Accepted for/Published in: JMIR Formative Research
Date Submitted: Feb 13, 2023
Date Accepted: Aug 8, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Development of the Implementing Technologies to Enhance Coordinated Specialty Care (iTECSC) Framework: Protocol for a Hybrid Effectiveness and Implementation Study of Technologically Supported Treatment in Coordinated Specialty Care.
ABSTRACT
Background:
Coordinated Specialty Care (CSC) has demonstrated efficacy in improving outcomes in Clinical High Risk for Psychosis (CHR-p) and First Episode Psychosis (FEP) populations. Given limitations in scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHI’s) may be explored to help support CSC service delivery.
Objective:
This study aims to understand methods to implement and support technology into routine CSC and offers a new protocol to further assess implementation barriers and facilitators.
Methods:
Patients and clinicians including psychiatrists, therapists, and supported education and employment (SEE) specialists from a CHR-p clinic (CEDAR) and a FEP clinic (ASPIRE) participated in a quality improvement project exploring the feasibility of DMHI’s following the Access, Alignment, Connection, Care, and Scalability (AACCS) framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients to implement mindLAMP. To explore differences in implementation effectiveness associated with application format, a menu-style format was delivered at CEDAR, and a modular approach was utilized at ASPIRE. Qualitative baseline and follow-up data were collected to assess specific implementation outcomes.
Results:
Participants (Aspire =3, CEDAR = 2) included 3 white (60%), 2 (40%) males, 2 (40%) females, and 1 (20%) transgender-man with a mean age of 19.6. Implementation outcome data revealed that patients and clinicians demonstrate readiness for digital technologies, but implementation barriers and facilitators may continue to be explored and improved through support from digital navigators, utilizing a patient-centered approach, and that versatility, autonomy, and structure are important features of any implementation model. These findings supported the development of the Implementing Technologies to Enhance Coordinated Specialty Care (iTECSC) protocol, an implementation framework directed at supporting implementation of DMHI’s towards clinician and patient dyads, guided by digital navigators that provides versatility, autonomy, and structure.
Conclusions:
This paper proposes a protocol that would further assess the effectiveness and implementation outcomes of iTECSC when compared with standard Digitally Enhanced Care (DEC). Results from this study would explore the effects of iTECSC in reducing symptoms and improving functioning, when compared to DEC, and would also provide further insights towards the nuanced implementation facilitators and barriers related to integrating digital technologies into CSC.
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Copyright
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