Videoconferencing system for distant/collective/multiprofessional consultations in Child Psychiatry and clinical supervision (Pohjois-Savo, Finland)
A video conferencing (VC) system is 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.
Video consultations by the consulting special needs education teacher complement the child psychiatric VC service by providing access to expertise in special needs education for class teachers and other adults working with children in classrooms in remote areas of Pohjois-Savo.
The service consists of an online booking system and VC. The consulting special needs teacher of the Alava Hospital School offers timeslots in the booking system approximately one day each week. The school staff in need of consultation may reserve the desired timeslot by filling in a short booking form.
Special needs service
The special needs service is based on a booking system provided by Vello (www.vello.fi) and video conferences by Skype for Business. These were chosen as Vello seemed to be very functional, adjustable and easy-to use electronic booking system available free of charge in small scale, and Skype for Business is widely available also for employees of City of Kuopio. University of Eastern Finland.
Support for the target groups in using the service has been provided mainly by the consulting special needs education teacher herself, who in turn has been supported by the project manager.
The used solutions are both very easy to use and practically no installations have been needed. However, some problems e.g. with sound quality have been encountered, and in those cases the IT support of the particular organization may have been contacted.
The feedback received during the pilot was positive, and the Alava School will continue providing the service in the similar manner also during the academic year 2018-2019.
Contact:
Hannele Turunen
Professor, PhD (Health Sciences, Nursing), RN
Head of the Department
Department of Nursing Science
Nurse Manager (part-time), Kuopio University Hospital
University of Eastern Finland
P.O. Box 1627, 70211 Kuopio, Finland
+358 40 355 2629
hannele.turunen{at}uef.fi
Kirsi Bykachev
Project manager
University of Eastern Finland
kirsi.bykachev{at}uef.fi
Booking System
During the eCAP project, a booking system was available in the KUH Extranet at extra.psshp.fi for allowing primary healthcare professionals and other target groups in non-specialist services in remote areas of the Pohjois-Savo region to make appointments for video conferencing (VC) meetings with the child psychiatry experts in the Kuopio University Hospital (KUH). The booking system was provided by Istekki Ltd. and consisted of an online eInvite calendar with one-hour time slots provided by four consulting specialists (one psychologist and three child psychiatrists) in four different eRooms/channels.
When for example a school nurse felt the need to ask for child psychiatric consultation, he/she filled in an online form in the booking system, and after submitting the form received a confirmation email with a link to the VC meeting. As the link was functional only during the settled meeting time, there was also a test link in the email for trying out the functionalities of the VC system beforehand.
The service was meant for professionals working with children under 15 years of age in primary healthcare and other non-specialist services in the Pohjois-Savo region. At the other end, the users would include the consulting experts in the Department of Child Psychiatry at KUH.
The service has been provided by the Department of Child Psychiatry of the KUH. Kuopio University Hospital caters for the specialist medical care of the 248,000 citizens in its area and for the nearly one million inhabitants in Eastern and Central Finland that require specialist medical care for especially demanding cases.
Optimal development and implementation of the service would have required more commitment, competence and flexibility from the ICT service provider throughout the process. Especially proper service design to ensure user-friendliness and tailoring the system to meet the needs was missed, as well as reliable log keeping for credible evaluation of the service.
Contact:
Hannele Turunen
Professor, PhD (Health Sciences, Nursing), RN
Head of the Department
Department of Nursing Science
Nurse Manager (part-time), Kuopio University Hospital
University of Eastern Finland
P.O. Box 1627, 70211 Kuopio, Finland
+358 40 355 2629
hannele.turunen{at}uef.fi
Kirsi Bykachev
Project manager
University of Eastern Finland
kirsi.bykachev{at}uef.fi
Videoconferencing system for distant/collective/multiprofessional consultations in Child Psychiatry and clinical supervision (North Norway)
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.
The users can take part in sessions from their own offices or dedicated meeting rooms. Training material have been provided for the users. In addition, the hospital offers an e-learning course that introduces the use of Skype for business.
To set up a meeting, the health care professionals send the participants a meeting invitation. If confidential information about patients will be discussed, the guidelines provided for clinical use of the tool must be complied with. For other purposes, security regulations are not that strict and virtual meeting rooms can be used.
Contact:
Elin Breivik
Project manager
Norwegian Centre for E-Health Research
Elin.breivik{at}ehealthresearch.no
Erlend Bønes
Project manager
University Hospital in North Norway
Erlend.bones{at}unn.no
Videoconferencing system for distant psychiatric treatment for children and adolescents (North Norway)
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.
Treatment on videoconference is offered the patient as an alternative to face-to-face consultations: the treatment itself is unchanged, but delivered in a new way. However, in the long run, treatment over Skype may change the way treatment is delivered. Instead of one 45-minute session at the hospital, the young patient can talk to the therapist in the morning and then again after school.
Patients with eating disorders may stay longer periods at home, receiving meal time support on videoconference.
The CAP Clinic management as well as health care professionals have contributed in the development and the implementation process. This is an important aspect for succeeding in implementing eHealth services. It is also important to focus on making procedures to make the new way of delivering treatment fit into daily routines at the Clinic.
The implementation process is complicated and normalization of the services takes time. The work on further development and implementation of the eCAP services at the CAP Clinic will continue after the project has ended.
Contact:
Elin Breivik
Project manager
Norwegian Centre for E-Health Research
Elin.breivik{at}ehealthresearch.no
Erlend Bønes
Project manager
University Hospital in North Norway
Erlend.bones{at}unn.no
Online rapid diagnosis using the Development and Wellbeing assessment (DAWBA) (Scottish Highlands)
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.
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.
The service is available in the Highland region of Scotland, specifically the area served by the Highland Council local authority. The DAWBA service is being offered as part of a randomised controlled trial (RCT). Participants are children, young people and their families at the first point at which contact with mental health services is being considered by a health professional. This community-based study aims to establish whether using the DAWBA in this way helps children and young people with mental health problems.
Referrals to the DAWBA study are made by GPs, school nurses, health visitors, community paediatricians, primary mental health workers or child and adolescent mental health (CAMHS) professionals. Participating children and young people are aged 2-17 years. Patient / parent name and telephone number is supplied to the NHS Highland research nurse after verbal agreement is given to the referring practitioner that they are to participate in the project. These details are supplied to enable the research nurse to initially make contact with each participant. The research nurse then telephones the parent. If the parent agrees, the participant information sheet and consent form is emailed or posted to the family.
The DAWBA is administered online whenever possible, but in cases where there are literacy problems or lack of internet connectivity, administration can be by telephone. Once all assessments are completed, the NHS research nurse alerts the local DAWBA rater. DAWBA ratings are done by a local psychiatrist familiar with diagnostic classification and local services. A computerised summary is generated from the data given by all the informants and a psychiatrist lists the likely diagnosis/es in a case summary and gives his view about the next steps.
The main objectives are to improve the patient’s mental health, reduce waiting times, change referral practice, increase satisfaction in services and improve cost effectiveness. The principal outcome measure is parent-rated Strengths and Difficulties Questionnaire (SDQ) score 6 months after randomisation. We also record service use data and family out of-pocket costs. A random sample of young people, family and referrers will be interviewed to explore satisfaction with service. Should the service prove to be effective and cost-effective as a result of the trial, local key stakeholders will work together to ascertain how feasible it will be to roll out as a viable service
Contact:
Professor Philip Wilson
Centre for Rural Health, University of Aberdeen
Tel: +44 (0)1463 255085
p.wilson@abdn.ac.uk
Evaluation tool
The evaluation work of eCAP services, namely, the booking system (in Finland), the video conferencing system (VC; in Norway and Finland) with electronic forms (in Finland) as well as the Development and Well-Being Assessment (DAWBA) RCTs (in Scotland and Finland), for further utilization and development in the pilot sites as well as for dissemination of the developed services into new regions. Furthermore, the project’s contribution to the sought programme result of “awareness and attitudes among health professionals towards the use of eHealth technologies” shall be assessed.
Thus, the evaluation work package aims to develop, test and disseminate common evaluation instruments for the documentation of quality experienced by both patients and clinicians. The evaluation tool/instrument consists of the evaluation plan, (standardized) data collection tools i.e. questionnaires and interview outlines for different target groups, field work protocols and guidelines, specified analysing methods, and report templates.
Contact:
Hannele Turunen
Professor, PhD (Health Sciences, Nursing), RN
Head of the Department
Department of Nursing Science
Nurse Manager (part-time), Kuopio University Hospital
University of Eastern Finland
P.O. Box 1627, 70211 Kuopio, Finland
+358 40 355 2629
hannele.turunen{at}uef.fi
Kirsi Bykachev
Project manager
University of Eastern Finland
kirsi.bykachev{at}uef.fi
Sweden
Contact:
Eva Lindgren
Luleå Technical University
eva.lindgren{at}ltu.se
Main results
Better and more timely care closer to home for children and young people with mental health problems. Ensuring higher involvment from children's developmental environments by offering consultations and supervision to teachers or daycare workers.
The eCAP service (including remote diagnosis and VC consultations) is rolled out and implemented on a large scale in the partner countries, providing common tools and strategies for the challenge of providing mental health services not only to the younger population but also to their families, child health services, school personnel and GPs.
In addition, through a special focus on transnational learning, innovative models addressing public service provision, tailored to the needs of each partner, has been developed and later made available to other interested parties for future use.
The introduction of the eCAP service has, among other things, contributed to an increased use of technology in public services working to improve child and adolescent mental health, first of all by the implementing partners, and secondly by partners following dissemination of the experiences of the eCAP partners. This all require a positive contribution to the awareness and attitudes among Health Professionals towards the use of eHealth technology.
A successful implementation of the eCAP service and a normalization of the use of technology can also contribute to increased use of technology in other areas of the health care sector.