About the Project
The aim of the eCap project was to create services that would help surmount the challenges in the delivery of mental health services to adolescents and children in remote areas.
Background
The need for psychiatric services for children and adolescents generally exceeds service capacity.
The eCAP project aimed to solve problems in the delivery of mental health promotion and child and adolescent psychiatry services to remote areas. The main problems in these areas are insufficient numbers of psychiatrists/specialists, long waiting times, limited capacity among primary care services and a heavy travel burden for both patients/their families and for outpatient specialists. This can be potentially damaging in conditions which are sensitive to neurodevelopmental maturation processes.
There was a need to develop IT-based solutions which increase both the quantity and quality of the available services in peripheral areas. Furthermore, there was a need to support multiprofessional collaboration between professionals working with the children, adolescents and their families (health and social services, daycare and schools).
Goals and results
The aim of this project was to develop diagnosis, consultation, supervision, treatment and collaboration between professionals by using modern information technology - videoconferencing (VC) systems and the Development and Wellbeing Assessment (DAWBA), a computerised structured instrument for gathering diagnostic data from families, teachers and young people themselves).
This could increase the knowledge of local multiprofessional experts about mental health and mental disorders of children and adolescents. This supports both preventive work and treatment close to the child and his/her developmental environments (school, daycare etc.). The service mentioned above used VC to bridge the distance between specialists, primary care, GPs, schools, patients and their families.
Norway
The project collaborating partner was the Child and Adolescent Psychiatry Clinic at the University Hospital of North Norway. The eCAP services were developed by the therapists at the three departments at CAP together with project managers from the Norwegian Centre for E-health Research.
Videoconferencing system for distant/collective/multiprofessional consultations in Child Psychiatry and clinical supervision
The child and adolescent clinic at the University hospital of North Norway (UNN) uses videoconference to treat patients and to carry out multi-professional meetings with collaboration partners. In addition, supervision sessions and a variety of courses and educational activities take advantage of the service.
An easily available technical solution for videoconferences is necessary to adapt this kind of service at large scale. The technology used to deliver the service is Skype for Business. The Northern Norway Regional Health Authority has provided Skype for Business and necessary equipment for all employees for administrative purposes. Eventually, guidelines for clinical use of Skype for Business were prepared, detailing how patient confidentially will be maintained during videoconferences.
Videoconferencing system for distant psychiatric treatment for children and adolescents
The project test site is the Child and Adolescent Psychiatry Clinic (CAP) at the University Hospital in North Norway, which provides diagnosing and treatment to children with mental health problems in the region. The clinic works together with the children’s families, as well as primary health care, public health nurses, schools, child welfare authorities and other hospital clinics. During the project period, treatment using videoconference has been developed and introduced. Using Skype for Business, a browser-based videoconference tool, the therapists conduct treatment from their own offices. The patients take part in their own homes or in dedicated rooms in their school. All three departments at the CAP Clinic cover large geographical distances and have participated in developing and using digital tools to improve the quality of and access to their services.
Scotland
The need for psychiatric services for children and adolescents is usually greater than the services available in the Scottish Highlands. Young people and their families often wait a long time to access mental health services due to limited available resources. Even when a service has become available, it often becomes apparent that the referral was not appropriate in the first place. Travel from the most remote regions to the urban centre (Inverness) and hospital is around 3 hours by road and longer for small island communities dependent on ferries. This is particularly challenging in the presence of mental health problems – travelling at all may be extremely problematic for many young people in our target population. Primary care practitioners are left unsure how best to direct young people and their families. The way children and young people access support may therefore be relatively inefficient and families could suffer as a result of this inefficiency.
Online rapid diagnosis using the Development and Wellbeing assessment (DAWBA)
The Development and Well-being Assessment (DAWBA) is a package of interviews, questionnaires and rating techniques designed to generate psychiatric diagnoses on 2-17 year olds. The use of a computerised structured questionnaire such as the DAWBA offers the opportunity for the difficulties described above to be addressed, for the avoidance of ‘inappropriate referrals’ and for more rational use of resources. It is usually administered online through a secure internet portal.
Finland
Videoconferencing system for distant/collective/multiprofessional consultations in Child Psychiatry and clinical supervision
A video conferencing (VC) system was used for communication between child psychiatric specialized healthcare/the Department of Child Psychiatry at the Kuopio University Hospital (KUH) and primary healthcare and other non-specialist professionals working with children in the municipalities in Pohjois-Savo. The service provides remote professionals an opportunity to flexibly consult experts in child psychiatry, psychology and remedial teaching in order to get support in decision-making for better treatment.
During the eCAP project the VC system was used for consultations, clinical supervision and so-called tutored peer group meetings aimed at capacity building. In addition, the service could have been used for support for treatment (e.g. for medication controls). The VC system was quite simple and did not require any specific skills or competences above normal IT literacy. For joining the VC meeting, the participants only had to click the link received by email, write their name in the specified field, choose the desired camera, microphone and speakers, and enter the VC meeting. All user groups received training and printed materials with detailed instructions on how to use the system, and extra encouragement was provided to the primary healthcare professionals by phone (telephone interviews) and also email whenever needed.