Social isolation, economic insecurity, and rapid increases in the numbers of COVID-19 cases and deaths resulted in alarming rates of mental health and substance use disorders. Furthermore, existing social, health, and mental health (MH) disparities among racial/ethnic minorities were exacerbated. MH care systems and collaborative care systems, which integrated MH into primary care settings, were hard pressed to provide psychiatric care to new patients with MH and substance use (SU) disorders (MHSUDs) arising from the pandemic—including patients who had recovered or were recovering from COVID-19 (“COVID survivors”) and their families.
The necessity of using telehealth strategies to protect patients and providers posed additional challenges for MH/SU care systems. Although telehealth may have increased patient engagement, no research had identified optimal, resource-efficient strategies for its use in MHSUD screening and care delivery. Thus, a novel approach that met both the demand and the safety challenges of the COVID-19 era was required to address the burgeoning COVID-related MHSUD care needs. Coupling a stepped-care strategy with automated triage, psychoeducation, and shared decision-making could not only address capacity and system-level barriers but also potentiate treatment effects and address patient/provider-level barriers to engagement.
To meet the critical MH challenges presented by the COVID-19 pandemic, the research adapted and applied a technology developed in the parent grant, the Electronic Mental Wellness Tool (EmwT), that guided providers in screening patients for any MHSUDs using 3 validated items with high sensitivity and then, using another 9 validated items, triaged patients to specific evidence-based treatments according to diagnostic categories with good specificity. The initial 3 items also detected, by proxy and with high sensitivity, any MHSUDs among relatives. The research extended this work to develop and implement StepWell, a telehealth stepped-care approach to MHSUD treatment that integrated the EmwT with an electronic patient-facing depression and anxiety care shared decision-making tool in use at New York Presbyterian Hospital (NYPH).
In a new cohort of 1,000 recently discharged COVID patients being followed by NYPH for one year, the team tested the feasibility of using StepWell to identify MHSUD problems among COVID survivors and their families and address their MHSUD treatment needs while monitoring MH outcomes for one year. They used human-centered design principles to integrate the eSDM (patient preference) and EmwT (assessment and treatment) technologies to develop StepWell. In a mixed-methods pilot test, they examined feasibility, acceptability, and factors influencing StepWell implementation in preparation for a larger implementation science R01 proposal.
