Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study (Preprint)

Abstract

Background: Globally, there is increasing recognition that new strategies are required to reduce the disability due to common mental health problems. As 75% of mental health and substance misuse disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, e-health technologies show promise in augmenting traditional clinicbased services. Objective: The aim of this study was to assess the effectiveness and accuracy of an online assessment of clinical staging for use in a prototypic Internet-based early intervention youth mental health service system, known as the Mental Health eClinic. Methods: An online version of clinical staging for early intervention youth mental health services, was compared directly with clinician assessments within two Sydney-based primary care service hubs (headspace Camperdown and Campbelltown). Two hundred and four (N=204) young people were recruited in the study. Eligible participants completed both faceto-face and online assessments which were randomly allocated and counterbalanced at a one-to-three ratio. These assessments were: (1) a traditional 45 to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician; and (2) a self-report online survey followed by an online 'video-visit' assessment with a clinician taking approximately 15 minutes. All assessments were completed within a two-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 72% were female and the mean age was 20.4 years. Sixty eight percent (49/72) of the participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Inter-rater agreement of participants' clinical stages, as determined after the face-to-face assessment and after the online assessment, demonstrated fair agreement (κ=0.39, P<0.001), with concordance in 68% of cases (49/72). In 26% of cases, the face-to-face assessment appeared to downrate the lifetime history of mental health problems. By contrast, the online evaluation placed greater weight on past history of mental health disorders (P=0.001), as well as any previous suicide planning (P=0.002) and current substance misuse (P=0.03). Conclusions:The online application of clinical staging presents a technologically-advanced and clinically-efficient method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connecting with traditional clinical services and assist to provide optimal care.