Blog Post 15- Amy Spear

This course has taught me a great deal about e-Mental health in general but also more about our delivery of care and how it is changing with our advances in technology. Our models of care are transforming from in-person therapies to hybrid models involving technology use to deliver treatment. I have become familiar with many online tools for delivery of these treatments as well as the advantages and disadvantages of these portals when delivering care.

When we normally think of treatment or attending a doctor's’ visit we thinking of the conventional methods of in person therapy. However, with our recent advancements in technology we have developed a new integrated model of care. Utilizing online or web-based technologies in conjunction with in-person therapy has been shown to be effective in treating mental health disorders. Over the course of this course we have discussed many applications that can be used in addition to these conventional therapies. We discussed many applications such as Pacifica, PTSD Coach, Virtual Hope Box these app vary in the disorders they are specialized for such as anxiety and PTSD. Many of these applications have universal advantages and disadvantages. These applications increase access to care and are typically very cost-effective. Many applications are also able to provide these therapies to hard to reach populations as well as eliminating the stigma that follows getting help for mental health disorders. However, we have had many discussions of how these technologies can impact the doctor-patient relationship. With these new models of care there are many boundaries that must be established between the physician and patient. Therefore, with the utilization of these applications we see many benefits for patients and physicians. Overall, I have learned a great deal about not just e-Mental health but many aspects of the mental health field in general. I have also developed a greater understanding for mental health disorders and various treatments. With this knowledge I believe as a future clinician I use these techniques in my practices.

Blog Post 15-Abbi Herrold

This class has helped to expand my knowledge on healthcare from the patient/consumer's perspective in addition to showing me all the possibilities and capabilities technology has brought to the field of mental health. I have learned about many smartphone apps and websites I had no clue existed prior to this class. Additionally, I have thought more thoroughly about the barriers to healthcare as a part of this class.

No matter what technologies we create there will always remain two barriers: cost and stigma. Even if therapy or healthcare is free one must still have viable transportation and time to get to said therapy. Additionally, regardless of treatment having a mental illness is stigmatizing and is something those who live with mental illness have no choice but to recognize. We cannot socially reconstruct a society that has been condemning mental illness for years through the use of an app, there is much more of a social reform needed. 

Through the duration of this class I have noticed that while these technologies help healthcare be more inclusive, we are still leaving the most vulnerable out: the poor. What about those who do not have access to a smart phone or internet? What about those in third world countries who do not have the means to access mental healthcare? Etc. I am astonished by how far these innovations have reached to help under-served populations, but there is still a long way to go. 

This class has increased my passion as an advocate for mental health awareness and has increased my knowledge of the barriers of the healthcare system. As a future clinician I hope I will be able to serve those who need it most and be able to provide time and cost efficient care. I must be aware of all the variables that may influence my client's treatment and how I can make access to treatment easier for them. 

Blog Post 14- Abbi Herrold

For this week's discussion I will be reflecting on the process of my presentation and final paper. I have chosen to write about the use of the mobile-phone based app Pacifica as an intervention for anxiety disorders in college students. I chose anxiety as it is a very prevalent issues among college students and young adults that up until recently people did not consider. Throughout the process of creating my presentation and writing my paper I have found there to be able sources that say the prevalence of anxiety disorders is high in college students and people in "emerging adulthood". However, I have found little research to find out why that is. Finding appropriate resources and research to back up my thoughts and claims has by far been the most difficult aspect of writing this paper. There is ample amounts of research on anxiety in general and cognitive behavioral therapy as a treatment, although the research for the treatment of anxiety via mobile-phone and computed based apps is sparse.

I feel as if this mainly has to do with the fact that the field of mental health is reluctant to use technology in treatment, and understandably so. A significant piece of therapy is focused on the patient-client relationship which ca not successfully be recreated through the use of technology and the internet. Although, I feel as is more research and treatment needs to focus on the patient as the primary provider of care and the therapist as the secondary provider of care. I would like to see more research done that focuses on self-help for mental illness and how effective they are or what can be done to make them better if found not to be effective. 

Additionally, through writing this paper I've recognized that their seems to be two relatively " hot topics" regarding anxiety in college students: test anxiety and anxiety as result of the college transition. While I recognize that there are important topics it disappoints me that there is not more research on Generalized Anxiety Disorder and other anxiety disorders in college students. Perhaps my search terms are not narrow enough, but I have had great difficulty researching this topic when I know these things exist. I work with NAMI on campus and other mental health organizations and I know based on many anecdotes that Anxiety is an issue for college students, but if it is such a leading issue then why don't we have more answers about its causes and effects? 

Lack of research and lack of time has made this paper rather frustrating to write, but it has also made me ask myself a lot of questions about research and the field of mental health. If nothing else, I hope this paper is able to reflect on the need for more research and increased mental health care for college students. 

Blog Post 14- Amy Spear

This week we did not discuss any presentation material in class. Therefore, I will reflect on our final presentations. My final presentation revolved around the mobile-based application, Virtual Hope Box. This app is designed for use by patients and their behavioral health providers as an accessory to treatment. This application could be helpful for veterans, active military members, families of military members, sexual assault/domestic violence victims. It has shown that this application could be very beneficial as an accessory to in-person therapy and can reduce the amount of medications that need to be used to treat PTSD. VHB is also very different from other therapies because it is portable, and easily accessible so every user always has access to help no matter where they are. This app was specifically designed for those suffering from PTSD that are at a greater risk for self-harm. These patients are able use the app by decreasing these urges for self-harm by use of the app. Users can customize the app based on their specific needs. They can include quotes, their favorite relaxation/distraction techniques, and even pictures and videos of loved ones. Overall, this application could be very helpful for patients with PTSD especially with those who often have urges to harm themselves.

In the development of Virtual Hope Box, the Military Suicide Research Consortium funded a pilot project and a randomized controlled trial to study the potential of the VHB for helping patients at high risk of intentional self-harm. This study is important in the overall understanding and effectiveness of the application and I will be sure to include information regarding this study in the final draft of my research.

The other application we discussed was Pacifica which is a mobile and web-based application used to treat anxiety and depression. This app is based on the principles of Cognitive Behavioral Therapy as well as meditation. We discussed why this app might be useful in college students and why college students suffer from anxiety and depression. This could be the result of the excessive stress that college students experience. Many students are overscheduled and lack the adequate diet, exercise, and sleep schedule. Many of these aspects make us susceptible to developing anxiety and depression. Furthermore, Pacifica makes it possible to track mood and health habits which can be very beneficial to user. Tracking mood over time can allow the user to notice trends and triggers, so that they are prepared for when these things arise again. In addition to mood tracking, Pacifica also lets you track your health habits. This includes aspects such as sleep, exercise, and caffeine intake. Research suggests that self-monitoring of these health behaviors has a positive impact on the user by promoting awareness and self-efficacy. Therefore, it is clear that both of these applications would be very beneficial to users and even beneficial to providers to include in their administration of care. In the future as a clinician, I would most likely incorporate these into methods of care.

Blog Post 13-Abbi Herrold

This week in class we discussed the impact that the internet has in the doctor-patient relationship and the importance of the consultation. The consultation is a key aspect to the doctor patient relationship as first impressions are a crucial point in any relationship. Consultations give the doctor an opportunity to build rapport with the patient, define their reasons for seeking consultation, give a diagnosis, create a management plan, and come up with a contingency plan for the patient. The consultation likely sets the stone how future interactions will be and confirm the patients feeling about the doctor (are they trustworthy, helpful, etc.) The internet often increases the amount of education that patients have and makes better use of the consultation time. However, this increased amount of information also has its disadvantages as patients have more information to sift through and evaluate whether such information is credible or not. Additionally, online forums can make patients more demanding in nature.

As a future clinician I will do my best to educate my clients on credible online resources for mental healthcare. Additionally, I will try to have a list of websites and applications that may help them manage their condition in conjunction with care.

One program which integrates internet usage, online information, and online consultation is known as Jeevom. Jeevom allows patients to search for a doctor online via proximity, availability, prices, experience and testimony. After selecting a doctor the patient is able to pay for the online consultation via the app. After the appointment has selected, and payment has been processed the patient will send their medical records and presenting problems/symptoms online via secure messaging to the doctor they selected. Finally, the doctor will consult with the patient at the selected appointment time. The doctor can then diagnosis, write prescriptions, and request/send lab work all through the internet. The patient is then able to fill select a nearby lab to get the tests done and confirm an appointment with the lab. Once the lab has been processed the results are released via Jeevom to both the patient and the doctor. The patient can then record symptoms for doctor to observe and contact the doctor free of charge for the next seven days. Therefore, virtually everything but the lab work and picking up prescriptions can be done via the internet and use of technology. Jeevom is a prime example of how the internet is changing our healthcare system.

While the use of the internet and technology further enhances healthcare we must consider those who these new models will not work for. For example, while Jeevom may be intended to help those who do not have insurance it is unlikely that they will have an online medical record accessible to them and they may not be able to cover expensive lab charges. Additionally, while majority of the population has a cell phone not all have a smartphone, webcam, or internet access. We must make sure that as we further advance we do not further exclude.

Blog Post 13-Amy Spear

This week we discussed various aspects of the consultation as well as how the internet affects doctor-patient relationship. The consultation is the initial point of connection between doctor and patient. In this setting, the doctor and patient establish initial chemistry and it sets the standard for the rest of the relationship. These consultations are important because it allows the physician to educate the patient as well instruct the patient on what to do next whether this is dealing with a diagnosis or seeking treatment. With our new development with hybrid care models, we also have different types of consultations. There are the in-person of telepsychiatry consultations. These are very similar with the advancements that we have made in these care models; however, some differences do exist. For example, the most beneficial aspect of an in-person consultation is the physical component. In these consultations physicians are able to gather information from the patient’s appearance and more specifically things such as gait or body language. Both of these are very important in monitoring a patient.  Although these aspect lack in videoconferencing consultations, there are also some advantages to this type of consultation. For example, it has been shown that patients feel less anxiety during these online consultations.

We also discussed how increased internet use affects the doctor-patient relationship as well as how it affects simply the patient. It has been shown by physicians that with increased internet use, consultations are often more time consuming because of the complex questions patients have an sometimes misleading information that they have gathered from the internet. However, sometimes patients’ internet research has been shown to enable more complex conversations with physicians during these meetings. Therefore, it is important that when seeking any information, especially medical, that we be very cautious as to what we believe to be true. Often information on the internet can be false or misleading. Although our advancements have made it possible to have information at our fingertips, it is very important that we be cautious with this information and careful not to be mislead.

I do believe that our internet usage has lead to changes in many aspects of the mental health field. Like we have discussed, it has transformed consultation style, patient education, and even our doctor-patient relationships. As a prospective clinician, I believe I will utilize these various technologies but I will do so with caution. These changes with technology can be very beneficial to all of medicine but it is important that we be careful and understand these new innovations in our fields.

Forum 4- Amy Spear

1. There are some differences in tele psychiatry consultation versus in-person consultations. For example, some important cues such as gait and physical aspects of the patient are missing in tele psychiatry consultation. It has been shown that videoconferencing provides an appropriate physical environment for decision-making. Also, nonverbal communication is very important within these consultations. Picking up on these nonverbal cues are somewhat difficult in telepsychiatry consultations. It has been shown that these videoconferencing consultations reduce anxiety within patients while physicians feel increased levels of anxiety. Although these differences exist, both in-person and videoconferencing have been shown to be effective.

2. Doctors have expressed that when patients have done more research on the internet that their consultations have become more time-consuming because patients have more complex questions and often have found misleading information. Although our increased internet usage has impacted the doctor-patient relationship, the increased internet usage by the patient has somewhat enhanced doctor-patient conversations. Patients have gained greater knowledge of their conditions and are able to have more complex conversations with physicians. However, this knowledge can be helpful, anxiety and distrust in the physician can lead the patient to seek help from the internet.

3. However, our increased internet usage can be helpful to us in many ways, it can often provide misleading information to patients. It is hard to find reliable information online and patients often believe that what they see on the internet is entirely true. However, most online sources can be edited by anyone and can even have false information included. Although some information we find on the internet is true, we must be careful with what we do with this information because we often do not know the value of this information.

Forum 4-Abbi Herrold

What is the difference between a telepsychiatry consultation and a face-to-face consultation?

The differences between consultation via videoconferencing and traditional consultation are limited, but they do still exist. One main difference is that it can be more difficult to pick up on body language and nonverbal cues via videoconferencing, this is known as the "cuelessness" phenomena. Additionally, the amount of patient disclosure may be affected with the use of teleconferencing if patients believe that they are being recorded or that others may be able to hear or view the conversation they are having with their physician. Finally, there may be technological issues like signal delay or interruptions between patient and physician as it can be difficult to interpret natural language processes with the lack of body language. It is found that in person consultations take less time, but both traditional and consultations via videoconferencing have been found to be effective

The Internet has provided a broader access to health-related information. How has the increased access changed the patient’s use of information and the doctor-patient relationship?

Many doctors have reported that the time of consultation has increased due to increased access to health information that is available online, while others report that it has decreased the time of consultation as patients are better able to narrow down their main concerns and questions. Health information available online nonetheless has increased the discussion between patient and doctor, patients now have more control and are able to  better be a mutual partner in their healthcare plan instead of having a care plan that is simply given to them without a lot of their input. Also, doctors are able to refer patients to certain online resources as supplementary versions of psychoeducation.  However, doctors do report some disadvantages to patients having access to health information via the internet such as patients are becoming more demanding as a result of online forums. Also, patients who have anxiety or a lack of trust in their doctor may seek further use of the internet and trust the information and advice given by the internet than that of the doctor. 

What are the possible problems with Internet use linked with the nature of the Internet itself?

The golden rule of the internet seems to the golden rule of the T.V. and any other source of media "don't believe everything you read, see, etc." It can be difficult to evaluate the authenticity and credibility of sources on the vast worldwide web. Therefore, patients must be cautious when searching for health information and make extra effort to evaluate the sources and how accurate, helpful, and valuable they may be. There is a lot of misleading information on the internet patients must keep this in mind. Additionally, through online forums and social media there is a risk of confidentiality being breached both to patients and physicians. One must always ere on the side of caution when using or posting on the internet!

Online forum on 4/12

Critically read Chapter 13 (257-264) and use your own words to describe:

1. What is the difference between a telepsychiatry consultation and a face-to-face consultation?
2. The Internet has provided a broader access to health-related information. How has the increased access changed the patient’s use of information and the doctor-patient relationship?
3. What are the possible problems with Internet use linked with the nature of the Internet itself?

Forum 3-Amy Spear

1.The key concept of the doctor-patient relationship is the consultation. Sir James Spence states it is “The occasion when, in the intimacy of the consulting room, a person who is ill, or believes himself to be ill, seeks the advice of a doctor whom he trusts” . This consultation is a way to integrate the expertise of physician as well as the information provided by the patient. This consultation is the central moment for the doctor-patient relationship and sets the standard for the relationship as a whole.

2. A doctor’s approach must be holistic meaning, treating the patient as a whole:mentally, physically, mentally, and spiritually. Sir James explains again that “Before explanation and advice can be given to a patient, three diagnoses must be made: the diagnosis of the disease, of the concept or fears of the disease in the mind of the patient and of the patient’s capacity to understand the explanation” . This approach makes treatment more effective. It allows the patient to be treated for every aspect of their being, not just physical ailments. Therefore, a physician must take all the aspects of the patients health into account when providing treatment.

3. It is the responsibility of the physician to ensure that the consultation is given in an appropriate manner. This means that there is a mutual understanding by the doctor and the patient. This an opportunity for the physician to give the patient information for the patient to provide the doctor with the proper information to find a solution to their problem. Consultation analysis has developed as a part of training to show the importance of how this understanding by the two parties is needed during the consultation. Roger Neighbour describes the five stages of a consultation. These are that the physician first connects with the patient and develops rapport, then summarizes the reason for the patient being there and the expectations of the consultation. Next, the physician “hands over” or shares with the patient the treatment plan and then “safety nets” with the patient in case something unexpected happens. Finally, after the patient has left, the doctor “housekeeps” and to ensure they are ready for the next patient. Consultation is necessary to establish effective communication between the patient and doctor. This also allows the physician to gather information from the patient, educate the patient, and then develop an appropriate diagnosis and effective treatment plan.

Forum 3 -Abbi Herrold

What is the key concept of the doctor patient relationship? How can trust between the doctor and patient achieved?

The key concept to this relationship is the consultation. The consultation is the central moment and often the beginning of the doctor patient relationship, it brings together the experiences and illness of the patient and the   experience and expertise of the doctor. Trust can between the doctor and patient can be created by valuing each other their as individuals with their own knowledge and experience. Additionally, the doctor and patient must both accept each other. 

Why must the doctor’s approach be holistic?

A holistic approach is important to make sure the doctor/practitioner does not overlook the impact of the individual on the diagnoses and vice versa. This approach recognizes that the disease/diagnosis does not live in a test tube but that it can be impacted by and/or impact the environment, experience, and personality of the patient. It also acknowledges that the function of the physician and their communication skills are key in the treatment/healing of the disease. This approach makes emphasizes that treatment is more than just a medication or empirical evidence, it values relationships, individual experience, and environment as well. 

What is the process of consultation analysis? Why is it important for managing the patient’s situation?

There are two basic methods of consultation analysis. The first is the "Inner Consultation" which is a  five stage mode which consists of connecting with the patient and developing rapport, followed by summarizing the patients reasons for being at the consultation, creating and sharing a management plan, making a contingency plan, and finally once the patients leaves the doctor conducts housekeeping work and ensures they are in the right state of mind for the next patient. The other method is known as the "Silverman's Calgary Cambridge method" which is based off of the previously mentioned model, however it goes into more detail of how these things should be done. Silverman's model is widely used for training purposes as it thoroughly breaks down the steps of consultation to future doctors and clinicians. This consultation is important to make sure that the doctor is making the correct diagnosis, knows the feelings of the patient and previous conceptions the patient has about the presenting problem/diagnosis, to create a plan of treatment, and to ensure that plan of treatment is desirable and comfortable for both the patient and the clinician. 

Online forum on 4/10

Critically read Chapter 13 (252-257) and use your own words to describe:

1. What is the key concept of the doctor patient relationship? How can trust between the doctor and patient achieved?
2. Why must the doctor’s approach be holistic?
3. What is the process of consultation analysis? Why is it important for managing the patient’s situation?

Blog Post 12-Amy Spear

This week we reviewed new hybrid models of care for eMH treatment and how it affects doctor-patient relationships as well as reaching underserved populations worldwide with proper care.   These new models hybrid models of care include online education and other various tools for patients as well as in-person therapy with a mental health professional. This method is growing very popular. It is even being considered the new standard of care. It is important that we change the minds of those who are stuck using traditional methods. Using these hybrid models could transform how we treat mental health patients. To accelerate the growth of such models we should begin to teach these methods to the new generation of mental health providers. Teaching this new model in nursing schools, medical schools, and psychiatric residency programs. Then we can use quality improvement and sustainability to continue to improve the model over time. These new models are especially important in treating children with mental health disorders. More specifically, those who suffer from ADHD. Utilizing online tools can be more comfortable for children. Especially with the use of virtual patient advocates which are computerized avatars that assist in treatment process. They are designed to integrate practices from provider-patient communication theory and are very beneficial to treating children. Children whose therapies integrate these VPAs are more likely to feel comfortable interacting with them than with an adult physician.

As we make advancements in these integrated models of care using online and in-person care, we have access to treat many other populations we were not able to before. These hybrid therapy models have made it possible to reach underserved populations where the need for care is highest but it is often not met. These are also very helpful in helping those where a language barrier makes it difficult for them to seek treatment. These methods make international patients feel more comfortable and are able to quality care.

Overall, this new standard of care is one that still needs to be studied and improved. However, it has the potential to transform the mental health care industry and change our delivery of care.

Blog post 12- Abbi Herrold

This week in class we discussed the influence of technology on the doctor-patient relationship, patient advocacy, and clinical processes. This includes the doctor-patient relationship shifting mainly from authority positions to partner positions. So, instead of a doctor telling a patient which treatment they will use and implementing the treatment in the patient, the doctor and patient can choose the best treatment plan for the patient together. The future of patient advocacy is considering a more virtual approach. This would include a realistic, medically educated virtual "character" who would be able to have conversations with you about your medical concerns and can be accessed nearly anywhere, in real time. Finally, we discussed the implication of technology on the clinical process and how a hybrid model between traditional care and telehealth is becoming increasingly popular. For example, a hybrid model may consist of in person consultation and diagnosis with biweekly traditional therapy sessions, while on the off weeks may have "homework" or online therapy exercises to complete online that the clinician has access too. This model is also more efficient for collaborative care and stepped care models. As an aspiring clinician, I feel as if the hybrid model makes the most sense and would unsure the highest satisfaction for both the patient and the provider. The hybrid model is a model that I see as ideal and will strongly consider implementing in my future career.

We also discussed the application of applying this technology to mental health treatments internationally and cross-culturally. This could include videoconferencing and treatment where the patient is located in one country and the practitioner in another. However, it could also include treatments in which both the provider and the patient live in the same country but there are no practitioners around that are culturally competent in the patient's or experiences or that the patient feels will understand them.

One article I found suggests that with the Affordable Care Act there would be an increase in patients and consumer demand. As a solution to the high demands that may be extremely taxing on the healthcare system they suggested the three key things healthcare systems should have is: integrated technology ( online health records), patient friendly portals (to send and receive secure messages) and increased advertising. I agree with this article as these have been things I have felt were key throughout many discussions in our class.
http://insights.wired.com/profiles/blogs/why-new-consumer-based-healthcare-models-require-innovative#axzz4dWcJyzoa

Forum 2-Abbi Herrold

1. Why are hybrid models of in-person and technology-delivered care considered as a new standard of care that we should move towards?

These models are easily accessible, more affordable, and more time efficient. Hybrid models have the ability to combine the best of both worlds: therapists and physicians are still able to meet with their patients in person and build a more genuine relationship, while at the same time they are able to ensure their client is doing their "homework" or performing intervention tasks via online modules. Additionally, it is easier for a team of healthcare providers to coordinate and collaborate via online platforms rather than in person. With this being said hybrid models can combine many "worlds" through stepped care models, access to specialists, endless options of delivery for online programs, asynchronous models, interdisciplinary roles, and improved training. A hybrid program combines all the advantages and eliminates all the disadvantages that the systems hold when utilized separately from each other, and this is why it should be implemented as a new standard of care

How are new technologies applied in the national and international cross-cultural MH services?

New technologies have been used to both improve communication between patient-and provider when there are language barriers, in addition to providing support to those living in other countries. Online translation systems have been used as a more cost effective way to help eliminate language barriers between the patient and provider. Additionally, these systems can be used in rural areas where one may not be able to find a professional translator. However, and even better option than the use of translators can be international telepsychiatry. For example, a patient who is a first generation immigrant from Italy who now resides in rural Indiana struggling with depression may not be able to effectively communicate with their therapist or feel that the therapist here cannot truly understand what he is going through as he has not lived in an Italian culture before. The patient could then be connected with a therapist in Italy and receive treatment from them via synchronous and asynchronous telepsychiatry. This system helps to eliminate stigma, improve care delivery, and patient satisfaction. However, it is important to note that this system does currently have limits as it is mainly being utilized in countries of the European Union. This excludes many countries, especially underdeveloped countries which may need access to this type of care the most. 

Forum 2-Amy Spear

1. Many practitioners are integrating a hybrid model of care using online and in-person techniques because it is becoming affordable, timely, and easier to access. For example, a study is being run in Seattle to utilize this model. They are using numerous in-person and technological approaches to provide assessment and treatment to children who suffer from ADHD living in the Northwest. This project psychiatrists provide in-person and online education, patients are able to see physicians and psychiatrists online and in person while the whole delivery platform is online. However, it is also focused on primary care clinics where all of the therapy sessions are held. These hybrid models are being considered the new model of care and the hope is that these approaches will continue to grow. If more mental health providers switch to this model of care, we could involve the Department of Veteran Affairs, the younger generations of mental health providers, and the patients and families who will help us move into a larger e-care industry. This larger technology platform could include the best of stepped care models, access to more specialists, and more e-mental health delivery options. We can start this movement by beginning to teach these new models of care in residency programs, nursing and medical schools to familiarize our upcoming generations to this new model.

2.  New technologies and these new models of hybrid care are becoming very important to our national and international mental health care delivery. E-mental health applications like these have been helping reduce disparities in access to relevant healthcare to the most vulnerable patient groups like refugees, migrants, and others in these underserved populations. These mental health tools have also helped significantly for patients who face language barriers and normally do not seek adequate treatment because of it.  Videoconferencing and other e-mental health tools have also been effective at making translators and interpretations services more readily available. Overall, these advancements made in e-care for mental health patients have ultimately helped us reach these underserved populations and make international patients more comfortable and willing to seek appropriate care.

Online forum on 4/5

Critically read Chapter 12 (243-248) and use your own words to describe:

1. Why are hybrid models of in-person and technology-delivered care considered as a new standard of care that we should move towards?
2. How are new technologies applied in the national and international cross-cultural MH services?

Forum 1-Amy Spear

1. Our great advancements in technology have already begun to impact doctor-patient relationships. Technology is becoming more and more common in healthcare. So common, that all areas in mental health can now provide e-therapy. Doctor-patient relationship is vital to medicine. It is especially important in mental health fields because it is a major part of the therapeutic process. It is clear the this doctor-patient relationship has changed with the use of technologies such as videoconferencing, email, and instant messaging. Anderson has written “Emerging evidence across trials clearly suggests that the computer cannot totally replace human contact”  . Therefore, he is stating that although technology use may be more efficient and easier to access, it may not be as beneficial as in-person therapy.  Also, that these therapies could be more helpful if in-person therapy was used as well. So although, online therapy is becoming more common, in-person consultations will stay the norm for most patient-doctor relationships. However, with the use of online therapy, it is vital that patients and doctors set boundaries especially when using these online portals. These are conversations that doctors and patients need to have especially when utilizing online therapies. It is also important that they establish back-up resources in the event that their online therapy is not sufficient or urgent issues arise. E-therapy can be very beneficial because it is convenient, private, and easily accessible for those in remote locations or those with disabilities. Online treatments are being created that can be just as effective as in-person therapies. Therefore, as our research and advancements we will continue to see these changes between doctor and patient to hopefully one day reform this relationship while using online therapies to make it just a strong as in-person doctor-patient relationships.

2. A virtual patient advocate(VPA) is computerized character such as an animated avatar that is that is designed to integrate practices from provider-patient communication theory. It portrays face-to-face communication with non-verbal communication like hand gestures, posture, and gazes. VPAs could be very beneficial for children. This is because children might find that interacting with a VPA like a “virtual friend” would be much less threatening than with a physician. This would be especially true if the VPA was also a child. Many children are used to seeing animated characters in video games and movies so they might be very comfortable using a VPA. VPAs could work similarly for veterans. The SimCoach was a project created to establish virtual support agents that serve as online guides and therapists to military service members, veterans, and their families. VPAs can elevate these methods and deliver new methods of care. VPAs can be used for PTSD patients in a similar way that VR is currently being used to treat these patients.

Forum 1 -Abbi Herrold

1. How has the doctor-patient relationship changed with the use of videoconferencing and e-therapy, and how should the practitioners deal with the change?

As a result of new technology and increased internet in the field of healthcare, the doctor patient relationship is changing. Doctors are becoming more of an informed partner to their patients rather than a complete director. Patients are able to interact with other individuals who have the same or similar medical conditions as them and hear what treatment options have worked best for them. In this way, patients are able to bring their own ideas about what treatment they feel would be best for them to their doctors and in turn doctors can give their feedback on whether or not they feel this treatment option is the most viable for the patient. This type of relationship works well to ensure the patient is receiving the best possible treatment and feels as if they have autonomy over their treatment plan.

Physicians should be prepared to deal with this change by assessing clients suitability for non-traditional treatments (such as online interventions or a hybrid model), having a back-up plan in case the current plan fails due to technological issues, increasing symptom severity, etc, providing education to clients on their condition and how the non-traditional process might work, providing consent, and ensure they are working/ providing treatment ethically. As the use of technology and the internet increases within the field of mental heath physicians must remain open to all options of treatment and be willing to educate and inform their clients on these options. 

2. What is a virtual patient advocates (VPA) and why might it work (e.g., for children, veterans, etc.)?

A virtual patient advocate is animated, online character used to enhance communication between the patient and doctor. Some clients may think of their advocate as a family member or friend that they brought along to make sure they ask all the right questions and bring up all the presenting problems to their doctor. The VPA is similar to this as its first and foremost responsibility is to the patient, however it is portable and can be utilized anywhere (even when both the patients and doctor are not in the room). VPAs could be increasing popular in children if presented like a cartoon character, they may feel less intimidated than by a traditional patient advocate. Children are more likely to open up to a cartoon character they deem as a friend rather than an adult who they may feel that they have to provide the "right" answer to. Additionally, this may be a popular option for veterans seeking help for PTSD as it takes much of the stigma and judgement away from the process of seeking help.