A Digital Platform Designed for Youth Mental Health Services to Deliver Personalized and Measurement-Based Care

Abstract

Mental disorders that commonly emerge during adolescence and young adulthood are associated with substantial immediate burden and risks, as well as potentially imparting lifetime morbidity and premature mortality. While the development of health services that are youth focused and prioritize early intervention has been a critical step forward, an ongoing challenge is the heterogeneous nature of symptom profiles and illness trajectories. Consequently, it is often difficult to provide quality mental health care, at scale, that addresses the broad range of health, social, and functional needs of young people. Here, we describe a new digital platform designed to deliver personalized and measurement-based care. It provides health services and clinicians with the tools to directly address the multidimensional needs of young people. The term "personalized" describes the notion that the assessment of, and the sequence of interventions for, mental disorders are tailored to the young person-and their changing needs over time, while "measurement-based" describes the use of systematic and continuing assessment of a young person's outcomes over the entire course of clinical care. Together, these concepts support a framework for care that transcends a narrow focus on symptom reduction or risk reduction. Instead, it prioritizes a broader focus on enhancing social, health, and physical outcomes for young people and a commitment to tracking these outcomes throughout this key developmental period. Now, with twenty-first century technologies, it is possible to provide health services with the tools needed to deliver quality mental health care.

Keywords: ehealth; mental disorders; mental health care; routine outcome monitoring; technology; transdiagnostic; youth.

Figure 1

The dashboard of results for the Innowell Platform. Panel (A) shows the summary dashboard which provides a broad overview of the young person’s results for key health domains. Panel (B) shows the more detailed dashboard (i.e., “your results and care plan” section expanded), whereby all of the results from the broad assessment are displayed on different “health cards.” Each domain is accompanied by a scale, the current result (represented using color and a dial), and an indication of personalized change. The Platform allows for the customization of specific domains, questions, and algorithms for this section. The use of color here is to make it easier for young people and clinicians to figure out what might be tracking well or not so well. The color is accompanied by a text description (e.g., high) as well as a timing (e.g., 3M, equal to “3 months”), which is used to indicate how recent the current result is. The middle of the health card presents the title and includes the personalized change status in text (e.g., improvement). The circles presented on the “suicidal thoughts and behaviors” health card provides an example of how the Platform communicates whether or not an intervention is currently active for a particular domain. Here, the initials of the treating clinician are displayed along with the young persons initials to indicate they are working on this together. Gray text and arrows highlight key components described the feedback section of this paper; blue text and arrows highlight other key components. Please note that the image presented here displays the Platform as it exists at the date of this publication, and is subject to further development and refinement.

Figure 2

The more detailed view of the dashboard of results, which facilitates shared-care planning and the management of mental ill-health. The figure presents the care options that are available for this particular domain and shows how the blue buttons can be used to facilitate shared decision-making. These care options are customized according the health service using the Platform, so that it accurately reflects their clinical offering. Each care option is accompanied by a title, a description, an action button, and a status icon on the bottom left. Specific actions can be performed for these care options using the buttons on the right of each care option. In this example, the circle with an “FI” on the “smiling mind” care option is used to indicate that this young person has started to use the app to address their anxiety. The circle with an “FI” and dotted circle on the “group therapy for social anxiety” care option is used to indicate that the young person is interested in this intervention and would like to speak to their clinician about it. Please note that the image presented here displays the Platform as it exists at the date of this publication, and is subject to further development and refinement.

Figure 3

Illustrative example of a young person’s journey through care. The figure shows how the Platform can be used at different points along the care journey to facilitate measurement-based care to drive personalized treatment decisions. Specifically, in this example, the Platform is being used at entry to care to identify young people reporting higher levels of suicidality, who may need to “skip” the waitlist. The first appointment (much like proceeding clinical contacts) can be used to engage in usual face-to-face clinical care or enhanced by the Platform enhanced by the Platform (as described in point 3 above). As care progresses, ongoing data collection and tracking are used to make personalized treatment decisions, such as connecting to an activity tracker to better understand a young person's sleep wake cycle in relation to their mood, start a new clinical intervention or engage a specialist due to a deterioration in outcomes, or engage in an online intervention when outcomes start to improve. “Computer” by Nikita Kozin from the Noun Project; “Alarm” icon made by Freepik from www.flaticon.com.