Integrating Digital Tools Into Children's Mental Health Care E-Book

Deborah J. Jones

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch
• Veröffentlichungsjahr: 2023

Seitenzahl: 187

Beschreibung

Practitioners need to know the evidence behind using digital mental health approaches and tools, including telemental health visits. This accessible book provides that help, as the authors guide the reader through the rationale, options, and strategies for incorporating digital tools into children's mental health care, drawing on their extensive knowledge of both current research and clinical practice. They outline the leading theoretical approaches that highlight mechanisms involved in digital tools increasing access to, engagement in, and outcomes of evidence-based mental health services for children and families. Through clinical vignettes and hands-on exercises included in this Advances in Psychotherapy series volume, mental health providers will gain insight into how to select a digital tool and identify its various uses. The reader is also given the opportunity to explore their own attitudes and comfort with incorporating digital tools into practice with their young clients and their families. Numerous downloadable handouts and forms for clinical use are provided in the appendix.

Leseprobe

Advances in Psychotherapy – Evidence-Based Practice, Volume 52

Integrating Digital Tools Into Children’s Mental Health Care

Deborah J. Jones

University of North Carolina at Chapel Hill, NC

Margaret T. Anton

Two Chairs, San Francisco, CA

About the Authors

Deborah J. Jones, PhD, is the Zachary Smith Distinguished Term Professor and Associate Chair of Psychology and Neuroscience at the University of North Carolina at Chapel Hill. She has had multiple grants from the National Institute of Mental Health to study the role of digital tools in children’s mental health and has over 100 publications on related topics. She also teaches a digital mental health course at the university.

Margaret T. Anton, PhD, is a senior clinical innovation and research manager at Two Chairs, a behavioral health company using technology and design to improve the process of accessing and receiving quality mental health care. Over the past ten years, she has developed, evaluated, and implemented technology-enabled behavioral interventions in academic, community, and industry settings.

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, Professor Emeritus, University of Missouri–Saint Louis, MO

Associate Editors

Jonathan S. Comer, PhD, Professor of Psychology and Psychiatry, Director of Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL

J. Kim Penberthy, PhD, ABPP, Professor of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Continuing Education Credits

Psychologists and other healthcare providers may earn five continuing education credits for reading the books in the Advances in Psychotherapy series and taking a multiple-choice exam. This continuing education program is a partnership of Hogrefe Publishing and the National Register of Health Service Psychologists. Details are available at https://www.hogrefe.com/us/cenatreg

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

Library of Congress of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2023943287

Library and Archives Canada Cataloguing in Publication

Title: Integrating digital tools into children’s mental health care / Deborah J. Jones, University

of North Carolina at Chapel Hill, NC ; Margaret T. Anton, Two Chairs, San Francisco, CA.

Names: Jones, Deborah J. (Deborah Jean), 1971- author. | Anton, Margaret T., author.

Series: Advances in psychotherapy--evidence-based practice ; v. 52.

Description: Series statement: Advances in psychotherapy--evidence-based practice ; volume 52 |

Includes bibliographical references.

Identifiers: Canadiana (print) 20230504612 | Canadiana (ebook) 20230504604 | ISBN 9780889376014

(softcover) | ISBN 9781613346013 (EPUB) | ISBN 9781616766016 (PDF)

Subjects: LCSH: Mentally ill children—Care—Technological innovations. | LCSH: Child mental health

services—Technological innovations.

Classification: LCC RJ499 .J66 2023 | DDC 618.92/8900285—dc23

© 2024 by Hogrefe Publishing

www.hogrefe.com

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

Registered trademarks are not noted specifically as such in this publication. The use of descriptive names, registered names, and trademarks does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

The cover image is an agency photo depicting models. Use of the photo on this publication does not imply any connection between the content of this publication and any person depicted in the cover image. Cover image: © vgajic – iStock.com

PUBLISHING OFFICES

USA:

Hogrefe Publishing Corporation, 44 Merrimac St., Suite 207, Newburyport, MA 01950

Phone [phone]; E-mail [email protected]

EUROPE:

Hogrefe Publishing GmbH, Merkelstr. 3, 37085 Göttingen, Germany

Phone [phone], Fax [phone]; E-mail [email protected]

SALES & DISTRIBUTION

USA:

Hogrefe Publishing, Customer Services Department, 30 Amberwood Parkway, Ashland, OH 44805

Phone [phone], Fax [phone]; E-mail [email protected]

UK:

Hogrefe Publishing, c/o Marston Book Services Ltd., 160 Eastern Ave., Milton Park, Abingdon, OX14 4SB

Phone [phone], Fax [phone]; E-mail [email protected]

EUROPE:

Hogrefe Publishing, Merkelstr. 3, 37085 Göttingen, Germany

Phone [phone], Fax [phone]; E-mail [email protected]

OTHER OFFICES

CANADA:

Hogrefe Publishing Corporation, 82 Laird Drive, East York, Ontario, M4G 3V1

SWITZERLAND:

Hogrefe Publishing, Länggass-Strasse 76, 3012 Bern

Copyright Information

The eBook, including all its individual chapters, is protected under international copyright law. The unauthorized use or distribution of copyrighted or proprietary content is illegal and could subject the purchaser to substantial damages. The user agrees to recognize and uphold the copyright.

License Agreement

The purchaser is granted a single, nontransferable license for the personal use of the eBook and all related files.

Making copies or printouts and storing a backup copy of the eBook on another device is permitted for private, personal use only. This does not apply to any materials explicitly designated as copyable material (e.g., questionnaires and worksheets for use in practice).

Other than as stated in this License Agreement, you may not copy, print, modify, remove, delete, augment, add to, publish, transmit, sell, resell, create derivative works from, or in any way exploit any of the eBook’s content, in whole or in part, and you may not aid or permit others to do so. You shall not: (1) rent, assign, timeshare, distribute, or transfer all or part of the eBook or any rights granted by this License Agreement to any other person; (2) duplicate the eBook, except for reasonable backup copies; (3) remove any proprietary or copyright notices, digital watermarks, labels, or other marks from the eBook or its contents; (4) transfer or sublicense title to the eBook to any other party.

These conditions are also applicable to any files accompanying the eBook that are made available for download.

Should the print edition of this book include electronic supplementary material then all this material (e.g., audio, video, pdf files) is also available with the eBook edition.

Format: EPUB

ISBN 978-0-88937-601-4 (print) • ISBN 978-1-61676-601-6 (PDF) • ISBN 978-1-61334-601-3 (EPUB)

https://doi.org/10.1027/00601-000

Citability: This EPUB includes page numbering between two vertical lines (Example: |1|) that corresponds to the page numbering of the print and PDF ebook versions of the title.

Dedication

We dedicate this book to the mentors who instilled in us the importance of the link between research and practice and the children and families with whom we have worked in both domains.

|vii|Acknowledgments

We are grateful to the American Psychological Association (APA Division 12) and Hogrefe for producing a book that aims to bridge the research-to-practice gap in children’s mental health. We thank our series editor, Jonathan Comer, for allowing us to share our knowledge and experience toward practical guidance for clinicians interested in incorporating digital tools into their practice. Dr. Jones also extends her gratitude to the APA Division 12 Task Force on Digital Mental Health (Jenna Carl, Jon Comer, Brian Doss, Oliver Lindhiem, Adela Timmons, Ken Weingardt). Participation in this group has profoundly enriched my understanding of the nuances inherent in the impact of digital innovation on mental health service delivery and the critical importance of collaboration between industry, academics, practitioners, and policymakers. Finally, both Dr. Anton and Dr. Jones would like to acknowledge the children and families with whom we have worked as our experiences with them helped to shape our interest in digital mental health.

Contents

Acknowledgments

Preface

1  Description

1.1  Terminology

1.2  Definition

1.3  Telemental Health

1.3.1  Nonpublic Facing Video Communication

1.3.2  HIPAA Compliance

1.3.3  HITECH Act

1.3.4  Reimbursement

1.4  Mobile (Mental) Health

1.5  Mental Health Apps

1.6  Digital Therapeutics

1.7  Stand-Alone Treatments

1.8  Digital Games

1.9  Augmented and Virtual Reality

1.10  Just-in-Time (Adaptive) Intervention

1.11  Artificial Intelligence and Machine Learning

1.12  Psychological Interjurisdictional Compact

2  Theories and Models

2.1  Evidence-Based Practice

2.1.1  Cognitive and Behavioral Theories

2.2  Health Behavior Models

2.3  Technology Acceptance Model

2.4  Implementation Models

2.5  User-Centered Design

2.6  Models of Incorporating Digital Mental Health Tools Into Practice

3  Assessment and Treatment Indications

3.1  Case Conceptualization

3.2  Participants (Parent or Child)

3.3  Sociodemographic Factors

3.3.1  Socioeconomic Status

3.3.2  Age

3.3.3  Parent Gender and Family Structure

3.3.4  Race/Ethnicity

3.3.5  Sexual and Gender Minority Youth

3.3.6  Geographic Region

3.4  Technological Literacy

3.5  Attitudes

3.6  Disorder

4  Treatment

4.1  Methods of Treatment

4.1.1  Evidence Base for Digital Tools in Clinical Practice With Children

4.1.2  Integration of Digital Tools in Clinical Practice With Children

4.1.3  Security and Privacy With Digital Tools in Clinical Practice With Children

4.1.4  Ethical Issues With Digital Tools in Clinical Practice With Children

4.1.5  Cultural Considerations With Digital Tools in Clinical Practice With Children

4.2  Mechanisms of Action

4.3  Efficacy and Prognosis

4.3.1  Does Technology Increase Access to Children’s Mental Health Services?

4.3.2  Does Technology Increase Engagement in Children’s Mental Health Services?

4.3.3  Does Technology Improve Outcomes of Children’s Mental Health Services?

4.3.4  Summary

4.3.5  Implementation Outcomes

4.4  Variations of the Method and Combinations With Other Approaches

4.5  Problems in Carrying Out the Treatments

4.6  Multicultural Issues

5  Case Vignettes

6   Further Reading

7  References

8  Appendix: Tools and Resources

|xi|Preface

COVID-19 and associated stay-at-home and social distancing public health guidelines dramatically expedited the use of digital tools in mental health generally, and children’s mental health is no exception (see Sullivan et al., 2021; Torous et al., 2022 for reviews). Changes in reimbursement policies for remote services have further paved the way for new service delivery models and options. Although vaccination efforts should ultimately allow for the resumption of in-person services, telemental health and other digital mental health approaches and tools will likely continue to be a part of the children’s mental health landscape moving forward.

As such progress unfolds, we are reminded of a quote by Steve Jobs, Apple cofounder, in a 1994 Rolling Stone interview: “Technology is nothing. What’s important is that you have faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them” (Goodell, 2011) We use this quote when training therapists, working clinically with children and families, and presenting our research at conferences as it echoes our evaluation of the role of digital tools in children’s mental health as well. That is, technology is one tool that clinicians have at their disposal that may help to increase access to, engagement in, and/or outcomes of evidence-based clinical practice. Accordingly, we aim to provide evidence-based and practical clinical information and illustrations along with supporting didactic materials to guide clinician adoption and integration of digital tools in assessment and treatment plans with children and families.

This book is divided into five chapters. Chapter 1 describes the broad range of terminology used in digital mental health. Chapter 2 reviews some leading theoretical approaches that highlight the mechanisms through which it is posited that digital tools can increase access to, engagement in, and outcomes of evidence-based mental health services for children and families. In Chapter 3, we present guidance for therapeutic decision making regarding if, when, and for whom digital tools may be most useful. Chapter 4 presents examples of ways in which digital tools can be incorporated into clinical practice, the efficacy data available for such examples, and common obstacles to successful outcomes. Finally, Chapter 5 presents case examples that describe the incorporation of digital tools into clinical practice. A variety of forms and handouts to guide the use of digital tools and related decision making are presented in the Appendix. One that may be helpful even before you dive into the first chapter on terminology is the Provider Self-Assessment of Technology Comfort and Attitudes handout in Appendix 1. Importantly, there is no scoring system or right or wrong answers to these questions. Rather, we hope that this assessment will encourage you to think about your comfort with and attitudes toward digital mental health and incorporating digital tools into your clinical care with child clients and their |xii|families. It may be helpful to revisit the questions as you work your way through each chapter of the book to see if your comfort and attitudes are changing and if so how.

|1|1Description

1.1  Terminology

Digital mental health and the terms used to describe it are evolving quickly much like technology generally. To clarify how we are using the terms for the purposes of this book, we chose to start here with those that we think are most reflective of the broader state of the digital mental health field. As the book continues, we emphasize the specific relevance of digital tools in children’s mental health in particular using more of a developmental lens, including theory, assessment and treatment, and case vignettes.

1.2  Definition

Digital mental health broadly refers to the use of digital, mobile, and connected technologies to advance assessment and treatment. The range of digital tools available to mental health providers continues to rapidly evolve. These include the use of electronic records, which is now standard in children’s mental health, but also a broader range of digital tools including examples highlighted in Box 1 and discussed in this chapter and throughout this volume. Our aim with this book is to maintain our focus on the promise of digital mental health, while also staying grounded in the evidence base underlying the rationale for this approach.

1.3  Telemental Health

Telemental health (or telehealth or teletherapy) generally refers to the use of video and audio data to facilitate therapist-led, synchronous (i.e., real-time) mental health care. A mass transition to telemental health was necessary for providers and clients at the start of the COVID-19 pandemic and associated stay-at-home and social distancing public health mandates. Accordingly, whereas telemental health was not a dominant mode of mental health care delivery prior to the COVID-19 pandemic, it has now entered the clinical mainstream (Comer, 2021). Generally, telemental health requires the provider and client both have a device (e.g., laptop computer, tablet, phone) |2|with audio and/or video-display functionality, a web camera, and nonpublic facing, Health Insurance Privacy and Portability Act (HIPAA)-compliant videoconferencing software (e.g., Doxy.me, Vidyo).

1.3.1  Nonpublic Facing Video Communication

There are generally two broad categories of videoconferencing software available to consumers – public and nonpublic facing. Public facing video communication software essentially refers to a software that allows video communication that is open or accessible to the public (e.g., Facebook Live, TikTok, Twitch) that generally precludes the possibility for confidentiality, privacy, or data security necessary for digital mental health. In contrast, nonpublic facing video communication uses end-to-end encryption or encoding of data (e.g., audio, video, text) that allows only the client (i.e., child, parent) and the mental health service provider to hear, see, or read the audio, video, or text that is being exchanged and vice versa. Nonpublic facing platforms also generally require individual user accounts (e.g., logins, passwords) to limit and verify users, as well settings relevant to privacy and security (e.g., choice to record, mute, or turn off the video or audio). Nonpublic facing video communication software (e.g., Zoom for Healthcare, Doxy.me, Thera-Link) is one criterion to meet current HIPAA standards, although there are others as well which are listed in Box 2 and described next in further detail.

1.3.2  HIPAA Compliance

What makes a telemental health (or any other digital) platform HIPAA compliant generally relates to how digital data (e.g., voice, audio, text) are transferred and stored (e.g., encryption). HIPAA standards are generally the responsibility of both the videoconferencing vendor and the clinician via a business associate agreement (BAA). The BAA is typically embedded within the terms of software use and makes explicit within those terms of use and accountability what happens should a HIPAA breach occur. Many nonpublic facing videoconferencing software platforms have BAAs (e.g., Zoom for Healthcare, Doxy.me, Thera-Link). Although there was a grace period extended at the start of the COVID-19 pandemic that emphasized the mental health providers’ good faith efforts to provide HIPAA-compliant remote-service delivery, ongoing awareness and education regarding the appropriateness of various options is essential. For example, Apple’s Facetime (and iCloud) meet many data privacy and security standards relevant to HIPAA compliance; however, their terms of use state that they do not constitute a BAA, should not be used for business that requires HIPAA compliance, and that they will not accept responsibility if a HIPAA or Health Information Technology for Economic and Clinical Health (HITECH) Act breach occurs. To ensure HIPAA compliance in one’s telemental health practice, it is always |3|recommended that legal counsel first review the selected telemental health platform and associated BAA.

1.3.3  HITECH Act

The HITECH Act, which was signed into law by President Obama, was instituted as part of the American Recovery and Reinvestment Act of 2009 as a part of a broader economic stimulus bill. HITECH was enacted to promote the implementation and use of electronic health records with the goal of achieving a more efficient, integrated, and cost-effective health care system. Embedded within HITECH (Subtitle D) is the mandate for privacy and security associated with the electronic transmission of health information, including enforcement of HIPAA rules and consequences for HIPAA breaches and violations. Although focused initially on electronic health records, companies that market and support videoconferencing and other mobile mental health interventions typically refer to both HIPAA and HITECH in their terms of use.

1.3.4  Reimbursement

Prior to the COVID-19 pandemic, most payers, including Medicaid and Medicare, did not reimburse telemental health services provided in patients’ homes and only five states offered telehealth parity for mental health conditions. As a result, fewer than 10% of the US population had used telehealth for a clinical encounter prior to the COVID-19 pandemic (Warren & Smalley, 2020). When a public health emergency was declared, it included emergency orders that rapidly increased access to and reimbursement for telemental health services. The uptake of telehealth services both for clinicians and their clients skyrocketed and thrust us into an era where most providers became familiar with this delivery method and most clients had access to these services if they preferred. Now, nearly 40% of the US population has used telehealth, and there is a desire from both providers and clients to continue to have telehealth options after the pandemic (American Psychiatric Association, 2021). Public guidance will likely continue to adapt and change over time, including if and how telemental health and other digital interventions are covered by insurance. Providers should stay up to date through organizations such as the American Psychological Association (APA) or other professional associations and agencies, as well as state licensing boards and relevant insurance panels.

1.4  Mobile (Mental) Health

The World Health Organization (WHO) defines mobile health (also known as mHealth) broadly “as the use of mobile wireless technologies for public |4|health” (Executive Board, 2017). Telemental health can also be included within mobile mental health, given that videoconferencing software, for example, can be used on a clinician’s or family’s mobile phone or tablet. Providers may also use mobile technologies to augment or supplement face-to-face treatment, including between-session video coaching calls (e.g., check-in, problem-solving, promoting skill generalizability) and the assignment of mental health software applications (apps) (Jones et al., 2014, 2021; Parent et al., 2022). As such, in the next section we provide an overview of some of the most common digital tools and approaches; however, we do not want to falsely suggest that these are all necessarily distinct. Rather, a clinician providing either in-person or telemental health services may use multiple additional tools and approaches throughout their care of a client.

1.5  Mental Health Apps

An app is a software program that uses the operating system on the device on which it is loaded to allow the user to do various tasks or activities. Apps for desktop or laptop computers are sometimes called desktop applications, whereas those for smartphones, tablets, and wearables (e.g., smart watches), for example, are called mobile apps. With 85% of Americans now owning a smartphone (Pew Research Center, 2019) and 130 billion app downloads in 2020, the number of mobile apps for mental health are rapidly proliferating. Furthermore, current data suggest that the move to “cut-the-cord” on landlines is equally if not more prevalent in low-income homes, which are also more likely to rely on mobile phones as their primary if not only device. Mental health apps offer tremendous potential to decrease mental health care disparities and can be used by clinicians to strengthen and extend the reach of services.

The ubiquity of mobile devices also opens the door for a range of other digital tools that are being increasingly democratized, including virtual reality (i.e., user immersed in technology), augmented reality (i.e., technology integrated into real world of user), and video games, each of which are defined in detail in subsequent sections in this chapter. That said, only 3–4% of the estimated 10,000–20,000 mobile mental health apps available to consumers are considered evidence based, making it critical for clinicians to investigate and evaluate efficacy data before incorporating these apps into treatment (Bry et al., 2018; Larsen et al., 2019; Lecomte et al., 2020). OneMind PsyberGuide attempts to provide consumers with information on currently available mobile mental health apps as well as available data and expert reviews; however, relatively few of the included apps focus on children’s mental health (see Appendix 8).