eheadspace Challenges and Directions Dr. Steve Leicester
Setting the scene • Youth Mental Health, early intervention • Enhanced access to care • headspace • Significant part of reform agenda • Australian of the year 2010 • Largest increase investment across mental health • Now seen as a ‘sector’ • Key focus within the Mental Health Commission Review
Strategically • Fundamentally: • Policy and funding is encouraging more people to access online supports ( e.g., Aust. Govt. E-Mental Health Strategy, 2014 ) • Cost reduction • Service demand • During more stages of illness/ distress • We need to think beyond entry into MH system • Closer alignment with face to face
Embedded in daily lives …
Embedded in daily lives …
Digital Health Agenda
Setting the scene • Mental Health Digital Agenda • MHR • Digital gateway • 2 year extension contracts
Setting the scene • What is the sector: • Teleweb sector • Major part of MH framework • Unknown – what else are people using; non linear • A way to go re: outcome measures • We still receive majority of GP interaction via fax!!!
How is Digital MH delivered? • Telephone: • Crisis lines** • 1 off support** • Information & referral • Structured therapeutic interventions** • Text Based: • Webchat** • Email** • Forum – threads; discussion groups; group chat • Closed communities • Social media • SMS
However … • Separate contracts; EMR; governance, etc. • A way to go re: outcome measures • Client pathways … who knows??? • Separation from primary, secondary & tertiary health … integration?? We still receive majority of GP interaction via fax!!!
This shit works!! • iCBT • Mild- moderate depression & anxiety (Meurk, et.al. 2016) • NICE guidelines • Self guided • Information based options • Telepsychiatry & telehealth • Well established • Embedded within health frameworks (Hilty, et al. 2013)
Streams eheadspace.org.au
Our Place in the Sector • Youth • Primarily 1:1 • Highly skilled & robust governance • Open to all presentations • Clinical in conceptualisation • Diverse client spectrum - growing • Part of headspace network (hSS, centres, DWSS)
eheadspace • Providing skilled mental health support and interventions • Webchat (dominant) – Phone – Email - recently SMS • Stand alone DoH contract, operates independently from centres • 9am – 1am AEST • Credentialed mental health clinicians (approx. 80) • Psychologists, social workers, mental health nurses, OTs • Treatment focused • Extensive client follow up • Regularly works with high complexity • Nation wide coverage
Service Delivery - Webchat dominant for young people - Phone preference for family
Who is using eheadspace? peak age of presentation 15 to 17
Prior help-seeking Just over half of eheadspace clients report that they have sought mental health support in the past (prior to their first use of eheadspace)
eheadspace registrations 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 2012 2013 2014 2015 2016 33,000 registrations, 90,000+ interactions in 2016
Service demand by hour of the day - 3 shifts per day - Acuity increases later in day - Head of service & CSM on call
Turned Away (no (not eno enough clin clinicians, , Ju July ly 201 2015 – Nov 201 2016)
Challenges … • Great appeal, however, meeting service demand is an increasing concern • Never actively marketed • Not yet capitalising on the breadth of digital options available • Increasing demand • Staffing (shift work, high credentialing) “ Decrease investments in first generation e- mental health type systems … e.g., eheadspace ”.
Challenges • Expectations of online • Immediate • Flexible • Confidential • Quick • Anonymous • Accessible
Next Steps ….
Dilemma • Great appeal, however, meeting service demand is an increasing concern • Never actively marketed • Not yet capitalising on the breadth of digital options available National Mental Health Commission’s Review of Mental Health Programmes and Services ‘first generation’ online services providing one to one interventions were outdated, potentially contributed to service duplication and failed to capitalize on new technologies. “ Decrease investments in first generation e- mental health type systems … e.g., eheadspace ”.
Forward … Mor ore tha than the the vi virtual hea headspace ce centre – suppor ort & & tr treatment hu hub Eas asy acc access “… dip in, dip out …” Imp mpermanence. Build Build the the pl platfor orm - con ontent, reso esources, etc. mus must be be agi agile le Prin rincip iple les of of stepped care can be be em embedded Facts Apps Peer Inform Dynamic Connect Guides Self Guided Forums Myths Interactive Group Chat Clinical Static options Facilitated Groups Interface 1:1
However … • Community still expects an interaction … “ approach your GP” “see a mental health professional” “contact a headspace centre or eheadspace” • Instead … • We have growing evidence that a range of options are effective • Support comes in many forms & stop referring to information, apps, etc. as an adjunct or separate from support • Inform what works instead of keeping our work secret • Connections • Purpose & future
Road Mapping … • Options for account creation outside of 1:1 “… we want a space… ” • Login & dem. in line with IDS • User pathway, rating & analytics – guide resources, links, endorsements, etc. • Integration with DH2 • Expand interactivity • No wait space – always within the environment • Links remain within eheadspace environment • Outward facing recommendations • YP & family led areas – forums, group chat, Qheadspace , increasing peer experts, etc. • Best options for those that come to eheadspace
Hopefully we are getting better at … • Digital health is no longer an adjunct • Preference for many – stop comparing with face to face • Still seeking human interaction • The old ways of designing health services are out • Concepts of EOC need rethinking • Outcome, distress & satisfaction measurement • Agile organisations • Respond quickly • Measure smartly • Transparent • Partnerships and collaborations are more critical than ever • No agency or product can do it alone • No shortage of demand – there is plenty of space for more than one • Stronger R&D • Analytics & traditional measures • Research is redundant quickly • Translation from academic to practice – currently too slow to be relevant
Development &translational research Absolutes o Improve access o Effective o Measurable o Contribute to knowledge base o Enhanced user design and feedback o Partnerships
Workforce Options
Concerning … • No specialist (or other) focus within post grad training • Clinical placements • Growing – but minimal PGrad research • Minimal private, PD or other skilled based courses to deliver teleweb • No standardised EMR or data sharing across teleweb
Workforce Realities Overall – major concerns across clinician sample (Orlowski, et al., 2016) 1. Prevailing sentiment that online activity was detrimental to well being & social engagement (i.e., “real relationships”). Response : Move on … it’s a viable and critical option. Here to stay – now adapt. Filters clinical practise. Lose essential non-verbal nuances – adverse impact on therapy. Despite 2. using SMS, email out of session. Response: New skill set. Distinct nuances including disclosure.
Workforce Realities Challenges clinician’s power dynamic. Language, digital skill set ease of access. 3. Response: Don’t pretend what we don’t know. Autonomy and counter -transference key supervision themes. Professional identity – ‘in person’ is the foundation. Clinical risk, familiarity with tech, data 4. governance. Tech options perceived as adjunct - rather than primary mode. Response: User perspectives are driving the ehealth push. Anonymity and associated risk are accepted components of practise. Data security is likely better than your current EMR.
Workforce Realities 5. Personal use and acceptance for the clinician Response: Acknowledge it is a shift. Training in ehealth essential 6. Organisational legitimacy. Priorities and strategy across the organisation. Response: A comprehensive digital strategy is essential for organisational legitimacy .
Recommendations
What should a teleweb – digital service be? • Not developers!! • Accessible • Effective • Responsive • Stable – i.e., not reactive to latest bling • Please no more apps!!
What should a teleweb – digital service be? • Create a framework / space - architecture • Don’t worry if someone else is doing it – clients are coming to you • If you’re not collaborating, you won’t survive • Stop assuming that you are the only service being accessed
What should a teleweb – digital service be? • More focus on long term – end of MBS, rather than front end only • Key area – high complexity, high need client groups • Fluency, rather than EOC.
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