StepWell: Stepped Care Mental Health and Substance Use Telehealth Services for COVID-19 Affected Patients

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Social isolation, economic insecurity, and rapid increases in numbers of COVID-19 cases and deaths are resulting in alarming rates of mental health and substance use disorders. Furthermore, existing social, health, and mental health (MH) disparities among racial/ethnic minorities have exacerbated . MH care systems and collaborative care systems, which integrate MH into primary care settings, have been hard pressed to provide psychiatric care to new patients with MH and substance use (SU) disorders (MHSUDs) arising from the pandemic – including patients recovered/ recovering from COVID-19 (“COVID survivors”) and their families. The necessity of using telehealth strategies to protect patients and providers has posed additional challenges for MH/SU care systems. Although telehealth may increase patient engagement, no research has identified optimal, resource- efficient strategies for its use in MHSUD screening and care delivery. Thus, a novel approach that meets both the demand and the safety challenges of the COVID-19 era is required to address the burgeoning COVID-related MHSUD care needs. Coupling a stepped-care strategy with automated triage, psychoeducation, and shared decision-making can 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 proposed supplement research will adapt and apply a technology developed in the parent grant, the Electronic Mental Wellness Tool (EmwT), that guides providers in screening patients for any MHSUDs using 3 validated items with high sensitivity and then, using another 9 validated items, triages patients to specific evidence-based treatments according to diagnostic categories with good specificity. The initial 3 items also can detect, by proxy and with high sensitivity, any MHSUDs among relatives. We will extend this work to develop and implement StepWell, a telehealth stepped-care approach to MHSUD treatment that integrates 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, we will test 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 1 year. We will use 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, we will examine feasibility, acceptability, and factors influencing StepWell implementation in preparation for a larger implementation science R01 proposal. This project addresses calls to monitor and address the MH impact of COVID-19 infected and affected patients, while expanding the ability of the health systems to address the existing treatment gap to provide a sustainable, generalizable MH services solution beyond the COVID-19 crisis.