Towards Adaptive Technology in Routine Mental Healthcare

This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.publishedVersio

Utilization of Media-Driven Technology for Health Promotion and Risk Reduction among American Indian and Alaska Native Young Adults: An Exploratory Study

Across the developmental spectrum, American Indian and Alaska Native (AI/AN) adolescents and young adults experience considerable behavioral and mental health disparities, including substance abuse, depression, and engagement in sexual behaviors which enhance risk of pregnancy and sexually transmitted infections. Health-focused interventions utilizing digital and media technology hold significant promise among tribal communities, as they have the capacity to eliminate geography-based barriers. Utilizing a sample of 210 self-identified AI/AN students attending tribal colleges, this study identified the most effective technologies and intervention strategies, as well as health seeking patterns and preferences, which may impact implementation and sustainable use in tribal settings. The use of technology was both diverse and pervasive among AI/AN young adults, mirroring or exceeding patterns of young adults from the broader population. These data suggest that technology-based interventions may effectively deliver information, resources, and behavior change tools to AI/AN young adults, particularly when reflecting their unique worldviews and social contexts

Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies.

Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities

Conducting Research with Community Groups

Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. While several barriers to conducting research with community groups exist, community based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This manuscript presents case studies that demonstrate how CBPR principles guided the development of: (a) a healthy body weight program for urban, underserved African-American women, (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women, and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research intensive academic environments

Creative approaches to mental health: a critical analysis of the mindfulness agenda in Sussex

Mindfulness is a packaged intervention with current popularity in East Sussex, and this study explores how it is embedded in mental health services, the processes of the gathering and presentation of evidence, how the experience of patients is organizationally shaped and the importance of indirect interventions. These forms of interventions are what has been termed ‘choice architecture’ by proponents of the ‘nudge agenda’, describing the way that decisions and behaviour are influenced by how the choices are presented or designed . I want to explore the feasibility of applying indirect interventions to mindfulness in order to increase take-up rates, evaluative mechanisms and follow-up support, based on the patient perspective. Mindfulness-based cognitive therapy (MBCT) was recommended by NICE in their guidelines in 2004, was brought fully into the mainstream and has now been specifically adapted for psychosis. My research is on the interaction between mindfulness as an innovative therapy, a marginalised group of people who experience psychosis, and the currently popular behavioural economics (nudge) agenda. The nudge agenda is being promoted on the basis of cost-effectiveness, the aptness of its ideology to the current political climate, and its evidence base in particular case studies. The use of creative indirect interventions such as nudge, ‘when carefully crafted and applied’, can be ‘a positive means of communication between physician and patient’

Developing Targeted Interventions to Advance Maternal Health in a Geographic Medicaid Accountable Care Organization: Lessons From the Implementation of Camden Delivers

Through the design and launch of Camden Delivers the Coalition developed targeted interventions within an ACO infrastructure to advance maternal health in a Medicaid-covered population. Key insights from this process include the need to:* Utilize data to understand community need and design interventions around that need* Establish a population health surveillance system to produce actionable data to intervene with a complex population* Institute a tiered intervention system targeted to identified need, and* Leverage and coordinate across existing resources in the community to reduce duplication.Going forward, with the infrastructure developed by the Coalition to collect and review health data, along with the intricate web of community partners and resources, the next step in this program is to enhance feedback loops between partners and to help navigate patients seamlessly between partners during the highly fragmented experience of managing a pregnancy and healthcare during the interconception period. A formal network of communication between patients, case workers, care managers, providers and community resources through more sophisticated use of data and convening will allow us to support vulnerable patients in an even more effective manner. The Coalition looks forward to playing this convener role and working across groups to the end of better care management services and improved health for women of maternal age in Camden

Equality in Health: An Annotated Bibliography With Resources on Health Disparities and Cultural and Linguistic Competency

Provides citations for articles, reports, books, and online resources on racial/ethnic disparities in health and health care, strategies to reduce them, assessment tools for cultural and linguistic competency, training and education, and other issues

Health and health promotion and applied health psychology in sexual and stigmatized minority populations : a collection of papers and a monograph presented in application for the degree of Doctor of Science at Massey University

This Doctor of Science comprises a number of published works, listed in the attached file. As such due to copyright restriction they are not included here but can be accessed individually from the publisher. The author's Curriculum Vitae has been redacted from the attached file for privacy reasons.In a career lifetime of working in both universities and in and with health departments, my work in applied psychology has dealt with stigmatized sexual minorities (particularly MSM) in many countries and settings, including before, during, and after the main impact of the AIDS epidemic (which in many locations and populations is still epidemic or in a subsequent “wave”). Applied health psychology must of necessity make use of many opportunities that cannot be planned in advance, or of situations where study of stigmatized groups is both dangerous (for them and for researchers) and difficult. The unifying theme in this DSc is the stigmatized minority group, the stigmatized disease, and the stigmatized setting. Massey University provided the training for the first “bookend” of my career at its beginning, and this dissertation as the second “bookend” some 45 years later of a career of surprises, opportunities, and challenges – some of the better parts of which are reflected in these pages