JMIR Publications

ABSTRACT

Background:

The rapid move online of mental health services following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need for learning from pre-pandemic digital services.

Objective:

To explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established digital provider to the UK National Health Service (NHS), and how online delivery enables young people and their families to access high quality assessments and interventions in a more timely, flexible and person centered manner.

Methods:

A realist evaluation (RE) multiple case-study design was used with 9 cases identified to be representative of the services provided by Healios. The research literature was used to define a program theory and 6 Context-Mechanism-Outcome (CMO) statements. The CMOs formed the basis for initial data extraction with novel elements added via an iterative process.

Results:

Ten key elements of online services were identified: 1. Flexibility of delivery and timely response, 2. Care is personalized to the individual, 3. Multiple interconnected services enable comprehensive care, 4. Effective client engagement and productive therapeutic relationships, 5. Utilization of multiple communication tools, 6. Clients are satisfied with the service, 7. Good clinical outcomes, 8. Ease of family involvement throughout sessions or from different locations, 9. Facilitates multi-agency working and integration with NHS services, 10. Risk and safeguarding can be managed. These elements supported the 6 CMOs: There was clear evidence that young people and their families valued the responsiveness and flexibility of the online mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic relationships, and client satisfaction. Multiple communication tools appeared to maximize engagement and working online facilitated multi-agency communication and the delivery of safe care. The above factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality.

Conclusions:

This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services, and how online delivery enables young people and their families to access assessments and interventions in a more timely, flexible and person centered manner. The 10 key elements of online service delivery explored through the 9 case studies suggest the potential advantages of online work. These elements can inform future research and aid the delivery of high-quality digital service provision. Clinical Trial: N/A