Implementation and Improvement Suggestions for Digital Technologies in Coordinated Specialty Cares for First Episode Psychosis (FEP) and Clinical High Risk for Psychosis (CHR-p)

Claire Goods, BS, James Green, BA, Joey Rodriquez, Michal Musikavanhu, BA, Isabel Brown, Wenhui Qi, Ananya Saluja, BA, John Tourous, MD

1. Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center
2. Harvard Medical School Department of Psychiatry, Boston, Massachusetts.

Abstract

Background: Coordinated Specialty Care (CSC) has demonstrated efficacy in improving outcomes in CHR-p and FEP populations. To help support CSC service delivery, the augmentation of services using digital mental health interventions (DMHI’s) may be explored. This study aims to understand methods to implement and support technology into routine CSC care.

Methods: Clients and clinicians from a CHR-p clinic (CEDAR) and a FEP clinic (ASPIRE) participated in a quality improvement project exploring the feasibility of following the AACCS framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and clients to implement MindLAMP. To explore differences in implementation effectiveness associated with application format, a menu-style format was delivered at CEDAR, and a module approach was utilized at ASPIRE. Qualitative baseline and follow-up data were collected to assess specific implementation outcomes.

Results: Participants (n =5) included 3 white (60%), 2 (40%) males, 2 (40%) females, and 1 (20%) transgender with a mean age of 19.6 years old. Implementation outcome data revealed that clinicians and clients demonstrated high levels of access, connection, and sustainability of technology. Clients and clinicians reported significant variations in the types of clinical care they wished the technologies to support, ranging from case-management, exposure and response prevention, and measurement-based care. Differences in implementation styles revealed that clients are more responsive and engaged in the intervention when delivered in a module approach including a schedule for data collection and interventions.

Discussion: Utilizing specific case studies, these findings provide insights to guide implementation of technologies supporting CSC care. This study demonstrates the importance of technology to provide autonomy for clients in and clinicians in their use, the utility of a digital navigator in training and implementation, and that technologies are best implemented when they are versatile, rather than complex.