Investigating the validity and usability of an interactive computer programme for assessing competence in telephone-based mental health triage

Characteristics of a Pediatric Emergency Psychiatric Telephone Triage Service

OBJECTIVES

Caregivers of youth in psychiatric crisis often seek treatment from hospital emergency departments (EDs) as their first point of entry into the mental health system. Emergency departments have struggled over the last decade with growing numbers and now, because of the pandemic, have experienced a deluge of mental health crises. As one approach to divert unnecessary ED admissions, pediatric emergency psychiatric telephone triage services have been created. This study aimed to define the characteristics and utilization of a pediatric triage service and to examine clinician documentation of calls to identify the assessment of risk and disposition.

METHODS

This study included 517 youth (2-18 years; mean, 12.42 years; SD, 3.40 years) who received triage services in the winter of 2 consecutive years. Triage calls were received from caregivers (>75%), schools (17.0%), and providers (6.6%) regarding concerns, including suicidal ideation (28.6%), school issues (28.6%), and physical aggression (23.4%).

RESULTS

Dispositions were for acute, same-day evaluation (9.7%), direct care service (28.8%), further evaluation (within 48-72 hours, 40.0%), and resource/service update information (21.5%). Findings revealed that most clinical concerns were referred for further evaluation. Both adolescent females and males were referred for emergency evaluations at high rates.

CONCLUSIONS

A dearth of information on pediatric crisis telephone triage services exists; thus, developing an evidence base is an important area for future work. This information assists not only in our understanding of which, why, and how many youths are diverted from the ED but allows us to extrapolate significant costs that have been saved because of the utilization of the triage service.

Usability Evaluations of Mobile Mental Health Technologies: Systematic Review

Background

Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice.

Objective

This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems.

Methods

We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Results

A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes.

Conclusions

This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.