Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study.

BACKGROUND: Inadequate and inequitable access to quality behavioral health services and high costs within the mental health systems are long-standing problems. System-level (e.g., fee-for-service payment model, lack of a universal payor) and individual factors (e.g., lack of knowledge of existing resources) contribute to difficulties in accessing resources and services. Patients are underserved in County behavioral health systems in the United States. Orange County's (California) Behavioral Health System Transformation project sought to improve access by addressing two parts of their system: developing a template for value-based contracts that promote payor-agnostic care (Part 1); developing a digital platform to support resource navigation (Part 2). Our aim was to evaluate facilitators of and barriers to each of these system changes. METHODS: We collected interview data from County or health care agency leaders, contracted partners, and community stakeholders. Themes were informed by the Consolidated Framework for Implementation Research. RESULTS: Five themes were identified related to behavioral health system transformation, including 1) aligning goals and values, 2) addressing fit, 3) fostering engagement and partnership, 4) being aware of implementation contexts, and 5) promoting communication. A lack of fit into incentive structures and changing state guidelines and priorities were barriers to contract development. Involving diverse communities to inform design and content facilitated the process of developing digital tools. CONCLUSIONS: The study highlights the multifaceted factors that help facilitate or hinder behavioral health system transformation, such as the need for addressing systematic and process behaviors, leveraging the knowledge of leadership and community stakeholders, fostering collaboration, and adapting to implementation contexts.

Variability in the Integration of Peers in a Multi-site Digital Mental Health Innovation Project.

Peer support specialists ("peers") who have the lived experience of, and are in recovery from, mental health challenges are increasingly being integrated into mental health care as a reimbursable service across the US. This study describes the ways peers were integrated into Help@Hand, a multi-site innovation project that engaged peers throughout efforts to develop and offer digital mental health interventions across counties/cities ("sites") in California. Using a mixed methods design, we collected quantitative data via quarterly online surveys, and qualitative data via semi-annual semi-structured phone interviews with key informants from Help@Hand sites. Quantitative data were summarized as descriptive findings and qualitative data from interviews were analyzed using rapid qualitative analysis methods. In the final analytic phase, interview quotes were used to illustrate the complex realities underlying quantitative responses. 117 quarterly surveys and 46 semi-annual interviews were completed by key informants from 14 sites between September 2020 and January 2023. Peers were integrated across diverse activities for support and implementation of digital mental health interventions, including development of training and educational materials (78.6% of sites), community outreach (64.3%), technology testing (85.7%), technology piloting (90.9%), digital literacy training (71.4%), device distribution (63.6%), technical assistance (72.7%), and cross-site collaboration (66.7%). Peer-engaged activities shifted over time, reflecting project phases. Peer-provided digital literacy training and technology-related support were key ingredients for project implementations. This study indicates the wide range of ways peers can be integrated into digital mental health intervention implementations. Considering contextual readiness for peer integration may enhance their engagement into programmatic activities.

Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study.

BACKGROUND: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. OBJECTIVE: This study aimed to understand facilitators of and barriers to mental health app use among community college students. METHODS: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. RESULTS: Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. CONCLUSIONS: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps.

Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review.

BACKGROUND: Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user's uptake and sustained interactions with these interventions. OBJECTIVE: This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. METHODS: A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. RESULTS: A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one's own health. CONCLUSIONS: Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.

Individual and organizational outcomes of engaging peers in the cocreation of digital mental health interventions.

Within mental health services, persons in recovery from their own experiences of mental health challenges (peers) are increasingly being trained to provide peer support. This study describes individual and organizational outcomes related to engaging peers in a multisite demonstration project in California that sought to integrate them as cocreators throughout planning and implementation of digital mental health interventions. We collected data from key informants across 11 sites. Quarterly online surveys invited key informants to report perceived outcomes of the peer component. Biannual interviews elicited details regarding survey-reported outcomes. Quantitative data provided indications of outcome prevalence and consistency, and quotes from the interviews illustrated the complex realities underlying survey responses. One hundred three quarterly surveys and 39 biannual interviews were completed between Summer 2020 and Fall 2022. Key informants reported diverse outcomes, including integration of peer input into local decision making, mental health benefits to peers and community members, reduced workplace mental health stigma, and new cross-site collaborations. Five sites reported outcomes with greater consistency compared to the other six sites. Reports of increased peer visibility in the workplace coincided with reports of reduced stigma and increased value of peer input by mental health professionals. This study offers encouragement for the potential positive impact of engaging peers as cocreators of mental health interventions. Data suggest integrating peers does not increase mental health stigma and may instead result in various positive outcomes. The degree to which these outcomes manifest in a specific setting, however, may vary. Future research should seek to identify contextual factors that support actualization of positive outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Understanding underlying moral values and language use of COVID-19 vaccine attitudes on twitter.

Public sentiment toward the COVID-19 vaccine as expressed on social media can interfere with communication by public health agencies on the importance of getting vaccinated. We investigated Twitter data to understand differences in sentiment, moral values, and language use between political ideologies on the COVID-19 vaccine. We estimated political ideology, conducted a sentiment analysis, and guided by the tenets of moral foundations theory (MFT), we analyzed 262,267 English language tweets from the United States containing COVID-19 vaccine-related keywords between May 2020 and October 2021. We applied the Moral Foundations Dictionary and used topic modeling and Word2Vec to understand moral values and the context of words central to the discussion of the vaccine debate. A quadratic trend showed that extreme ideologies of both Liberals and Conservatives expressed a higher negative sentiment than Moderates, with Conservatives expressing more negative sentiment than Liberals. Compared to Conservative tweets, we found the expression of Liberal tweets to be rooted in a wider set of moral values, associated with moral foundations of care (getting the vaccine for protection), fairness (having access to the vaccine), liberty (related to the vaccine mandate), and authority (trusting the vaccine mandate imposed by the government). Conservative tweets were found to be associated with harm (around safety of the vaccine) and oppression (around the government mandate). Furthermore, political ideology was associated with the expression of different meanings for the same words, e.g. "science" and "death." Our results inform public health outreach communication strategies to best tailor vaccine information to different groups.

Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users' Perspective and Mixed Methods Study.

BACKGROUND: Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits. OBJECTIVE: This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety. METHODS: A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis. RESULTS: A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others. CONCLUSIONS: Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness.

Understanding the Potential of Mental Health Apps to Address Mental Health Needs of the Deaf and Hard of Hearing Community: Mixed Methods Study.

BACKGROUND: Mental health concerns are a significant issue among the deaf and hard of hearing (D/HH) community, but community members can face several unique challenges to accessing appropriate resources. OBJECTIVE: The aim of this study was to investigate the mental health needs of the D/HH community and how mental health apps may be able to support these needs. METHODS: A total of 10 members of the D/HH community participated in a focus group and survey to provide their perspectives and experiences. Participants were members of the Center on Deafness Inland Empire team, which comprises people with lived experience as members of and advocates for the D/HH community. RESULTS: Findings identified a spectrum of needs for mental health apps, including offering American Sign Language and English support, increased education of mental health to reduce stigma around mental health, direct communication with a Deaf worker, and apps that are accessible to a range of community members in terms of culture, resources required, and location. CONCLUSIONS: These findings can inform the development of digital mental health resources and outreach strategies that are appropriate for the D/HH community.