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Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development

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Digital mental health interventions (DMHIs) show promise for enhancing coordinated specialty care (CSC) for psychosis. A patient- and clinician-centered approach with digital navigators is key for successful implementation and wider adoption.

Keywords:
clinical high riskcoordinated specialty caredigital healthdigital mental healthdigital navigatorimplementation sciencemobile phonepsychosisschizophreniatechnology

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Area of Science:

  • Digital Mental Health
  • Psychosis Care
  • Implementation Science

Background:

  • Coordinated specialty care (CSC) is effective for early psychosis intervention.
  • Scalability and staffing challenges necessitate exploring digital mental health interventions (DMHIs) to augment CSC.
  • DMHIs can potentially enhance service delivery and patient outcomes in psychosis care.

Purpose of the Study:

  • To investigate methods for implementing and supporting technology within routine CSC.
  • To assess implementation outcomes of DMHIs in CSC through a quality improvement study.
  • To understand patient and clinician perspectives on DMHI feasibility and utility.

Main Methods:

  • A quality improvement project utilized the Access, Alignment, Connection, Care, and Scalability (AACC) framework to implement the mindLAMP DMHI.
  • Digital navigators supported patients and clinicians across a clinical-high-risk-for-psychosis clinic (CEDAR) and a first-episode-psychosis clinic (ASPIRE).
  • Qualitative data were collected to evaluate implementation outcomes, comparing a menu-style app format (CEDAR) with a modular format (ASPIRE).

Main Results:

  • Patients and clinicians reported high accessibility, acceptability, interest, and belief in the sustainability of DMHIs.
  • Varied interest in specific DMHI use cases and perceived feasibility/appropriateness were noted, highlighting nuanced barriers.
  • Moderate adoption, penetration, feasibility, and appropriateness outcomes suggest areas for further development and targeting.

Conclusions:

  • A patient- and clinician-centered approach, guided by digital navigators, is crucial for successful DMHI implementation in CSC.
  • Versatility, autonomy, and structure within DMHIs are essential for optimal engagement and outcomes.
  • Addressing implementation barriers is vital to improve DMHI adoption, penetration, and ultimately, patient access to technology-augmented care.