Evaluation and recommendation of mobile technology for early course psychosis care
Camacho, Erica Jazmine
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BACKGROUND: Demand for mental health services, especially for clinical high-risk and early psychosis, has increased, creating a need for new solutions to increase access to and quality of care. Smartphones and mobile technology are potential tools to support coordinated specialty care (CSC) for early psychosis, given their potential to augment the six core roles of care: case management and team leadership, recovery-oriented psychotherapy, medication management, support for employment and education, coordination with primary care services, and family education and support. Such digital tools could enhance patient care and mitigate challenges for CSC. However, the services smartphones are offering specifically for coordinated specialty care and the level of evidence are unknown. OBJECTIVE: This thesis consists of three phases: 1) to review the published literature on smartphone technology to enhance care for patients with prodromal and early course psychosis and schizophrenia, 2) to create technology implementation guidelines for coordinated specialty care programs, and 3) to assess the framework created in phase two by implementing it at diverse sites across the country. METHODS: Phase I involved a systematic literature search conducted on August 16 and 17, 2019 which used PubMed, EMBASE, Web of Sciences, and PsycINFO electronic databases. All eligible studies were reviewed and screened based on inclusion and exclusion criteria. Phase II was guided by the results discovered in phase I and consisted of modifying the Replicating Effective Programs framework to create a CSC focused model. Phase III entailed the implementation of the framework at eight coordinated specialty care programs in the United States. Findings from each visit guide improvements for the framework. RESULTS: The search conducted in phase I uncovered 388 unique results, of which 21 eligible studies on 16 unique app platforms were identified. Feasibility studies showed high user engagement and interest among patients, monitoring studies demonstrated correlations between app assessments and clinical outcomes, and intervention studies indicated that these apps have the potential to advance care. The AACCS framework was developed in phase II which is composed of five stages: 1) Assess (e.g. identifying access to and comfort with technology), 2) Align (e.g. understanding aspects of coordinated specialty care that technology can augment), 3) Connect (e.g. customizing technology to the needs of patients and clinicians), 4) Care (e.g. implementing the digital tools into treatment), and 5) Sustain (e.g. creating sustainable technology-enabled mental health services). As phase III is ongoing, only results from the first few site visits are shared. Site 1, an amalgamation of three distinct programs, showcased that access to technology was not a barrier, however other aspects necessary for successful technology implementation were missing, such as access to high-speed internet and adequate technology training. Although staff members reported low confidence with technology, they all believed in the potential of technology to assist with all six key roles of CSC. CONCLUSION: The published literature on smartphone apps for prodromal and first-episode psychosis is small but is growing exponentially. Although the research results and protocols for app studies do not align well with all key roles of coordinated specialty care, high rates of adoption and feasibility suggest the potential for future efforts. The findings from the literature review guided the creation of the AACCS framework. This framework is intended to assist CSC programs in the identification of clinical targets to be augmented with digital tools. Implementation of the AACCS framework at many sites highlighted a need for digital literacy training for both patients and staff members. Technology has the unique potential to reduce staff workload, support CSC efforts, and expand the reach of early course psychosis care by erasing distance.