Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to advance context-specific and generalizable knowledge of implementation determinants: case study of a digital contingency management platform

BACKGROUND

Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs) despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation.

METHODS

Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. A detailed review of implementation facilitation meeting notes was conducted to examine how the IFASIS was used to guide facilitation.

RESULTS

Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts.

CONCLUSIONS

The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

Differences Between Stressed Parents and Their Children: A Brief Analysis on Parent-Child Depression, Stress, Aggression and Possible Roles of Digitalized Parenting Education

Objectives

Digital therapeutics are becoming increasingly important in mental health due to their numerous advantages. One area that could benefit significantly is parenting education. To address this, we developed a short-term, smartphone-based parenting education program designed to support parents who lack access to relevant resources. This study analyzed baseline data from participants to identify factors influencing depressive symptoms in both parents and children.

Methods

Participants were recruited from a rural region of the Republic of Korea. The study included parents experiencing stress related to raising children aged 11 to 16 years. Data on psychological well-being and family relationships were collected and analyzed from 47 parent-child dyads. Participants engaged with a six-week parenting education application aimed at reducing parenting stress. This article does not include an analysis of the intervention's efficacy.

Results

The child perceived their families as more chaotic compared their parents (t=-2.55, p=0.01). Parental depression was significantly associated with their stress levels (B=0.70, p=0.004), anxiety (B=0.32, p=0.03), relational frustration (B=0.16, p=0.04), family enmeshment (B=-0.13, p=0.04) and the child's perception of family flexibility (B=0.10, p=0.04). In contrast, children's depression was associated with lower self-esteem (B=-0.55, p=0.02) and aggression (B=0.23, p=0.01).

Conclusion

These findings highlight the importance of individualized parenting education programs, particularly those that address the specific needs of both parents and children. Digital therapeutics hold significant potential for providing accessible, evidence-based parenting support aimed at improving mental health outcomes in families.

Narrative Review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy

OBJECTIVE

In 2014, the US National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018)1 updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices.

METHOD

The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research.

RESULTS

Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research.

CONCLUSION

These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.

PLAIN LANGUAGE SUMMARY

In this review article and building upon previous work in this area, the authors describe principles and practices for adolescent substance use treatment and identified areas of treatment in need of further research. The authors also outline recommendations for policy changes and support for funding to implement these principles and practices to further improve the standard of care for adolescent substance use disorders services.

Trends in Treatment Need and Receipt for Substance Use Disorders in the US

This cross-sectional study uses data from the National Survey on Drug Use and Health (NSDUH) to investigate trends in substance use disorder treatment need and receipt from 2013 to 2023 among the US population.

An Observational Study of a Digital Substance Use and Recovery Program

OBJECTIVE

Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders.

METHODS

An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes.

RESULTS

In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders.

CONCLUSIONS

BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.

Technology-Based Interventions for Substance Use Treatment Among People Who Identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native: Scoping Review

BACKGROUND

In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity.

OBJECTIVE

This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants.

METHODS

We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study's potential to facilitate insights into the impact of a TBI for members of specific URM groups.

RESULTS

Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups.

CONCLUSIONS

While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.

Repercussions of the covid-19 pandemic on the work of psychosocial care centers for alcohol and other drugs

OBJECTIVE

to analyze the repercussions of the Covid-19 pandemic on the work of Psychosocial Care Centers for Alcohol and other Drugs.

METHOD

qualitative, descriptive - exploratory study, with 60 health workers from Psychosocial Care Centers for Alcohol and other Drugs in Porto Alegre/ Rio Grande do Sul, from January to December 2021. Collection was carried out using a questionnaire sent by email or in person and the analysis of the content of the responses was of the thematic type of the open question.

RESULTS

an increase in demand from users and crises, social determinants of the pandemic, changes in work, contingency plans, moral distress and expressions of feelings by healthcare workers were observed.

FINAL CONSIDERATIONS

the repercussions of the pandemic on work and workers' mental health reflect the need for monitoring and care for workers in the post-pandemic period. It is also suggested to incorporate online activities to support the psychosocial care model.

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to Advance Context-Specific and Generalizable Knowledge of Implementation Determinants: Case Study of a Digital Contingency Management Platform

Background

Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation.

Methods

Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation.

Results

Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts.

Conclusions

The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

A Digital Cognitive Behavioral Therapy Program for Adults With Alcohol Use Disorder: A Randomized Clinical Trial

Importance

Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use, yet patient access is limited and may be enhanced through digital therapeutics.

Objective

To evaluate the efficacy of a digital CBT program (Computer-Based Training for Cognitive Behavioral Therapy [CBT4CBT]) or clinician-delivered CBT compared with standard treatment for reducing alcohol use.

Design, Setting, and Participants

A 3-arm randomized clinical trial was conducted at outpatient substance use treatment facilities in Connecticut between February 14, 2017, and December 31, 2021, that included an 8-week treatment period with a 6-month follow-up period. Treatment-seeking adults were included who met criteria for current alcohol use disorder and reported drinking at least 14 (men) or 7 (women) drinks per week in the past month and were sufficiently stable for outpatient treatment.

Interventions

Participants were randomly assigned to 1 of the following groups: (1) treatment as usual (TAU) consisting of weekly group or individual counseling, (2) CBT delivered weekly by trained and fidelity-monitored clinicians, or (3) web-based CBT plus brief weekly clinical monitoring.

Main Outcomes and Measures

Rates of alcohol use were measured weekly during the treatment period and at 1-, 3-, and 6-month follow-up using the timeline follow-back method. The primary outcome was the percentage of days abstinent (PDA) from alcohol per month. Intention-to-treat analyses were conducted.

Results

Of the 99 randomized participants (mean [SD] age, 45.5 [12.7]), 66 were male (66.7%); 39 identified as Black/African American (39.8%), 19 (19.2%) as Hispanic, and 47 (48.0%) as White. Mean (SD) rates of PDA from baseline to 6-month follow-up were 49.3% (27.8%) to 69.6% (34.4%) for TAU; 53.7% (29.8%) to 70.2% (35.1%) for CBT; and 47.6% (31.8%) to 82.6% (25.3%) for digital CBT. Results of random-effects regression showed a significant increase in PDA during the study period, with those assigned to digital CBT increasing PDA at a faster rate than TAU (t733 = 2.55; P = .01) and CBT (t733 = 3.36; P < .001). However, there was no statistically significant difference between treatment groups during the 8-week treatment period.

Conclusions and Relevance

In this randomized clinical trial, while there was no significant difference between treatment groups during the 8-week treatment period, there was differential change between treatments during the 8-month study period that provides support for the efficacy of this digital CBT program.

Trial Registration

ClinicalTrials.gov Identifier: NCT02742246.

A pilot study of virtual Harm Reduction Talking Circles for American Indian and Alaska Native adults with alcohol use disorder

Prior research suggests that culturally aligned, accessible and lower-barrier interventions are well-placed to align with the needs of American Indian and Alaska Native (AI/AN) people with alcohol use disorder (AUD). Taking into account community members' suggestions and the need for physical distancing during the COVID-19 pandemic, our team developed a protocol for virtual Harm Reduction Talking Circles (HaRTC) to incorporate these points. The aims of this 8-week, single-arm pilot were to initially document feasibility, acceptability, and outcomes associated with attendance at virtual HaRTC, which integrates the accessibility of virtual connection, a lower-barrier harm-reduction approach, and a culturally aligned intervention. Participants (N = 51) were AI/AN people with AUD (current or in remission) across 41 Tribal affiliations and 25 US states. After a baseline interview, participants were invited to attend 8, weekly virtual HaRTC sessions. At the baseline, midpoint and post-test assessments, we collected data on virtual HaRTC acceptability, cultural connectedness, quality of life, and alcohol outcomes. Of the 123 people approached, 63% were interested in and consented to participation. Participants attended an average of 2.1 (SD = 2.02) virtual HaRTC sessions, with 64% of participants attending at least one. On a scale from 1 to 10, participants rated the virtual HaRTC as highly acceptable (M = 9.3, SD = 1.9), effective (M = 8.4, SD = 2.9), culturally aligned (M = 9.2, SD = 1.5), helpful (M = 8.8, SD = 1.9), and conducted in a good way (M = 9.8, SD = 0.5). Although the single-arm study design precludes causal inferences, participants evinced statistically significant decreases in days of alcohol use and alcohol-related harm over the three timepoints. Additionally, both sense of spirituality, which is a factor of cultural connectedness, and health-related quality of life increased over time as a function of the number of HaRTC sessions attended. Virtual HaRTC shows initial feasibility and acceptability as a culturally aligned intervention for AI/AN people with AUD. Future randomized controlled trials will provide a test of the efficacy of this approach.

Mobile Health Interventions for Substance Use Disorders

Substance use disorders (SUDs) have an enormous negative impact on individuals, families, and society as a whole. Most individuals with SUDs do not receive treatment because of the limited availability of treatment providers, costs, inflexible work schedules, required treatment-related time commitments, and other hurdles. A paradigm shift in the provision of SUD treatments is currently underway. Indeed, with rapid technological advances, novel mobile health (mHealth) interventions can now be downloaded and accessed by those that need them anytime and anywhere. Nevertheless, the development and evaluation process for mHealth interventions for SUDs is still in its infancy. This review provides a critical appraisal of the significant literature in the field of mHealth interventions for SUDs with a particular emphasis on interventions for understudied and underserved populations. We also discuss the mHealth intervention development process, intervention optimization, and important remaining questions.

Virtual focus groups among individuals with use disorders: assessing feasibility and acceptability in an underserved clinical population

Objective

There are substantial barriers to conducting research among individuals with stigmatized and complicated health conditions like substance use disorders. These barriers slow progress when developing, refining, and assessing interventions to better treat underserved populations. Virtual focus groups are an innovative method for collecting data from individuals via a discreet and accessible platform which can inform novel as well as existing treatment approaches. This article reports on the feasibility and acceptability of virtual focus groups as a mechanism to recruit and engage geographically and demographically diverse samples of participants with substance use disorders that are otherwise logistically difficult to assess.

Method

Participants were assessed for eligibility for a virtual focus group study based on demographic features, drug use history, and psychiatric history via a remote, interview-based screening. Focus groups were completed anonymously without video or name-sharing. Discussion contributions, quantified with number of times speaking and total number of words spoken, were compared across gender, and treatment status. Participants provided quantitative and qualitative feedback on the focus group experience in a follow-up survey.

Results

Focus groups (N=26) based in geographical areas throughout the United States were conducted with 88 individuals with opioid use disorder or stimulant use disorder. Discussion contributions were comparable between genders and among individuals in treatment versus those seeking treatment. A follow-up survey (n=50, 57% of focus group participants) reflected high levels of enjoyment, comfort, and honesty during focus group discussions.

Discussion

Findings suggest virtual focus groups can be an effective and efficient tool for substance use research.

Toward an era of impact of digital contingency management in the treatment of substance use disorders

Digital contingency management entails remote methods to obtain biochemical confirmation of drug status and provide desirable, tangible consequences contingent on abstinence. Advances in digital CM suggest that it may be on the cusp of making a public health impact. Specific advances include technological capabilities and affordability, companies that specialize in digital CM, policies and reimbursement models, and the increasing availability of resources related to CM. Digital CM has expanded from cigarette smoking to alcohol and illicit substance misuse, and to include a diverse range of underserved and high-risk groups (e.g., pregnant and postpartum women, socioeconomically disadvantaged individuals, adolescents, and rural populations). Although the digital divide continues to narrow, culturally responsive methods may increase uptake and engagement with digital CM. The promise of digital CM is widescale access to an evidence-based treatment with low staff burden, no side effects, high fidelity engagement, acceptability, and effectiveness, and greater equity. We may be close to realizing this promise.

Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology

The promise of transforming digital technologies into treatments is what drives the development of digital therapeutics (DTx), generally known as software applications embedded within accessible technologies-such as smartphones-to treat, manage, or prevent a pathological condition. Whereas DTx solutions that successfully demonstrate effectiveness and safety could drastically improve the life of patients in multiple therapeutic areas, there is a general consensus that generating therapeutic evidence for DTx presents challenges and open questions. We believe there are three main areas where the application of clinical pharmacology principles from the drug development field could benefit DTx development: the characterization of the mechanism of action, the optimization of the intervention, and, finally, its dosing. We reviewed DTx studies to explore how the field is approaching these topics and to better characterize the challenges associated with them. This leads us to emphasize the role that the application of clinical pharmacology principles could play in the development of DTx and to advocate for a development approach that merges such principles from development of traditional therapeutics with important considerations from the highly attractive and fast-paced world of digital solutions.

Demonstration of an app-delivered digital therapeutic program for methamphetamine use disorder

This study assessed the feasibility and utility of a digital, all-virtual program designed for treatment of methamphetamine use disorder (MUD). Forty-nine adults with moderate- to severe-level MUD (per DSM-5 criteria) commenced the 8-week intervention. All aspects of the program were delivered via smartphone-based app. Intervention components included counseling (cognitive behavioral therapy in group and individual sessions), app-based therapeutic tasks, remote biological drug testing, medical oversight by psychiatrists/nurse practitioners, and contingency management procedures (including rewards for methamphetamine-free saliva drug tests, accomplishing tasks, and engaging in assigned activities). Of the 49 participants who commenced treatment, 27 participants (55%) completed the program. Repeated-measures mixed-model analyses show that participants were more likely to test negative for meth use from week 1 to week 8 (OR = 1.57, 95% CI [1.28, 1.97]; p = 0.034). Well-being and social functioning improved among the majority of participants. These results demonstrate the utility of the all-virtual, digital therapeutic program and its ability to help individuals with MUD to reduce or cease methamphetamine use. The program was efficiently implemented and was well received by participants and clinical personnel, indicating its ability to deliver comprehensive, effective care and to retain the difficult-to-engage population of persons with MUD. Of the 27 completers, 16 responded to a 1-month follow-up survey and reported no meth use in the month since completing the program.

Remote Therapeutic Monitoring in Rheumatic and Musculoskeletal Diseases: Opportunities and Implementation

Therapeutic Monitoring (RTM) is a new program in the United States that began in 2022 allowing electronic patient-reported outcomes (ePRO) and other patient-generated data to be reviewed by clinical staff between visits so that patients can receive clinical attention as needed. Remote Therapeutic Monitoring simultaneously enhances the capacity to generate prospective longitudinal data that may be useful for secondary research purposes. As many governmental and private insurance programs in the United States now provide reimbursement for Remote Therapeutic Monitoring, increasing numbers of rheumatologists may be incentivized to provide this service for their patient populations. Launched in 2015, the ArthritisPower® Research Registry and associated mobile and desktop application, registered with the Food & Drug Administration (FDA) as a Class I medical device, enables patients to track their disease across dozens of domains and to securely participate in voluntary research studies. ArthritisPower, in partnership with Illumination Health, has developed infrastructure and a clinical workflow for Remote Therapeutic Monitoring that will help rheumatologists more closely track their patients' disease activity and flares, identify primary non-adherence, record changes in key health domains (e.g. fatigue, pain, physical function, mental health) and meet the needs for other data elements important for clinical care identified by individual providers. Ultimately, the approach to use digital health tools between visits seeks to improve clinical outcomes for patients with rheumatic and musculoskeletal diseases. This editorial review discusses the evolution of remote monitoring in rheumatologic care, describes the opportunities for physician reimbursement as of 2023, and provides a suggested workflow in order to establish Remote Therapeutic Monitoring within rheumatology practices.

A Computational Platform to Support the Detection, Follow-up, and Epidemiological Surveillance of Mental Health and Substance Use Disorders: Protocol for a Development and Evaluation Study

BACKGROUND

According to the World Health Organization, approximately 15% of the global population is affected by mental health or substance use disorders. These conditions contribute significantly to the global disease burden, which has worsened because of the direct and indirect effects of COVID-19. In Mexico, a quarter of the population between the ages of 18 and 65 years who reside in urban areas present a mental health condition. The presence of a mental or substance abuse disorder is behind a significant percentage of suicidal behaviors in Mexico, where only 1 in 5 of those who have these disorders receive any treatment.

OBJECTIVE

This study aims to develop, deploy, and evaluate a computational platform to support the early detection and intervention of mental and substance use disorders in secondary and high schools as well as primary care units. The platform also aims to facilitate monitoring, treatment, and epidemiological surveillance ultimately helping specialized health units at the secondary level of care.

METHODS

The development and evaluation of the proposed computational platform will run during 3 stages. In stage 1, the identification of the functional and user requirements and the implementation of the modules to support the screening, follow-up, treatment, and epidemiological surveillance will be performed. In stage 2, the initial deployment of the screening module will be carried out in a set of secondary and high schools, as well as the deployment of the modules to support the follow-up, treatment, and epidemiological surveillance processes in primary and secondary care health units. In parallel, during stage 2, patient applications to support early interventions and continuous monitoring will also be developed. Finally, during stage 3, the deployment of the complete platform will be performed jointly with a quantitative and qualitative evaluation.

RESULTS

The screening process has started, and 6 schools have been currently enrolled. As of February 2023, a total of 1501 students have undergone screening, and the referral of those students presenting a risk in mental health or substance use to primary care units has also started. The development, deployment, and evaluation of all the modules of the proposed platform are expected to be completed by late 2024.

CONCLUSIONS

The expected results of this study are to impact a better integration between the different levels of health care, from early detection to follow-up and epidemiological surveillance of mental and substance use disorders contributing to reducing the gap in the attention to these problems in the community.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44607.

[Effect of antibiotics on D-serotonin-reactive structures]

Experiments on the isolated organs showed that ampicillin and levomycetin have pronounced D-antiserotoninergic effects; antagonism of antibodies and serotonin was found to be of competitive type. At an increase in levomycetin dosage D-antiserotoninergic effect was followed by the spasmolytic effect. Kefzol and benzylpenicillin failed to show any D-antiserotonin-ergic properties.