Mental health issues are common in the communities served by Milwaukee-based Froedtert & the Medical College of Wisconsin Health Network. However, they are often unrecognized, underexposed and undertreated – mainly due to limited access to specialized mental health care.
THE PROBLEM
In 2017, a multidisciplinary team at the health network began building a digital form to provide evidence-based tools, powered by high-quality software, to prevent, manage or treat a spectrum of physical, mental and behavioral problems. This focus on digital therapeutics aimed to expand access, allowing the healthcare network’s patients to manage their mental health outside of traditional healthcare settings.
Given the complexity of mental health access challenges, digital tools provided an accessible, technology-based alternative, said Dr. Bradley Crotty, chief digital officer at Froedtert & MCW and interim president of Inception Health, the innovation branch of Froedtert & MCW.
“Such tools could complement or complement conventional therapy, giving patients the flexibility to work on mental wellness at their own pace and outside of usual office hours,” Crotty explains. “Digital tools, especially internet-based cognitive behavioral therapy (CBT), also provide a pathway to address broader behavioral health issues, including anxiety, depression, insomnia, excessive alcohol use and chronic pain management.
“Recognizing this potential, we identified a digital CBT program as an appropriate solution to support both patients and clinicians, bridge access gaps and deliver timely, individualized care,” he added.
PROPOSAL
When the team began assessing the options for digital cognitive behavioral therapy, Froedtert & MCW partnered with SilverCloud. SilverCloud provides cognitive behavioral therapy education designed to help people develop skills to identify, challenge and then change their unhelpful thoughts, feelings or behaviors related to challenging situations, helping users improve both physical and mental health .
“This program empowered patients to take charge of their mental health, giving them the access and tools they need to increase their mental well-being,” Crotty noted. “SilverCloud also offers a digital health coaching component, allowing users to have a live person check in throughout their program to improve accountability and outcomes.
“A digital system can also be integrated into healthcare provider workflows, making it accessible for orders when patients indicate a need for mental health care,” he continued. “Because it could be integrated into our EHR, we could easily scale the program so it was in the hands of everyone who would benefit from it.”
MEETING THE CHALLENGE
When SilverCloud launched on the healthcare network, it immediately began to address a number of financial issues planning concerns preventing patients from seeking help.
“By offering the program at no cost to patients, we were able to get resources into the hands of patients as soon as they told their providers there was a problem,” said Jay Burns, digital behavioral health coach at Froedtert & MCW. “Since SilverCloud is available on any smart device, people can work on it whenever their schedule allows.
“People with multiple jobs, busy parents and students with upcoming deadlines all had the freedom to log in at their convenience,” he added. “Customizing the program to meet patients’ needs was the philosophy we wanted to use going forward.”
When a patient first creates an account, they are asked to share a list of goals with their coach. These goals are then used to connect SilverCloud users with the measurements most relevant to them.
“As time went on, we saw the success of this philosophy and changed the registration process so that patients could choose which program they wanted to enroll in rather than which provider,” Burns explains. “This change will allow patients to learn skills that can help with anxiety, depression, stress, insomnia, chronic pain, diabetes, alcohol use and ADHD symptoms, while avoiding the perceived stigma associated with any of these topics.
“After using SilverCloud for six years, we recognized that there was an opportunity to allow patients to self-enroll in the program,” he continued. ‘Patients may not know how to discuss their problems need mental health care or may not have time to bring it up during an already busy appointment with a healthcare provider. That is why we have given patients the opportunity to register themselves in SilverCloud via the Froedtert & MCW mobile app.”
RESULTS
While mental health remains one of the top health issues facing the health network’s communities, more than 10,000 people have joined since the technology launched in 2017.
“Clinical improvement, as measured by changes in PHQ-9 and GAD-7 scores for depression and anxiety, respectively, showed statistically significant reductions,” Burns reported. “Patients with at least moderate depression experienced an average 23% reduction in PHQ-9 scores, while those with at least moderate anxiety showed a 26% reduction in GAD-7 scores.
“These improvements were both clinically and statistically significantconfirming the effectiveness of digital cognitive behavioral therapy in supporting mental health,” he added.
In addition to these clinical outcomes, Froedtert & MCW has the ability to view patient user satisfaction data.
“Since launch, our patients have reported a 92% satisfaction rate,” said Burns. “This data asks users if what they learned was interesting, relevant, useful and actionable. We also get the opportunity to hear from our patients.
“Our patients have relearned how to drive after surviving a car accident, how to deal with the grief of losing a spouse, or how to gain the confidence to leave a career that didn’t work for them,” he noted. “The voices of our patients help us know that digital solutions can make a real difference.”
The healthcare network has seen such great results for patients with the technology it is working on to provide an uncoached, stress and resilience module available to community members who do not have a Froedtert & MCW provider.
“We look forward to providing all adults in our community with mental health resources to improve their mental and physical health,” Burns added.
ADVICE FOR OTHERS
Using a digital therapeutic tool can help patients get the right care they need, at the right time and in a way that works best for them, Crotty said.
“It is important to conduct a full market analysis when determining which device to use, to ensure it is the best device and provider for your organization and your patients,” he advised.
“Once you have determined which digital therapy to use, it is important to educate your care teams about the offering and get it into the hands of as many patients as possible,” he concluded. “Multiple enrollment options – manual orders, automated orders and self-enrollment – can make the program a success.”
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