Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation

Abstract

Background The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods A realist evaluation multiple case–study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services.

Using Digital Measurement–Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health

“…Extant studies of DMHIs offer mixed results: for example, there is evidence that teletherapy may improve oppositional symptoms but not inattention and hyperactivity symptoms [ 37 ]. Others have cited individual case studies of improvement in ADHD symptoms over the duration of care with a DMHI [ 38 ]. Clinicians consistently recommend including behavioral care as a core component of ADHD treatment [ 2 ].…”

“…ADHD is 1 of the most common diagnoses of children and adolescents referred to telepsychiatry by their PCP [ 37 ]. However, findings are mixed regarding whether teletherapy benefits those with ADHD [ 38 , 39 ]. There are also current investigations of the use of DMHIs to deliver training to parents of children with ADHD, but these findings are not yet available [ 39 ].…”

Telemedicine use in the managment of ADHD patients.

“…и соавт. на основании собственного опыта создания телемедицинской службы цифрового психического здоровья выделяют десять основных компонентов, которые должны лежать в основе качественной интернет системы: гибкое предоставление помощи и своевременное реагирование; персонализированная помощь каждому человеку; комплексное ведение пациентов, обеспечиваемое мультидисциплинарными службами; эффективное вовлечение пациентов и междисциплинарных команд; использование различных средств коммуникации; удовлетворенность клиентов услугами; хорошие клинические исходы; простота вовлечения семьи в любую из консультаций из разных мест; содействие межведомственной работе и интеграции с национальными службами здравоохранения, а также управление рисками и обеспечение безопасности [12]. 8 В последние годы основным прорывным фактором для проведения телемедицинских консультаций и создания систем удаленного ведения пациентов с психиатрическими заболеваниями, в частности СДВГ, стала пандемия COVID-19, которая привела к тому, что большинство пациентов с хроническими психиатрическими заболеваниями, не требующими экстренного вмешательства, оказались изолированы от медицинской помощи.…”