Is e-therapy the answer to our youth mental health issues?

Return to eHealthNews.nz home page

Picture: Images from the app The Quest – Te Whitianga

eHealthNews.nz editor Rebecca McBeth

A team at Auckland University is working to connect young people with mental health difficulties to the therapy and advice they need by offering services online. Rebecca McBeth reports.

Youth mental health issues are increasing in New Zealand and traditional health services are failing to keep up.

More than half of all young people with mental health difficulties never get help due to limited access to evidence-based therapy and advice.

One solution that allows scalability of both assessment and treatments is being developed by a team at Auckland University led by professor Sally Merry.

HABITs (Health Advances through Behavioural Intervention Technologies) is a Better Start project, which is one of 11 National Science Challenges taking a more strategic approach to science investment.

The project aim is to increase detection and improve access to evidence-based advice through an ecosystem of e-health screening and intervention tools being co-designed with Māori and Pasifika youth.

The tools are integrated through a digital platform to track results and enable the team to trial the tools and research the results.

The tools

Auckland University chair of health informatics Jim Warren is leading the digital platform work. He says the vision for HABITs is to get apps into the hands of young people, meaning they have to be mobile and co-designed with youth, particularly Māori and Pasifika, to ensure they fit the most at-need populations.

Apps for youth also need to be personalised and ‘snackafied’: something young people can grab and do when they have a bit of time, such as waiting for a bus, rather than having a large workbook to complete.

The HABITs team, working with game development firm InGame, has developed The Quest - Te Whitianga. The app is aimed at 13-year-olds with mild to moderate anxiety or depression and involves cognitive behavioural therapy and positive psychology, including dealing positively in relationships and thinking positively.

A randomised controlled trial of the app is set to begin at the end of April 2019 and will involve a four-week exposure to the app and a control group with delayed exposure.

Participants are screened with YouthCHAT, an online tool developed at the university specifically for youth, and only the results of those classed as having mild to moderate anxiety or depression will be randomised for the study, although others will also be offered use of the technology.

The team has also co-developed, with partner RushDigital, a mental health chatbot delivered by FaceBook Messenger called Headstrong, which is going into open trial.

It is aimed at a slightly older audience and involves four avatars of different ages and genders who ask young people about themselves, and tell stories about situations they have been in and how they dealt with problems, reinforcing positive messages.

Another intervention, called SPARX, has an established track record of effectiveness for youth with mild to moderate depression or anxiety and delivers treatment through a first-person adventure game. The tool, originally developed for PCs, has now been mobilised and the new version is being tested.

The platform

Warren’s job is to create a platform so that a user can go into a portal and navigate to the YouthCHAT assessment and back to the portal and be recommended an app or to connect to the chatbot service, all seamlessly.

“The big picture for me as the IT guy is that we want to create a digital platform to enable both trials and ongoing application or use of these apps, so my responsibility is to integrate the screening tools and assessment tools we might use so they can interoperate,” says Warren.

The underlying digital platform does identity management using FireBase encrypted storage on the cloud. This only stores a person’s log-in email and password with all demographic information stored locally, but creates a token to allow the portal to recognise a particular user and therefore collect research data about their movements between assessments and apps, as well as usage.

Part of the capability of the server is that it can interoperate with the services, meaning it can perform queries and get answers. This allows researchers to see what PHQ9 (Patient Health Questionnaire-9) score a person entered the eco-system with and whether that changes after using the apps.

The platform also interoperates with the apps to get additional data about how the young people are using the tools, as one of the biggest issues is people not completing online therapies. This also tracks any markers of engagement or achievement within the app, such as completing certain levels or assessments.

The platform supports role-based access, so a designated clinical user, such as a school nurse, can see scores and usage data for young people associated with their site. A researcher user can see these data too (and across sites within a trial), but only as an anonymous case.

“We want an infrastructure that lets us effectively and with good quality run lots of experiments and get lots of young people through to experience these therapies, so we can learn and ultimately have something scalable enough to be able to roll it out more widely,” Warren explains.

The research

Warren says the platform is key as it supports clinical trial logic by allowing researchers to track a user’s experience with the tools and match it with the effectiveness of the interventions.

Further, it also allows young people to self-enrol in trials and give informed consent to their data being used. While recruitment is done face to face, the registration process is completely online.

Warren says the electronic consent process allows people to make an informed decision in their own time and includes the use of video explanations, which are particularly attractive to young people.

The team is still in the process of defining the next five years of the project and wants to bring things together more, by potentially using the platform technology to link with other Better Start projects, such as one focused on literacy.

“We think all low decile schools, if not all middle and secondary school students, should have the opportunity to use these helpful interventions because there’s not enough healthcare workers for everyone to have their own counsellor,” Warren says.

“The thing about electronic interventions is the scalability.”

Read more features

Ian Martin: CiLN: Getting clinicians and IT talking to each other

Rebecca George: Raising the profile of allied health

Return to eHealthNews.nz home page