Information and Communication Technologies in Behavioral Health

A Literature Review with Recommendations for the Air Force

by Joshua Breslau, Charles C. Engel

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Research Questions

  1. According to the scientific literature, when are mental health care information and communication technologies (ICTs) most effective?
  2. Do they improve the quality and effectiveness of care?
  3. Can they improve patient adherence to treatment?
  4. What are the costs and benefits?
  5. What considerations must be given to incorporating these methods into military care options?

The dramatic evolution in information and communication technologies (ICTs) online and on smartphones has led to rapid innovations in behavioral health care. To assist the U.S. Air Force in developing a strategy for use of ICTs, the authors reviewed the scientific literature on their use to prevent and treat behavioral health conditions, such as major depression, posttraumatic stress disorder, and alcohol misuse. There is currently little scientific evidence supporting additional investment in ICT-based psychosocial programs for resilience or prevention of posttraumatic stress symptoms, depression, or anxiety. Instead, preventive interventions might prioritize problems of alcohol misuse and intimate partner violence. ICT applications that play a role in the treatment process may be used for patient education and activation, to improve decisionmaking by clinicians, to provide a therapy, to improve adherence to treatment, or to maintain treatment gains over time. However, partly due to the rapid pace of development of the technology, there is little or no evidence in the literature regarding the efficacy of the most recently developed types of ICTs, in particular those using smartphones. Despite the lack of solid research evidence to date, ICTs hold promise in addressing the challenges of mental health care. One promising avenue is development of reliable methods for patient-clinician communication between therapy sessions; another is Internet-based cognitive behavioral therapy. The authors recommend that the Air Force should take an incremental approach to adopting the use of ICTs — one that involves a program of measurement-based implementation and process and outcome monitoring rather than urgent dissemination.

Key Findings

Preventive Information and Communication Technologies (ICTs)

  • Preventive ICTs use such new technological forms as online education, email or text-based communication between clinicians and patients, and smartphone or video-linked social support tools.
  • There is currently no scientific evidence suggesting that ICT-based psychosocial programs to promote resilience or prevent posttraumatic stress symptoms, depression, or anxiety are more effective than existing prevention methods.
  • Instead, preventive interventions might prioritize problems of alcohol misuse and intimate partner violence.

Clinical Treatment ICTs

  • ICT applications have been developed to enhance clinical treatment by educating and activating patients, improving decisionmaking by clinicians, providing a therapy, encouraging adherence to treatment, and maintaining treatment gains over time.
  • There is little scientific evidence of the efficacy of most ICT applications in behavioral health treatment, in part because the development of new applications outpaces the conduct of rigorous scientific studies.
  • One promising avenue is development of reliable methods for patient-clinician communication between therapy sessions; another is Internet-based cognitive behavioral therapy.

Recommendations

  • The Air Force should develop and adopt a coordinated interdisciplinary strategy for behavioral health information and communication technology (ICT) implementation.
  • The Air Force should develop standards and objectives for adapting and fielding ICTs.
  • Air Force behavioral health ICTs should be designed for monitoring aggregate use and intervention outcomes, including adverse or unintended effects.
  • If the Air Force introduces ICTs for prevention, it should review existing ICTs provided to airmen across the Department of Defense (DoD), the services, and supporting private organizations to harmonize efforts with existing programs.
  • The Air Force should collate aggregate search engine data from Air Force and DoD websites that provide preventive assistance to airmen and families.
  • The Air Force should not use ICTs for the purpose of targeting traumatized units or individuals for "critical incident stress debriefings" or "psychological debriefings."
  • The Air Force should consider adapting and implementing ICTs offering Internet-based, personalized single-session feedback for airmen at identified risk for future alcohol-related incidents.
  • The Air Force should consider the use of ICTs for universal and targeted prevention efforts relating to intimate partner violence. At least one universal preventive ICT approach, ePREP, is well studied and effective.
  • The Air Force should adopt a tailored Internet-based treatment program for depression and anxiety.
  • The Air Force should monitor the development of Internet-based treatments for substance misuse.
  • The Air Force should select smartphone apps that airmen can use to monitor medication use and communicate with mental health clinicians between in-person visits.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Prevention: Universal and Targeted Approaches

  • Chapter Three

    ICTs in the Clinical Process

  • Chapter Four

    Conclusions and Recommendations

Research conducted by

The research reported here was sponsored by the Air Force Surgeon General and conducted within the Manpower, Personnel, and Training Program of RAND Project AIR FORCE.

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