Blog Post 7- Amy Spear

This week we discussed the importance of integrative practices within the realm of eMH.  We discussed the most efficient way to treat mental illnesses in conjunction with other co-existing illness. This can be done using integrative medicine. We see many advantages to this type of treatment. For example, integrated models of care are patient-centered, improve medical outcomes in primary care settings, and help reduce the onset of new illness. Integrating telemedicine and eMH to treat illness can follow the Stepped Care model. Stepped Care is a system of delivering and maintaining treatments, so that the most effective and and inexpensive treatment is delivered to patients first; only ‘stepping up’ to specialist services as clinically needed. We also see contemporary platforms becoming more common to integrate various types of care. Here we bring together in-person care and eMH using technologies like electronic medical records, phone, email, and video.

Even integrating mental health with primary care will decrease the number of patients not seeking treatment for their disorders and will ultimately be more cost-effective. As the professionals at the InterCommunity Health Network in Oregon explain, we treat mental illness separate from physical illness. We think of these as two separate entities. However, we should be treating these as one. As a future clinician, I think that integrative models are care will be more beneficial in treating illness. Especially when this mental illness co-exists with other disorders. With the advancements we have made in eMH it is easier than ever. For example, like we explained in class, using these integrative therapies, we can have a patient who is pregnant and also suffering from depression and gestational diabetes and treat her using integrative care methods that will be more effective. Treatment could be provided by joint dietetic and psychiatric consultations and well as online coordinators from dietary and obstetric areas providing support and education via web portals. Moreover, I believe methods such as video conferencing, online education, and joint consultations are the best methods that we can use in integrative health. Using these techniques we can provide accessible, affordable care to all patients.

Blog Post 7- Abbi Herrold

This week in class we discussed the integrative model of healthcare and how e-mental health can have an immense amount of benefit to these type of programs. E-mental health provides increased access to care and provides timely access to education and learning opportunities. These aspects of e-mental health are crucial to integrative care. Integrative healthcare systems are kind of a " one stop shop" kind of deal, in the ideal integrative healthcare system a patient would be able to see their psychologists, psychiatrists, general practitioner, dietitian, pharmacists, etc. all at one location. An example of this would be teaching hospitals, for example my friend goes to the University of Chicago to see a rare disease specialist, neurologist, psychologist, and is able to complete all her medical testing in one visit. I feel as if this is truly an ideal model of integrative care as she is able to see all her doctors in one day, and they are all in open communication with each other in regards to her health and well-being. I would consider this model of care to be very high in medical care and in the middle range of mental health care. She sees all of her doctors and her psychologist here, but still must go out of the network to see a psychiatrist, if she also saw a psychiatrist here i would consider this model to be both high in medical and mental health integration.

I think the methods of educating clients and training clinicians via telehealth is a brilliant idea as educating via the internet or web conferencing is in general the most accessible option. If patients are able to be educated via online services and technology for simple tasks, that it may save very long trips which can be very costly. Training clinicians is effective in this way as well as it may be very difficult to find a day in which all of those on a team from different offices are able to meet, but it is not as difficult to find fifteen minutes within the day where everyone can be on a Skype conference call.

I found a video of a place in Merillville, Indiana ( right by home town!) where they have integrated both medical care and mental health care. The video discusses how having a integrated system in community health  has really been successful in helping patients. I feel as I would be very grateful as an anticipating clinician to be working in a health care center which uses an integrative healthcare model. I feel as if this type of model is the most effective and satisfying for patients, and possibly even for providers as well.

https://www.youtube.com/watch?v=9-mZA4vphJw&index=6&list=PL2737C2C6E81E9177

Blog Post 6-Amy Spear

This week we discussed how culture affects health. We know that every culture has its own unique values, customs, and traditions. Health care varies among culture as well. That is why it is advantageous that  eMH is able to facilitate clinical services to culturally diverse populations.

The use of eMH throughout various cultures and populations is beneficial because it can promote adaptation and reduce the stigma and discrimination that comes along with mental health and varying cultures. There many steps that can be taken to be more accepting of different cultures in healthcare and how to treat these patients effectively. For example, we can utilize the ASKED framework. This is an acronym that helps us treat patients from different cultures. The letters can be explained by A- Awareness, S- Skills, K- Knowledge, E-Encounters, and D- Design. Each aspect is important and essentially means that it is important to be appreciative and sensitive to other cultures, collect relevant cultural data regarding patient histories, have knowledge of varying cultures, engaging in cross-cultural interactions, and having the desire to work with these unique cultures.

Although there are many challenges that come along with treating different cultures, it is important that as health care professionals we are accepting of these other cultures. Language barriers can be especially challenging for health care workers. Because of the language barriers, with in-person therapy, it is common that patients will not return, will not adhere to medication regimens, and the quality of care delivered to them is poor. It is vital that we integrate methods to overcome these language and cultural barriers. We can do this by employing Bilingual and bicultural providers, professional interpreters, and providing written translation materials.

Using eMH could eliminate all of these problems.  Utilizing eMH incorporating techniques like video conferencing, we can treat hard-to-reach populations. It can also bring together health professionals with interpreters to eliminate these cultural and language barriers and help provide the greatest quality of care to these varying cultures.

Blog Post 6-Abbi Herrold

This week in class we discussed cultural and cross-cultural impacts on healthcare and e-mental health. Some of the ways in which culture can impact healthcare and outcomes are: how symptoms are communicated, how various types of treatment is perceived/ viewed, and what expectations of the physician-patient relationship may be. For example, in non-western societies more collectivistic styles of treatment or holistic medicines may be more of the expectation than the exception to treatment and medicine. Additionally we discussed the importance of cultural competence in healthcare and the "ASKED" model. Finally, we ended with a review of international studies.

As we are becoming an increasingly diverse country, the American Psychological Association, is acknowledging more and more the need to consider culture in both research studies and patient practice. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), a cultural formulation interview guide has been added to encourage professionals to understand their patients' culture and background. This interview is significant because it gives the professionals the means to ask these questions; previously if there was a will to understand a patient's culture there wasn't necessarily a "way" (meaning that now clinicians and professionals can no longer say they do not know how to approach or ask questions about culture). The interview is broken up into four sections:1) cultural definition of the problem, 2) cultural perceptions of cause, context, and support, 3) cultural factors affecting self-coping and past help-seeking, and 4)cultural factors affecting current help-seeking,

I feel as if this addition to the DSM is very important in showing efforts to recognize cultural differences which can be a crucial aspect of healthcare and a patient-client relationship, however it is important to recognize that this interview is just a guideline. The professional who is asking these questions must still be able to use their discretion in identifying which aspects are the most crucial, which answers may need follow up questioning, and the most appropriate timing to ask these questions. As someone who will one day be trying to understand a patient's culture, I think it is important to have this interview formulation published as a guideline

file:///C:/Users/Abigail591/Downloads/APA_DSM5_Cultural-Formulation-Interview.pdf

Blog Post 5-Amy Spear

This week we discussed the effectiveness of E-mental health. We mentioned how eMH is thought be equally as effective or even more effective than in-person care. I think that eMH is more beneficial than these conventional therapies. There are many disadvantages and advantages that explain this.

We see that eMH can have many benefits over in-person care. For example, patients being treated using eMH have a greater treatment adherence,reduced anxiety, and less PTSD symptoms.  eMh also has varying models of care that can differ program to program. Low intensity models involve case review and follow up as well as telepsychiatric consultation to primary care. Moderate intensity models are integrate mental health screenings with therapy on site. They also include telepsychiatric consultation, healthcare education, and training of staff to improve patient outcomes. Then there are high intensity models that use collaborative care using STP and ATP.

A program utilizing a low intensity model as we mentioned in lecture is PTSD coach. This is an app that I find especially interesting and can relate to considering many of my family members are military veterans and I think this would benefit them.This app is available for veterans and servicemembers who have PTSD. It provides tools to help manage this disorder. It can help manage symptoms related to the disease along with other stress. The app provides self-assessments, symptom-tracking tools, education materials, and provides coping skills to help with stress. Patients take their self-assessment and if the assessment  scores indicate they may have PTSD, and if they are VA patients, the App can be used to share the scores with your VA health care team. If the score is severe and they are not  a VA patient, this app will provide options for seeking professional treatment.

Therefore, we can see this program most likely follows a low intensity model because it is an mobile-based intervention that allows patients to educate themselves and then if help by a healthcare professional is needed, they are given the means to do so.

Blog Post 5 - Abbi Herrold

This week in class we discussed the effectiveness of telepsychiatry, also known as e-mental health. We reviewed the three phases of research that telepsychiatry has gone through. We discussed how there has been a lot of information gathered on the effectiveness of telepsychiatry with adults, but much more information needs to be collected about telepsychiatry in geriatric care. Currently, there is a lot of research being done on the use of e-mental health in child and adolescent populations. In addition to this we discussed the different models for care such as web-based care, patient-centered medical home, and the stepped care model. Finally we watched a webinar reviewing some of the online applications for mental health aimed at child and adolescent populations in Australia.

I was very intrigued by the BRAVE program, used to manage anxiety in children and adolescents. I like how the program had two separate dashboards based on the age group. It really appealed to me, and I'm sure many other consumers as well, because it is absolutely free of charge and walks you through a step by step program. However, one drawback for me was that the dashboard for adolescents shown in the presentation still seemed rather childish. I feel as if this could have implications for how teens perceive and accept the program; if they feel as if it appears too childish they may think that they are too mature for this site or that it is not applicable to people their age.

Many of the apps I have found online or that we have discussed in class allow the patient to track their mood, and share this data. I think this feature is very practical to many populations in the sense that it is just like a fitness tracker where you log your meals, or activities every day. For example, the application "Mood 24/7" developed at John Hopkins University allows users to record their daily mood via text message. The data collected can then be printed and shared with whomever the person wants to share it with, including mental health professionals. As someone who will one day be working as a professional in the mental health field, I see this as a very easy way to have clients record and report mood stability. Many of these applications and websites have benefits to the practitioner and the client, with the previous example being only one benefit of many.

Link to mood 24/7: https://www.mood247.com/aboutmood

Blog Post 4-Amy Spear

This week we discussed heavily the topic of program evaluation. We defined program as "the use of social research procedures to systematically investigate the effectiveness of social intervention programs to assess whether the desired results of a program have been achieved"(Program Evaluation, 2017). Program evaluation is vital in meeting the needs of the program, patient, and provider. Program evaluation serves to follow the progression of programs, manage budgets, and ultimately to show program success .

We also discussed the use of the Program Logic Model(PLM). It is a flowchart that illustrates the sequencing of events  as well as the various components of a program and the relationship between these components. What this model does is it shows the connections between the treatments that contribute to the need of the program within a community, the activities that will address these conditions, and then the outcome that is expected from the practice of these activities. Looking closer at the model, we can see that there are various inputs that include components of what was invested in the program. These things may include staff, volunteers, equipment, and money. The next step in the model is looking at what the program is outputting. Considering this, we think about what was done and who was impacted. Activities such as counselling, training, or workshops can take place throughout the program and each different program can reach out to a specific demographic. Then after this, we can observe the outcomes of our program. What do we see the program has done in short term and then overtime, how has it had an affect on the targeted group overall.

As a prospective health care professional, I believe that in the future we will be more readily utilizing e-mental health services; therefore,I will discuss a program that has already been implemented. Lantern is a web-based and mobile-based portal that combines Cognitive behavioral therapy techniques along with help from clinicians. Their aim is to help lessen the affects of depression and anxiety on the lives of those who are diagnosed(GoLantern, 2014). We can use this application as an example to see how these founders could have used the PLM in implementing their program. When we consider this program, we can say that the inputs for the program were most likely clinicians such as psychiatrists or psychologists to help provide feedback for patients. They would have invested money and materials to create their online program.  As far as outputs, we can look at what is being done with the program. We can see that the clinicians are counseling users in a way to get their anxiety and depression under control. They are also utilizing initial patient assessments in order to learn more about their disorder and how to treat it. The application is clearly targeting individuals who are struggling with problems like anxiety and depression in an attempt to help patients gain emotional strength and well-being. Their short term goals are to provide awareness and also inform patients of their services. Overall, their long term goal is to ultimately eliminate the stress on patients lives from dealing with their disorder and to provide an easy, cost-effective way to treat them. Moreover, this program could implement quantitative tools such as surveys or discussion among users to test the effectiveness of their program.

As we can see, the PLM and four step model are very simple and effective models that can be used in creating programs and then evaluating them. It is important the e-mental programs use program evaluation to make changes if needed and watch their program flourish.

Blog 4- Abbi Herrold easily

This week in class we discussed situations in which e-mental health may be superior to traditional care in addition discussing program evaluation. We went into depth about the program logic model (PLM) as well as the four step model of program evaluation. For example we could evaluate "Operation Reach Out" an app designed to aid in suicide prevention by storing emergency contacts and information about a person's mental health history. The input for this program might include the cost to create the app, cost to advertise the app, hiring people to monitor the app, hand having people available to tech support for the app.This may also include computers, smartphones, and software used to create the app. The output might include  adapting to different software (android vs iphone), finding local resources to be provided on the app, training staff how to use technology, etc. The target population may consist of teenagers and young adults, or anyone who is in frequent use of applications on their smartphone. The short-term outcomes could include teaching people how to prevent suicide, raising awareness in the prevalence of suicide, being able to communicate with others about suicide, and being able to use the app efficiently and as intended. The long term outcome could include lower rates of attempted suicide and less death as a result of suicide. I feel as if the goal of reducing suicide via an application may be a slightly overachieving goal, but perhaps it is possible with the right team, proper use, and consistent re-evaluation.

I see many ways in which the program logic model and four-step model of program evaluation would be practical. As a future clinician I could sit down with a patient and 1) diagnose them and determine if whether my primary goal is to manage their symptoms or return them to normal daily functioning, 2) figure out what the best way to treat this patient may be ( Cognitive Behavioral Therapy, medication, etc.), 3) determine it the treatment in which I have implemented seem to be helping, making things worse, or showing no difference?, 4) decide if this treatment will be sustainable for long-term use or may other methods be more efficient? I could then evaluate this by asking my patient some questions via a survey or short interview in addition to feedback from other mental health professionals.