Read [[Book - Digital Therapeutics for Mental Health and Addiction]] and how it can be applied in [[HOPES Project Index]] [[What we are experiencing now, the going back and forth, non-linear progression, is part of the design process]] # Guided Therapeutics and Blended Care Model 1. Based on what I have read, digital therapeutics should be "Guided", meaning the user can access clinicians or a coach. 2. It should also be "blended care"; integrated into the existing clinical care. [[The definitions of Blended Care]], [[Blended Care should be understood as a continuum]]. 3. Ideally, interventions provided to the patients will depend on the severity and complexity of the individual needs. It should be in a "[[Stepped Care Model]]"; however, [[There are no gold standards for defining how much human therapeutic support should be in Blended Care]]. 4. Section 5.5.2 of the book listed the [[value of blended care]]. 5. 5.3.3 It is not set-up-once-and-forget-about-it, it's a new tool, and providers have to be familiar with it, and check in with the patients regularly to discuss how to obtain maximum benefits from the tools. [[202308230849 Check in with patients regular collaboration]] ## Stepped Care Model 6. This is similar to the "multi-tier approach" we talked about, i.e patients can use digital platform for self-assistance on one end of the continuum and face-to-face sessions with a therapist. - *Alternatively, Internet Based Programme (IBP)s for depression and anxiety may serve a role as part of stepped-care, allowing for an initial trial of psychotherapy via the internet, followed by assessment and referral for additional treatment if the patient does not achieve full remission of symptoms (Aspvall et al., 2021). - within the National Health Service in the UK, this is a key consideration of the “stepped care model” (Kendrick & Pilling, 2012) that seeks to match and adapt the level of treatment to a client’s needs. To illustrate this, a client with mild to moderate symptoms of panic disorder might be offered a course of BC which involves working with a psychological wellbeing practitioner (a specialist mental health worker in the UK) and simultaneously working through an internet-based program between sessions* 7. Implications/Questions: How can the different services (e.g Family Therapy, Occupational Therapy, Psychotherapy, Case management) be designed in a stepped care model? # On Engagement and Adherence (In mental health apps) - [[20230823 Define Engagement]] Engagement is the degree to which consumers use a digital therapeutic in the way it was designed to be used for an optimal length of time (treatment dosage) to ensure long-term behavioral and emotional change (Cole- Lewis, Ezeanochie, & Turgiss, 2019) - Long term engagement is poor. Several studies find that people do not engage as developers intended, and long-term engagement is poor (Hatch, Hoffman, Ross, & Docherty, 2018; Lattie et al., 2019; Ng, Firth, Minen, & Torous, 2019; Yeager & Benight, 2018). [[Engagement]] 1. [[Engagement is usually higher in Research than in real-world settings]] 2. [[Less than 1 per cent of users complete all their sessions]] 3. Hard to define and measure 4. [[Low use doesn't mean no use; people can re-engage the app overtime]]. # On designing digital therapeutics Therefore, how to go about doing this? Framework and way to think about doing it. [[202308231714 Three questions in making design decisions]] EMA - How to determine the right time, Receptivity Just In Time - challenges in determining Listing down intervention goals, Impact level MRT