Technological Innovation Intervention Fact Sheet


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Technological Innovation Intervention Fact Sheet

  1. 1. Intervention Fact Sheet Technological Innovations in Behavioral Health Services The Center Authors: Steven Belenko, Ph.D and Brandy Blasko, M.A., Temple University homework. A drug treatment example is the TherapeuticThe Center for Behavioral Health Services & Criminal Engagement System (TES), using cognitive-behavioralJustice Research, funded by the National Institute of therapy (CBT).4 TES is being tested in prison facilities inMental Health, studies the effectiveness of behavioral four states in a National Institute on Drug Abuse-fundedhealth interventions to engage and treat people with mental randomized clinical trial, and can potentially increase theillnesses (with or without co-occurring substance abuse percentage of inmates getting drug treatment. CivilWorld5problems) who have criminal justice involvement. Fact is a cognitive interactive computer program that teachesSheets on other interventions can be found on at skills to reduce criminal thinking, drug relapse, and prove self-control and decision making. The program is onIntroduction computer kiosks, thus requiring no internet connection,Over the past decade, growing use of technological inno- and has been used in jails, prisons, and drug courts.vations (internet-based and computerized therapy, interac- In web-based group counseling, clients anonymously jointive cell phone and personal digital assistant technology) an on-line group. Video allows the client to see otherhas increased access to behavioral health services. This group members and the counselor and chat privately withFact Sheet summarizes findings from studies of technolo- the counselor. One example is eGetGoing,6 accredited bygical innovations in behavioral health care for persons with the Commission on Accreditation of Rehabilitation Facili-mental illnesses or substance abuse disorders. It is de- ties. On-line counseling can be accessed from home andsigned to help policymakers, practitioners, researchers, and thus facilitate access to group therapy without issues ofadvocates make sense of the evidence as they consider transportation, child care, or confidentiality.whether to test or adopt such innovations. Personal digital assistants or cell phones can be used toAbout 79% of Americans aged 18+ are online, 66% have deliver health promotion or prevention messages, behaviorhome broadband access,1 and 82% own cell phones.2 The management (e.g., relapse prevention) or therapy, andthird most frequent online activity for those aged 18+ is quickly connect clients with counseling or crisis assis-getting health information (83%). Technology use is com- tance. It also has potential applications for getting real-mon even among those earning less than $30,000/year: time data on the context of risky behaviors, relapse, bar-75% own a cell phone, 42% a desktop computer, 40% riers to accessing services, and other factors affecting men-have home broadband access, and 57% use the internet.3 tal health or substance abuse problems. This technology isNew generations of cell phones and easily downloadable being tested in studies of drug and smoking cessation.7applications allow instant access to the internet. Thespread of this technology suggests considering its potential What does the research indicate?for persons in the criminal justice system: to monitor and These technologies are relatively new, with limited effica-manage mental health and substance abuse disorders; im- cy research but encouraging results from some studies:prove medication adherence; provide more access to clini-  In randomized controlled trials, TES has been found ascal interventions; facilitate assessment; provide primary effective as standard counseling for adolescent drug8and secondary prevention; and provide research data on and adult opioid4 users, with higher satisfaction. Anoth-relapse, environmental risks, and recovery. For popula- er clinical trial found that substance abusers in standardtions with limited transportation access or physical mobili- treatment plus six computer-based modules had fewerty, or living in remote or rural areas, these innovations positive urines, longer abstinence, and more satisfactionhave the potential to greatly increase access to behavioral than the standard treatment only group.9health interventions, lower behavioral health care costs,and reduce health care access disparities.  Meta-analyses of computerized or internet-based thera- py for depression or anxiety found that the largest effectWhat are the types of technological innovations? on reducing symptoms was a computerized intervention“Telerehabilitation” or “telemedicine” includes web-based with support from a therapist.10,11diagnostic screening and assessment, transmission of bio-  Some computerized interventions for panic and anxietylogical data and behavioral health information, and web- disorders, social phobia, and psychotic symptoms werebased interactive health promotion programs. efficacious and others had positive outcomes only when coupled with therapist support.Computerized substance abuse prevention or treatment,mental health counseling, or sexually transmitted diseases  A small randomized trial of relapsed methadone main-(STD) and human immunodeficiency virus (HIV) preven- tenance clients found that those receiving eGetGoingtion may be DVD-based or loaded on a hard drive, interac- had equal satisfaction and outcomes as those who re-tive, and include skills training, educational material, and received onsite group counseling.12 Internet counseling clients reported more convenience and confidentiality. 176 Ryders Lane, New Brunswick, NJ 08901 Tel: 732.932.1225 Fax 732.932.1233 Website:
  2. 2.  Computerized, self-paced health prevention interven- Technology innovations in behavioral health services can tions reduced STD/HIV risk behaviors and increased expand access to interventions. Without the need to travel knowledge the same as person-delivered interventions.13 or make appointments, services can be tailored to clients’ Computerized risk assessment predicted violence among schedules and needs. Diagnoses and assessments can be offenders with mental health disorders.14 Among female facilitated, and real-time relapse prevention and health drug abusers, data from a brief computerized interven- promotion messages disseminated through cell phones. tion predicted substance abuse and treatment attrition.15 Although the evidence base is still limited, these interven- tions offer exciting potential for improving and expanding Clients in anxiety therapy were randomly assigned to the delivery of effective prevention and treatment to un- computer treatment with technician assistance, computer derserved populations, augmenting traditional behavioral treatment with clinician assistance, or standard outpa- health services, and informing new research on risk factors tient treatment. Both computer-based groups significant- and relapse. ly decreased symptoms compared to the standard outpa- tient group; the clinician-assisted group did better than References the technician-assisted group.16 1 Zickuhr, K. (2010). Generations 2010. Washington DC: Pew The Robert Wood Johnson Foundation’s Health eTech- Internet and American Life Project, Pew Research Center. 2 nologies Initiative17 compared online prevention or Smith, A. (2010). Mobile access 2010. Washington DC: Pew health promotion discussion groups, internet assessment Internet and American Life Project, Pew Research Center. 3 and diagnosis, online health coaching, PDA and email Jansen, J. (2010). Use of the internet in higher-income house- holds. Washington DC: Pew Internet and American Life reminders for health promotion, and telerehabilitation. Project, Pew Research Center. Outcomes were mixed, with several internet-based dis- 4 Bickel, W. et al. (2008). Computerized behavior therapy for ease management systems showing no effect on health opioid dependent outpatients: A randomized, controlled trial. behavior outcomes. Experiments in Clinical Psychopharmacology, 16, 132-143. 5Limitations and concerns about the innovations 6 7New technology innovations offer great potential for im- Ferguson, S., & Shiffman, S. (2011). Using the methods ofproving outcomes and access to behavioral health services. ecological momentary assessment in substance dependence re-Research findings are mixed but some studies have found search – smoking cessation as a case study. Substance Use andpositive impacts. Yet some limitations exist for offenders Misuse, 46, 87-95. 8and others. Marsch, L. et al. (2007). Applying computer technology to sub- stance abuse prevention: Results of a preliminary examination.Computerized and internet therapies can reach the hard-to- J. of Child and Adolescent Substance Abuse, 16, 69-94. 9serve but lack key dimensions of counselor-client alliance Carroll, K. et al. (2009). Enduring effects of a computer-and therapeutic engagement from direct therapist contact. assisted training program for CBT: A six month follow-up ofAlthough online group counseling may provide a certain CBT4CBT. Drug and Alcohol Dependence, 100, 178-181. 10level of anonymity and confidentiality, it is relatively easy Andersson, G., & Cuijpers, P. (2009). Internet based and otherfor marketers or computer hackers compromise anonymity computerized psychological treatments for depression: A meta- analysis. Cognitive Behaviour Therapy, 38, 196-205.(e.g., by knowing email and computer addresses). 11 Spek, V. et al. (2007). Internet-based cognitive behavior thera-Many offenders are low-income with less access to lap- py for symptoms of depression and anxiety: A meta-analysis.tops, new generation cell phones, and the internet. Prison Psychological Medicine, 37, 319-328. 12and jail inmates lack internet access. Aside from the TES King, V. et al. (2009). Assessing the effectiveness of an Inter-study, research is lacking on the feasibility, acceptability, net-based videoconferencing platform for delivering intensifiedand efficacy of technology innovations among offenders. substance abuse counseling. Journal of Substance Abuse Treat- ment, 36, 331-338. 13Finally, the unregulated nature of the internet can allow Noar, S. et al. (2010). Can computer mediated interventionsuntrained or unlicensed persons to offer assessment, coun- change theoretical mediators of safer sex: A meta-analysis. Hu-seling, and other behavioral health services. man Communication Research, 36, 261-207. 14 Wjik, L. et al. (2009). A pilot for a computer-based simulationFuture research on technological innovations system for risk estimation and treatment of mentally disordered offenders. Informatics for Health and Social Care, 34, 106-114.More research is needed, especially in criminal justice set- 15 Ondersma, S. et al. (2011). The potential for technology intings, about the effectiveness of these technologies, and brief interventions for substance use, and during-session predic-acceptance and feasibility among staff and clients. These tion of computer-delivered brief intervention response. Sub-interventions are potentially cost-effective by reducing stance Use and Misuse, 46, 77-86. 16transportation and infrastructure costs, and allowing lower Robinson, E. et al. (2010). Internet treatment for generalizedclinician-client ratios, but there has been little research on anxiety disorder: A randomized controlled trial comparing clini-their net economic benefits or incremental cost effective- cian vs. technician assistance. PLoS ONE 5(6): e10942.ness. Comparative effectiveness research should gauge doi:10.1371/ journal.pone.0010942. 17impacts against existing interventions. Ryders Lane, New Brunswick, NJ 08901 Tel: 732.932.1225 Fax 732.932.1233 Website: