JMIR Publications

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) 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 insights from a quality improvement study assessing implementation outcomes of DMHI in CSC.

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 outcomes 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 high accessibility, acceptability, interest, and belief in the sustainability of DMHI. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, results suggested that adoption, penetration, feasibility, and appropriateness outcomes were moderate and may continue to be explored and targeted.

Conclusions:

Implementation outcomes from this project suggest the need for a patient and clinician-centered approach guided by digital navigators that provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHI in CSC, accessibility and uptake of DMHI will improve, therefore connecting patients to demonstrated benefits of technology-augmented care.