Clinician perspectives on providing telepsychiatry services to young adults with first-episode psychosis during COVID-19.

BACKGROUND: Telepsychiatry has the potential to facilitate access to mental health services for young people with first-episode of psychosis (FEP); however, limited attention has been given regarding the perceptions of mental health providers in this regard. OBJECTIVE: To assess service providers' perceptions on the use of telepsychiatry and changes over time. METHODS: Longitudinal survey (conducted at two time points) of 26 service providers, including physicians, nurses, social workers, occupational therapists, and peer support workers, recruited from a specialized program for FEP providing telepsychiatry services through REACTS (videoconferencing platform). RESULTS: Responses during the initial and the follow-up survey were similar. Most participants used REACTS nine times or more, with more than half reporting that sessions lasted more than 30 min. Over time, there was a trend towards higher frequency of use and lower duration of sessions. The majority perceived REACTS as safe and easy to use and indicated they would recommend REACTS to colleagues. Although participants reported some issues related to set-up and initial use, internet accessibility, and sound and image, most of these concerns decreased during follow-up. Participants appreciated the usability and utility of REACTS, and reported several benefits of telepsychiatry, including facilitating client engagement, assessment and continuity. CONCLUSIONS: Service providers expressed positive perceptions regarding the use of telepsychiatry. Despite analysis being limited to a small sample, this study raises awareness of telepsychiatry's value and feasibility for offering services to young populations with FEP and the importance of conducting research on clinician perspectives in this regard.

Telepsychiatry services during COVID-19: A cross-sectional survey on the experiences and perspectives of young adults with first-episode psychosis.

INTRODUCTION: Limited evidence exists on the implementation of telepsychiatry within the context of early intervention services for psychosis, the need for which has become even more relevant during the COVID-19 pandemic. To address this gap, we investigated the experiences and perspectives of young adults recovering from a first-episode psychosis (FEP) following their use of telepsychiatry services (i.e. use of video conferencing technology to deliver mental health services to patients in real time). METHODS: A cross-sectional online survey study was implemented between November 19th , 2020 and March 9th , 2021 with young adults recruited from a specialized program for FEP located in an urban Canadian setting. Data were analysed using descriptive statistics, exploratory (Fisher's exact test), and content analysis. RESULTS: Among 51 participants (mean age = 26.0, SD = 4.7; 56.9% female), the majority were satisfied with the service (91%, 46/51), perceived that the platform was easy to use (90%, 46/51) and felt secure in terms of confidentiality (82%, 42/51). Satisfaction was related to perceptions regarding ease of use, image quality, and employment/studying status. Several partially or totally agreed that the presence of a third party was essential to login during the first few sessions (35%, 18/51), and some needed technical support (24%, 12/51) throughout the sessions. CONCLUSIONS: This study shows that telepsychiatry is feasible and acceptable to implement for patients in the early phase of psychosis recovery. It also highlights the importance of making technical support available, especially in the first few times of using the service, and addressing patient concerns regarding confidentiality, even when using secured health technologies.

Use of technology to provide mental health services to youth experiencing homelessness: a scoping review protocol.

INTRODUCTION: Despite the importance to address mental health issues as early as possible, youth experiencing homelessness (YEH) often lack prompt and easy access to health services. Recently, there has been a surge of studies focusing on leveraging technology to improve access to mental health services for YEH; however, limited efforts have been made to synthesise this literature, which can have important implications for the planning of mental health service delivery. Thus, this scoping review aims to map and synthesise research on the use of information and communication technologies (ICTs) to provide mental health services and interventions to YEH. METHODS AND ANALYSIS: A scoping review of the literature will be conducted, following Arksey and O'Malley's proposed methodology, the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews and recent guidelines from the Joanna Briggs Institute. All peer-reviewed papers using ICTs as a means of intervention will be considered, as well as grey literature. Only documents in English or French will be included in the analysis. First, 10 electronic databases will be consulted. Next, all data will be extracted into Covidence. Then, two reviewers will independently conduct the screening and data extraction process, in the case of discrepancies, a third reviewer will be included. Finally, data will be synthesised according to our objectives. ETHICS AND DISSEMINATION: Ethics approval is not required, as data will be collected from published literature. Findings will be disseminated through conference presentations and peer-reviewed journals.

Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion.

Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.

COVID-19 pandemic's effects and telehealth in Early Psychosis Services of Quebec, Canada: Will changes last?

AIM: To explore the impacts of the COVID-19 pandemic first wave in Quebec, Canada on practices in early intervention services (EIS) for first-episode psychosis, including reorganization of clinical and administrative practices and teleconsultation use. METHODS: Adopting a cross-sectional descriptive study design, a 41 questions online survey was sent to the team leaders of all the 33 Quebec EIS, of which 100% responded. Data were collected from 18 May to 4 June 2020 and analysed using descriptive statistics and content analysis. Programmes were categorized as urban/non-urban and results were compared between these. RESULTS: All 33 existing Quebec EIS (16 urban and 17 non-urban) completed the survey. Among them, 85% did not experience redeployment of EIS team staff and 58% reported stable frequency of patient interactions, either in-person or through telemedicine. During the studied period, 64% of programmes reported that all professionals used teleconsultation at least occasionally. However, 73% of programmes, mostly in non-urban areas, reported some limitations regarding clinicians' degree of ease with teleconferencing platforms and half of EIS could not access technical support to use them. The majority of EIS (94%) expressed interest to participate in a training program about the use of technologies for teleconsultations. Many smaller clinics reported interest in offering multiregional/multiclinics group teletherapy, therefore merging their pool of patients and clinical staff workforce. CONCLUSIONS: Further studies are warranted to improve access to and use of technology-mediated treatment, which seems to be a promising alternative to provide high-quality mental healthcare during the COVID-19 pandemic and beyond.

Priority Given to Technology in Government-Based Mental Health and Addictions Vision and Strategy Documents: Systematic Policy Review.

BACKGROUND: The use of information and communication technologies (ICTs) to deliver mental health and addictions (MHA) services is a global priority, especially considering the urgent shift towards virtual delivery of care in response to the COVID-19 pandemic. It is important to monitor the evolving role of technology in MHA services. Given that MHA policy documents represent the highest level of priorities for a government's vision and strategy for mental health care, one starting point is to measure the frequency with which technology is mentioned and the terms used to describe its use in MHA policy documents (before, during, and after COVID-19). Yet, to our knowledge, no such review of the extent to which ICTs are referred to in Canadian MHA policy documents exists to date. OBJECTIVE: The objective of this systematic policy review was to examine the extent to which technology is addressed in Canadian government-based MHA policy documents prior to the COVID-19 pandemic to establish a baseline for documenting change. METHODS: We reviewed 22 government-based MHA policy documents, published between 2011 and 2019 by 13 Canadian provinces and territories. We conducted content analysis to synthesize the policy priorities addressed in these documents into key themes, and then systematically searched for and tabulated the use of 39 technology-related keywords (in English and French) to describe and compare jurisdictions. RESULTS: Technology was addressed in every document, however, to a varying degree. Of the 39 searched keywords, we identified 22 categories of keywords pertaining to the use of technology to deliver MHA services and information. The 6 most common categories were tele (n=16/22), phone (n=12/22), tech (n=11/22), online (n=10/22), line (n=10/22), and web (n=10/22), with n being the number of policy documents in which the category was mentioned out of 22 documents. The use of terms referring to advanced technologies, such as virtual (n=6/22) and app (n= 4/22), were less frequent. Additionally, policy documents from some provinces and territories (eg, Alberta and Newfoundland and Labrador) mentioned a diverse range of ICTs, whereas others described only 1 form of ICT. CONCLUSIONS: This review indicates that technology has been given limited strategic attention in Canadian MHA policy. Policy makers may have limited knowledge on the evidence and potential of using technology in this field, highlighting the value for knowledge translation and collaborative initiatives among policy makers and researchers. The development of a pan-Canadian framework for action addressing the integration and coordination of technology in mental health services can also guide initiatives in this field. Our findings provide a prepandemic baseline and replicable methods to monitor how the use of technology-supported services and innovations emerge relative to other priorities in MHA policy during and after the COVID-19 pandemic.

Adaptation of a Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Services for First-Episode Psychosis: Results From the Horyzons-Canada Phase 1 Study.

BACKGROUND: Developing a digital health innovation can require a substantial amount of financial and human resource investment before it can be scaled for implementation across geographical, cultural, and health care contexts. As such, there is an increased interest in leveraging eHealth innovations developed and tested in one country or jurisdiction and using these innovations in local settings. However, limited knowledge exists on the processes needed to appropriately adapt digital health innovations to optimize their transferability across geographical, cultural, and contextual settings. OBJECTIVE: We report on the results of an adaptation study of Horyzons, a digital health innovation originally developed and tested in Australia. Horyzons is designed to prevent relapses and support recovery in young people receiving services for first-episode psychosis (FEP). The aim of this study is to assess the initial acceptability of Horyzons and adapt it in preparation for pilot testing in Canada. METHODS: This research took place in 2 specialized early intervention clinics for FEP, located in 1 urban and 1 urban-rural setting, in 2 Canadian provinces. A total of 26 participants were recruited: 15 clinicians (age range 26-56 years) and 11 patients (age range 19-37 years). Following the digital health adaptation framework developed by our team, we used a mixed methods approach, combining descriptive quantitative and qualitative methods across 3 stages of data collection (focus groups, interviews, and consultations), analysis, and adaptations. RESULTS: Overall, patients and clinicians appreciated the strengths-based approach and social media features of Horyzons. However, participants expressed concerns related to implementation, especially in relation to capacity (eg, site moderation, crisis management, internet speed in rural locations). They also provided suggestions for adapting content and features, for example, in relation to community resources, volume of text, universal accessibility (eg, for individuals with limitations in vision), and optimization of platform accessibility through mobile devices. Additional aspects of the innovation were flagged for adaptation during the final stages of preparing it for live implementation. These included terms of use, time zone configuration to reflect local time and date, safety and moderation protocols, the need help now feature, and the list of trigger words to flag posts indicative of potential risk. CONCLUSIONS: In the context of the COVID-19 pandemic and public health guidelines for social distancing, there is an increasing interest and need to leverage the internet and mobile technologies for delivering youth mental health services. As countries look to one another for guidance on how to navigate changing social dynamics, knowledge on how to utilize and adapt existing innovations across contexts is now more important than ever. Using a systematic approach, this study illustrates the methods, processes, results, and lessons learned on adapting a digital health innovation to enhance its local acceptability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.8810.