17: Therapist Led Telehealth/phone Therapies - MIRECC / CoE
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17: Therapist Led Telehealth/phone Therapies

Risk Management and Treatment » Technology-based Modalities
17: Treatment Adjuncts

There is insufficient evidence to recommend for or against the use of technology-based adjuncts (e.g., web or telephone applications) to routine suicide prevention treatment for individuals with suicidal ideation.

Strength:

Neither for nor against

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Studies evaluating the effect of technology-based interventions as adjuncts to routine suicide prevention treatment are rare. The CPG Work Group reviewed two such studies, neither of which included the critical outcomes of suicidal ideation or suicide attempt as primary study outcomes. There was also no evidence of harm with any of the interventions, and technology-based adjunct treatment may help with patient engagement and self-management. Important considerations, however, include accessibility and patients' comfort with technology-based interventions; concerns about Health Insurance Portability and Accountability Act (HIPAA) compliance and patient safety; network security and vulnerabilities; and comfort with using smartphones or other handheld devices/tablets.

Training Resources

This section includes links to recommended training resources about technology-based treatment adjuncts.

Clinician's Guide: VA Virtual Care Tools
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Mobile Applications

This section includes links to recommended technology-based treatment adjuncts.

VA Mobile App Store
mHealth VA Mobile Apps

Webinars

This section includes links to recommended webinars about technology-based treatment adjuncts.

CPG Webinar Digital Delivery of Treatment Protocols as Upstream and Downstream Suicide Prevention Strategies: State of the Science Presenters: Drs. Lisa A. Brenner & Carolyn Greene
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Videos

This section includes links to recommended video resources about technology-based treatment adjuncts.

VA Digital Tools for Veteran Health Care Delivery and Self-Care Management
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Articles

This section includes links to recommended articles about technology-based treatment adjuncts.

Betthauser, L. M., Stearns-Yoder, K. A., McGarity, S., Smith, V., Place, S., & Brenner, L. A. (2020). Mobile App for Mental Health Monitoring and Clinical Outreach in Veterans: Mixed Methods Feasibility and Acceptability Study. Journal of medical Internet research, 22(8), e15506. https://doi.org/10.2196/15506
Bush, N. E., Smolenski, D. J., Denneson, L. M., Williams, H. B., Thomas, E. K., & Dobscha, S. K. (2017). A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress. Psychiatric services (Washington, D.C.), 68(4). 330-336. https://doi.org/10.1176/appi.ps.201600283
Büscher, R., Torok, M., Terhorst, Y., & Sander, L. (2020). Internet-Based Cognitive Behavioral Therapy to Reduce Suicidal Ideation: A Systematic Review and Meta-analysis. JAMA network open, 3(4), e203933. https://doi.org/10.1001/jamanetworkopen.2020.3933
Kasckow, J., Zickmund, S., Gurklis, J., Luther, J., Fox, L., Taylor, M., Richmond, I., & Haas, G. L. (2016). Using telehealth to augment an intensive case monitoring program in veterans with schizophrenia and suicidal ideation: A pilot trial. Psychiatry research, 239. 111-116. https://doi.org/10.1016/j.psychres.2016.02.049
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Visual Abstracts

This section includes visual abstracts that are relevant to technology-based treatment adjuncts.

Integrating Mobile health (mHealth) Technology into Behavioral Health Care
Click/Tap for smaller image text
Betthauser, Stearns-Yoder, McGarity et al. 2020. Journal of Medical Internet Research
Integrating Mobile health (mHealth) Technology into Behavioral Health Care
Background

New m(Health) Technology

  • Real-time symptom monitoring & Tracking
  • Patient engagement

n = 83 Veterans
at least 1 symptom, dx or PTSD

Current Study Methods

Collect Data

  • clinical interviews &
  • self-report
  • participants download Cogito app
Results

79% of participants reported acceptibility of the app.

Perceived Benefits

Increased motivation for activity & engagement, as well as enhanced connection with care providers

Future Directions

Investigate

  • maintaining user engagement over time
  • gamification techniques
  • intrinsic motivation
  • studying specific populations

Betthauser, Stearns-Yoder, McGarity et al. 2020. Journal of Medical Internet Research

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Podcasts

This section includes links to recommended podcasts that are relevant to technology-based treatment adjuncts.

Rocky Mountain MIRECC Short Takes on Suicide Prevention
Short Takes podcast icon A Mobile Safety Planning App with Dr. Pearl McGee-Vincent
Short Takes podcast icon Talking to T2 about Mobile Apps for Mental Health