (MHCs) intervened using videoconferencing and/or telephone. Clients (n=80) and clinicians reported self-assessed outcomes using Qualtrics XM and attended exit interviews by videoconferencing. The teacher’s union website listed mental health coverage options including CMHP. Participants called CMHP directly for intakes. Once accepted, a supervisor assigned clients to MHCs: navigation (mild distress) or psychotherapy (moderate distress). At session one, clinicians presented this study and reviewed informed consent. Clients were union-eligible as active or retired educators and their family members, and study-eligible if over age 19, not high risk, and signed consent. The seven MHCs signed informed consent and completed questionnaires at baseline, end-of-study, and over time for each of their clients. Researchers evaluated feasibility using the percentage of those eligible entering the study and acceptability by median number and IQR of sessions attended and assessment dropouts. Self-reported suitability and working alliance over time explored formative questions. For usefulness, analyses explored trajectories of one primary (SF-36) and three secondary (GAD-7; PHQ-9; PCL-5) quantitative outcomes.

Results:

This study was feasible, with consecutive clients (77.24%, 123/167) meeting both CMHP criteria, and study eligibility. The majority (62.02%, 80/123) enrolled versus (38%, 49/123) who declined. Assigned clinical groups (navigation (n=41) and psychotherapy (n=39)) participated in a median eight sessions (median 6–7 months). Four clients completed no follow-ups. Suitability and working alliance ratings increased over time in each group, also indicating acceptability. By intention-to-treat using linear mixed effects (LME) models, all models showed improvement: SF-36 (t= 5.52, p<.001); GAD-7 (t= -5.66, p<0.001); PHQ-9 (t= -5.83, p<.001); PCL-5 (t= -2.95, p<.01).

Conclusions:

This study suggests that an RCT of these telephone/videoconferencing interventions is likely feasible, acceptable, and useful. This early-stage study had no control nor randomization. A future RCT, testing program effectiveness, would require control groups for each intervention (navigation and psychotherapy). If effective, the program could enhance Canadian options to fill mental-health service gaps for those who cannot meet face-to-face, or prefer distance interventions. Broadly implemented, it could fill mental-health service gaps for teacher’s union members and other employees. Clinical Trial: None