Mobile Health Platform to Augment Integrated Behavioral Health Care: Pilot in a Large Health System (Preprint)

BACKGROUND Digital and mobile technologies have potential to improve the delivery and scale of integrated care models. OBJECTIVE We aimed to assess acceptability and feasibility, preliminary clinical outcomes, and implementation barriers of a mobile health platform used to augment an existing integrated behavioral health program. METHODS The mobile platform was used by three behavioral health care managers responsible for coordinating disease management in six primary care practices. 89 of 245 individuals (36%) who were referred by their PCP for behavioral health services consented to app-augmented behavioral health care. The mobile health platform functions included chat communication, monthly depression self-report assessments, and psychoeducational content. RESULTS The clinical improvement rate in our sample was 72% although follow-up assessments were only available for 49% of participants. At least one action in the mobile app was completed by 87% of participants (n=78; median=7; IQR=12, 0-130). Behavioral health care managers cited increased documentation burden and language as barriers to use. CONCLUSIONS Our pilot of mobile technology in collaborative care highlights important implementation barriers. Future research should systematically evaluate the implementation of digital and mobile health technology in collaborative care.

Integrating Psychological Services Into Community-Based Clinics

In Alabama, where mental health stigma is a critical barrier to care, integrated behavioral health services are vital to address the mental health needs that underlie substance use disorder (SUD) and opioid use disorder (OUD). Since October 2019, our team has developed partnerships with one rural and two peri-urban primary care clinics to offer behavioral health services with an emphasis on SUD/OUD prevention, screening, and treatment. The patient populations receiving services at these three facilities are under-resourced with multiple disadvantages placing them at risk for morbidity, mortality, SUD/OUD, and poor behavioral and mental health outcomes. Behavioral health services have been delivered primarily via telehealth due to the COVID-19 pandemic. This presentation will describe the process, current status, and future goals for implementing integrated behavioral health care, with a focus on identifying the barriers and facilitators during the COVID-19 pandemic era.

Implementing a low-threshold audio-only telehealth model for medication-assisted treatment of opioid use disorder at a community-based non-profit organization in Washington, D.C.

Background The COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the USA, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Lessons learned have the potential to improve MAT delivery to people with OUD. Case presentation This case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. Patients were predominantly male (74.4%) and black (90.6%). The mean age was 53 years old with more than half of the clients aged 55 or older. Less than half (42.3%) of the patients lived in stable housing. Patients commonly had self-reported comorbid conditions such as hypertension (35.4%), hepatitis C (23.5%), diabetes (11.9%), human immunodeficiency virus (HIV) (7.2%). A majority of patients (68.6%) reported engagement with behavioral health care. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. In-person retention rates at 90- and 180-days were substantially higher than telehealth retention rates (93.9% vs 68.4% and 91.5% vs 51.9%, respectively). Conclusions Low-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.

Advancing Behavioral Health Literacy

Accessing, comprehending, and using information to make informed decisions and improve one’s overall health or well-being are the foci of health literacy. The concept of behavioral health was introduced in the early 1980s and, since then, it has influenced new ideas (e.g., behavioral health literacy and integrated behavioral health care) and gained research and public attention. My aim is to provide an overview of definitions (i.e., health literacy, mental health literacy, and behavioral health literacy) and their connection to each other. I propose an expanded and honed definition of behavioral health literacy to enhance the behavioral health literacy and well-being of the individual as well as the community, with the hope of reducing both physical and behavioral negative health conditions and improving overall quality of life for all people.

Guidelines for Adapting Evidence-based Interventions with Marginalized Youth in Under-Resourced Schools

With the growing diversity within the US population and notable barriers to accessing behavioral health care, marginalized youth (i.e., youth who experience discrimination and exclusion because of unequal power relationships across economic, social, and cultural dimensions) are placed at risk for developing psychosocial and mental health problems. Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Given the need to enhance equity in youth mental health care, we provide guidelines for implementing and adapting EBIs with marginalized youth in under-resourced schools. First, we offer recommendations for overcoming barriers to implementing EBIs in under-resourced schools while emphasizing the importance of using a community-based participatory research approach for implementing and sustaining EBIs. Following, we discuss techniques for tailoring culturally sensitive interventions that better engage marginalized youth and their families in school-based prevention and treatment. These cultural tailoring techniques include adapting communication styles, emphasizing family values, and considering how sociopolitical history can impact youth, their families, and their communities. We hope these guidelines offered might inform more equitable practice in youth mental health care and motivate future studies advancing evidence-based mental health care with marginalized youth in under-resourced schools.

Facing social disparity and racial justice issues regarding Covid-19 and access to behavioral health care in the U.S.

The Covid-19 pandemic exposed and amplified many problems in political and healthcare systems around the world, and the United States has been no exception. One such issue is racial injustice, including its impact as a social determinant of health and its manifestation in disparities in healthcare access - including behavioral healthcare. This paper examines this problem in detail and highlights the work of the Center for Practice Innovations. This intermediary organization provides training and implementation support to behavioral healthcare organizations across New York State. This work includes changes and awareness building related to racial injustice within its organization that will drive changes in training and supports provided to behavioral healthcare organizations across New York State.