A scoping review of social media in child, adolescents and young adults: research findings in depression, anxiety and other clinical challenges.

BACKGROUND: Social media and other technologies are reshaping communication and health. AIMS: This review addresses the relationship between social media use, behavioural health conditions and psychological well-being for youth aged <25 years. METHOD: A scoping review of 11 literature databases from 2000 to 2020 explored research studies in youth in five areas: clinical depression and anxiety, quantitative use, social media mode, engagement and qualitative dimensions and health and well-being. RESULTS: Out of 2820 potential literature references, 140 met the inclusion criteria. The foci were clinical depression and anxiety disorders (n = 78), clinical challenges (e.g. suicidal ideation, cyberbullying) (n = 34) and psychological well-being (n = 28). Most studies focused on Facebook, Twitter, Instagram and YouTube. Few studies are longitudinal in design (n = 26), had comparison groups (n = 27), were randomised controlled trials (n = 3) or used structured assessments (n = 4). Few focused on different youth and sociodemographic populations, particularly for low-income, equity-seeking and deserving populations. Studies examined association (n = 120; 85.7%), mediating (n = 16; 11.4%) and causal (n = 4; 2.9%) relationships. Prospective, longitudinal studies of depression and anxiety appear to indicate that shorter use (≤3 h/day) and purposeful engagement is associated with better mood and psychological well-being. Depression may predict social media use and reduce perception of support. Findings provide families, teachers and providers ways to engage youth. CONCLUSIONS: Research opportunities include clinical outcomes from functional perspective on a health continuum, diverse youth and sociodemographic populations, methodology, intervention and privacy issues. More longitudinal studies, comparison designs and effectiveness approaches are also needed. Health systems face clinical, training and professional development challenges.

Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue.

The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.

A Telehealth and Telepsychiatry Economic Cost Analysis Framework: Scoping Review.

Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.

Flipping a Single Lecture in a Survey Course to Active Learning: Do the Benefits Justify the Costs?

Health education has seen a surge of interest in active learning strategies like the flipped classroom. In response to the need for physical distancing in the age of COVID-19, schools are rapidly shifting to web-based and video technology, sometimes without being able to predict the outcomes of this change. The objectives of this pilot experiment were to (1) compare active learning (AL) methods versus traditional lecture for transmitting and retaining knowledge in the introductory pre-clinical medical school curriculum and (2) weigh whether the costs required to flip instruction were justified by learning gains. The authors took a 2 h lecture for first-year medical students and converted half of it into an AL format. In-person lecture and active learning groups were compared in terms of student knowledge at pre-intervention, immediately post-intervention, and 6 months post-intervention. Costs for first-time delivery and anticipated costs for repeat delivery of each format were calculated. Students' gains in knowledge increased in both groups, though more by lecture (control) than via AL. Delivering a single hour of new AL costs 3.4 times that of a new lecture. Repeat offerings of the AL intervention were estimated to cost 5.4 times that of the repeat lecture. The 1 h AL session was less effective than the 1 h lecture for knowledge acquisition and retention at 6-month follow-up. The AL was more expensive to produce and to repeat. Future research needs to evaluate the impact of AL with a larger N, control group, structured faculty/resident procedures, and assessment of gaining and applying attitudes and skills in addition to knowledge.

Child and adolescent asynchronous technology competencies for clinical care and training: Scoping review.

Objective: Asynchronous technologies such as mobile health, e-mail, e-consult, and social media are being added to in-person and synchronous service delivery. To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. This study sought out competencies for asynchronous technologies and/or an approach to define them. Methods: This 6-stage scoping review of Pubmed/Medline, APA PsycNET, PsycINFO and other databases was based on a broad research question, "What skills are needed for clinicians and trainees to provide quality care using asynchronous technologies for children and adolescents, and how can they be made measurable to implement, teach and evaluate?" The search focused on key words in 4 concept areas: (a) competencies; (b) asynchronous technology; (c) synchronous telepsychiatry, telebehavioral or telemental health; and (d) clinical. The screeners reviewed the full-text articles based on inclusion (mesh of the key words) and exclusion criteria. Results: From a total of 5,877 potential references, 2 authors found 509 eligible for full text review and found 110 articles directly relevant to the concepts. Clinical studies discuss clinical, technical and administrative workflow rather than competencies, though behavioral health professions' position statements advise on adapting care and training. Existing technology competencies for video, social media, mobile health, and other asynchronous technologies were used to build a framework. Training, faculty development, and organizational suggestions are suggested. Conclusions: Research is needed on how to implement and evaluate asynchronous competencies to ensure quality clinical care and training, which is a paradigm shift for participants. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care.

INTRODUCTION: In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD: This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS: The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION: Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.

Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies.

Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.

Telepsychiatry integration of mental health services into rural primary care settings.

From a population health perspective, the mental health care system in the USA faces two fundamental challenges: (1) a lack of capacity and (2) an inequitable geographic distribution of services. Telepsychiatry can help address the equity problem, and if applied thoughtfully, can also help address the capacity problem. In this paper we describe how telepsychiatry can be used to address the capacity and equity challenges related to the delivery of mental health services in rural areas. Five models of telepsychiatry are described, including (1) the traditional telepsychiatry referral model, (2) The telepsychiatry collaborative care model, (3) the telepsychiatry behavioural health consultant model, (4) the telepsychiatry consultation-liaison model, and (5) the telepsychiatry curbside consultation model. The strong empirical evidence for the telepsychiatry collaborative care model is presented along with two case studies of telepsychiatry consultation in the context of the telepsychiatry collaborative care model. By placing telepsychiatrists and tele-therapists in consultation roles, telepsychiatry collaborative care has the potential to leverage scarce specialist mental health resources to reach more patients, thereby allowing these providers to have a greater population level impact compared to traditional referral models of care. Comparative effectiveness trials are needed to identify which models of telepsychiatry are the most appropriate for patients with complex psychiatric disorders.

Impact of the information age on residency training: communication, access to public information, and clinical care.

Access to technology in practice helps physicians manage information, communicate, and research topics; however, those in training receive almost no formal preparation for integrating web-based technologies into practice. One reason for this is that many faculty-aside from junior faculty or those in recent generations-did not grow up using Internet communication, may use it minimally, if at all, in their own practices, and may know little about its forms and varieties. This report presents a case to illustrate how these disparities may play out in the supervisory situation and makes suggestions about helping supervisors integrate technology-awareness into their teaching.

Telepsychiatry reduces geographic physician disparity in rural settings, but is it financially feasible because of reimbursement?

Telemedicine has been shown to improve rural patient outcomes in two randomized controlled trials, to increase access to many patients, to serve underserved minorities, and to train primary care providers. Yet, programs are dwindling even after successful grants due to inadequate reimbursement. Studies have been thoroughly done to gauge the payor status of potential rural telemedicine patients, as the "floodgates" are not generally open to all-including those who cannot pay-in typical grants. Or the population of one community may not be representative of others. This study is part of a grant that explored the use of telemedicine for rural service delivery, attempted to get a clear snapshot of whom would be served if all were invited (paying or not), and to understand issues with the reimbursement systems. This article (1) examines the receipts of reimbursement and insurance coverage during the 1-year grant period by determining actual versus projected reimbursements, (2) identifies what payor(s) typical patients use, and (3) identifies problems and barriers for future study. Other administrative issues pertinent to telemedicine and costs are briefly discussed (eg, no-show rates, staffing, scheduling).

Rural versus suburban primary care needs, utilization, and satisfaction with telepsychiatric consultation.

CONTEXT AND PURPOSE: Rural and suburban populations remain underserved in terms of psychiatric services but have not been compared directly in terms of using telepsychiatry. METHODS: Patient demographics, reasons for consultation, diagnosis, and alternatives to telepsychiatric consultation were collected for 200 consecutive, first-time telepsychiatric consultations at rural and suburban clinics. FINDINGS: Rural patients were more likely than suburban patients to be younger than 18 years, using Medicaid, and needing treatment planning (lest they be referred out of the community). Rural patient and primary care physician satisfaction was higher than that of suburban counterparts. CONCLUSION: Telepsychiatry programs may enhance access, satisfaction, and quality of rural care.

The importance of distributed broadband networks to academic biomedical research and education programs.

OBJECTIVE: This article highlights the importance of distributed broadband networks as part of the core infrastructure necessary to deliver academic research and education programs. METHOD: The authors review recent developments in the field and present the University of California, Davis, environment as a case study of a future virtual regional academic medical center. RESULTS: Achieving the potential benefits of distributed broadband networks through regional health information organizations will involve considerable collaboration between different academic groups and the development and implementation of standardized technological and business approaches. CONCLUSIONS: Broadband technologies offer a substantial opportunity to improve the way academic education and research programs are delivered.

APA summit on medical student education task force on informatics and technology: steps to enhance the use of technology in education through faculty development, funding and change management.

OBJECTIVE: This article provides an overview of how trainees, faculty, and institutions use technology for acquiring knowledge, skills, and attitudes for practicing modern medicine. METHOD: The authors reviewed the literature on medical education, technology, and change, and identify the key themes and make recommendations for implementing technology in medical education. RESULTS: Administrators and faculty should initially assess their own competencies with technology and then develop a variety of teaching methods that use technology to improve their curricula. Programs should decrease the general knowledge-based content of curricula and increase the use of technology for learning skills. For programs to be successful, they must address faculty development, change management, and funding. CONCLUSIONS: Willingness for change, collaboration, and leadership at all levels are essential factors for successfully implementing technology.

A qualitative needs assessment for development of a cultural consultation service.

Cross-cultural mental health services were assessed using qualitative interviews and focus groups of 43 mental health clinicians and program directors in one of the most ethnically integrated cities in the U.S. The commonly used strategy of ethnic matching between clinician and patient was found to be difficult to effectively apply to an ethnically diverse and highly integrated patient population. Information from cultural-competency training was also found to be difficult to apply, particularly due to time limitations and language barriers. Implementation of a cultural consultation service, which uses in-depth cultural evaluations and case-based learning, may help bridge these service gaps.

Cost issues with telepsychiatry in the United States.

Videoconferencing has increased patient access to psychiatric care by linking specialists at academic or regional health centres with primary health care professionals in shortage areas (Hilty et al, 1999, 2002). Preliminary studies have demonstrated positive outcomes and user satisfaction (Hilty et al, 2002). Information is still being sought regarding costs because of a paucity of clinical outcome studies, cost data and randomised trials.

Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models.

The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

Telepsychiatry: an overview for psychiatrists.

Telepsychiatry, in the form of videoconferencing and other modalities, brings enormous opportunities for clinical care, education, research and administration to the field of medicine. A comprehensive review of the literature related to telepsychiatry - specifically videoconferencing - was conducted using the MEDLINE, Embase, Science Citation Index, Social Sciences Citation Index and Telemedicine Information Exchange databases (1965 to June 2001). The keywords used were telepsychiatry, telemedicine, videoconferencing, Internet, primary care, education, personal digital assistant and handheld computers. Studies were selected for review if they discussed videoconferencing for patient care, satisfaction, outcomes, education and costs, and provided models of facilitating clinical service delivery. Literature on other technologies was also assessed and compared with telepsychiatry to provide an idea of future applications of technology. Published data indicate that telepsychiatry is successfully used for a variety of clinical services and educational initiatives. Telepsychiatry is generally feasible, offers a number of models of care and consultation, in general satisfies patients and providers, and has positive and negative effects on interpersonal behaviour. More quantitative and qualitative research is warranted with regard to the use of telepsychiatry in clinical and educational programmes and interventions.