Background Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. Objective In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Methods Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode–psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. Results In total, 5 patients (ASPIRE: n=3, 60%; CEDAR: n=2, 40%) were included: 3 (60%) White individuals, 2 (40%) male and 2 (40%) female patients, and 1 (20%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. 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, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Conclusions Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and 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 that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care.
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’s) 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 a new protocol to further assess implementation barriers and facilitators. 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 effectiveness 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 readiness for digital technologies, but implementation barriers and facilitators may continue to be explored and improved through support from digital navigators, utilizing a patient-centered approach, and that versatility, autonomy, and structure are important features of any implementation model. These findings supported the development of the Implementing Technologies to Enhance Coordinated Specialty Care (iTECSC) protocol, an implementation framework directed at supporting implementation of DMHI’s towards clinician and patient dyads, guided by digital navigators that provides versatility, autonomy, and structure. CONCLUSIONS This paper proposes a protocol that would further assess the effectiveness and implementation outcomes of iTECSC when compared with standard Digitally Enhanced Care (DEC). Results from this study would explore the effects of iTECSC in reducing symptoms and improving functioning, when compared to DEC, and would also provide further insights towards the nuanced implementation facilitators and barriers related to integrating digital technologies into CSC.
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