Digital health technologies in the psychosocial treatment of core symptoms of psychotic disorders - literature review and practical aspects

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The Finnish therapy navigator – Digital support system for introducing stepped care in Finland

Introduction: The need to improve quick access to effective psychological treatments is urgent. Success requires effective tools for identifying what kind of therapies an individual is likely to benefit from and managing a comprehensive therapy offering that matches an individual’s needs. First-line therapies initiative (Terapiat etulinjaan–toimintamalli) is a national initiative started 2020 in Finland. It aims to help Finnish regions in building locally sustainable stepped care systems and providing the support services needed. One key service of First-line therapies initiative is the Finnish therapy navigator (FTN). The FTN is a digital tool to help assess individual needs for psychosocial treatments and to build a regionally sustainable stepped care treatment offering, as part of the national reform of social and health services. This paper describes the development, content, implementation and feasibility of the FTN. Materials and Methods: The system was piloted in six regions in Finland between October 2021 and May 2022, with a catchment area of around 600 000. The feasibility data was collected from professionals (n = 48) using the system at 1 and 4 months after implementation, and from the anonymous FTN responses (n = 2630). Results: Professionals estimated the FTN had a positive impact on their work, quality of assessment and notes, and patient experience at 1 month after starting to use the FTN. Satisfaction scores improved further at 4 months, and 93% of users wanted to keep FTN as a permanent tool. The mean time patients used to fill the FTN was 24 minutes; 75% of clinical interviews lasted under 30 minutes. The FTN provides important data on treatment seekers. In our sample 57% of respondents scored between 10-19 points on PHQ-9 and 59% between 5-14 on GAD-7, suggesting mild-to-moderate depressive and anxiety symptoms. 28% reported no previous psychosocial treatments and 33% previous treatments shorter than 6 months. Thus, it seems that a significant proportion of treatment seekers in Finland could benefit from readily available, short-term, evidence-based psychosocial treatments that the First-line therapies initiative supports. Conclusions: FTN is a feasible tool for first assessment of mental health issues in primary care. Implemented and localized using the manualized co-creation process results in very high user satisfaction and acceptability of the system. The FTN provides important real-time data on mental health treatment seekers to support service development and planning. The First-line therapies model that includes introducing FTN in combination with regionally adapted care pathway development, education in short evidence-based psychological interventions and increase in use of digital support systems appears a feasible way to build regionally sustainable stepped systems.publishedVersionPeer reviewe

The Finnish therapy navigator – Digital support system for introducing stepped care in Finland

Introduction: The need to improve quick access to effective psychological treatments is urgent. Success requires effective tools for identifying what kind of therapies an individual is likely to benefit from and managing a comprehensive therapy offering that matches an individual’s needs. First-line therapies initiative (Terapiat etulinjaan–toimintamalli) is a national initiative started 2020 in Finland. It aims to help Finnish regions in building locally sustainable stepped care systems and providing the support services needed. One key service of First-line therapies initiative is the Finnish therapy navigator (FTN). The FTN is a digital tool to help assess individual needs for psychosocial treatments and to build a regionally sustainable stepped care treatment offering, as part of the national reform of social and health services. This paper describes the development, content, implementation and feasibility of the FTN. Materials and Methods: The system was piloted in six regions in Finland between October 2021 and May 2022, with a catchment area of around 600 000. The feasibility data was collected from professionals (n = 48) using the system at 1 and 4 months after implementation, and from the anonymous FTN responses (n = 2630). Results: Professionals estimated the FTN had a positive impact on their work, quality of assessment and notes, and patient experience at 1 month after starting to use the FTN. Satisfaction scores improved further at 4 months, and 93% of users wanted to keep FTN as a permanent tool. The mean time patients used to fill the FTN was 24 minutes; 75% of clinical interviews lasted under 30 minutes. The FTN provides important data on treatment seekers. In our sample 57% of respondents scored between 10-19 points on PHQ-9 and 59% between 5-14 on GAD-7, suggesting mild-to-moderate depressive and anxiety symptoms. 28% reported no previous psychosocial treatments and 33% previous treatments shorter than 6 months. Thus, it seems that a significant proportion of treatment seekers in Finland could benefit from readily available, short-term, evidence-based psychosocial treatments that the First-line therapies initiative supports. Conclusions: FTN is a feasible tool for first assessment of mental health issues in primary care. Implemented and localized using the manualized co-creation process results in very high user satisfaction and acceptability of the system. The FTN provides important real-time data on mental health treatment seekers to support service development and planning. The First-line therapies model that includes introducing FTN in combination with regionally adapted care pathway development, education in short evidence-based psychological interventions and increase in use of digital support systems appears a feasible way to build regionally sustainable stepped systems.publishedVersionPeer reviewe

Early behavioral indicators to an entertainment focused information system

Playing video games is a popular way to spend time and mobile gaming is one of the most growing entertainment industries in the world. Gaming is often associated with high level of motivation from the user as well as many negative and positive outcomes. Commitment towards games has invited countless of researches to examine what makes them so intriguing and motivating. This growing understanding gives developers more tools to design even better games and allows game-like features to be used in other contexts as well. This master’s thesis examines automatically gathered early log-data (n=100 000) from two free-to-play mobile games in order to create a model for retention. A model created using early log-data (first three days of play) creates opportunities to recognize potential players in an early phase and to evaluate early iterations of games that are in development. Furthermore, individual features are analyzed to study, what are the factors that influence coming back to the game at a later point (30 days after the installation of the game). The research questions in this thesis are: 1) Can commitment towards mobile games be modeled using early log-data? 2) How accurate predictions the created model can do? 3) What are the most important in-game features that predict retention? The model is created using a decision tree analysis, which was selected as a method due to its transparency and because it has been used before in earlier studies with similar designs. In both games, the rate of coming back to the game after 30 days of installation was 7.6%. A working model for retention was formulated which was able to predict coming back to the game with 33% accuracy. The most important in-game features that affect retention were the number of victories, the number of starts and the number of in-app-purchases during the three-day period after the game’s installation. Surprisingly, in-game rewards and achievements were the most insignificant features when predicting retention although they are often specifically designed to elevate user motivation. These results can influence design decisions made in game development by setting the focus on the factors that influence player commitment and behavior. Achievements and in-game rewards might feel too artificial and superficial compared to winning in game. If the system gives direct feedback of the effect of time and monetary sacrifice to the player’s performance, one might be able to reduce the number of players that decide to leave the game. The results also can be used to examine how game-like features are used in non-game systems where the goal is to tie together the high-level of motivation seen in games and socially impactful endeavors. Further studies of in-game behavior might also give new insights on game addiction and its negative effects on player well-being and business

Virtual reality intervention for psychotic disorders using 360-degree video technology - development and initial pilot for feasibility

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