Telehealth Mental Health Support for Developmental Disabilities

Recruiting in Palo Alto (17 mi)

Overseen by Joan B Beasley, PhD

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of New Hampshire

No Placebo Group

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

Roughly 40% of those with intellectual and developmental disabilities (IDD) have mental health needs, which is twice the national average. Nevertheless, there is dearth of evidenced-based mental health treatment for youth and young adults with IDD. The disparity in access to mental health care places those with IDD at greater risk of crisis service use. While telemental health studies demonstrate potential to enhance access to care, little of this research includes those with IDD, or crisis prevention and intervention. This project will refine and evaluate telemental health services for youth and young adults with IDD delivered within START (Systemic, Therapeutic, Assessment, Resources, and Treatment), a national, evidence-based model of crisis prevention and intervention for people with IDD. The study will begin with stakeholder feedback (service recipients, families, and providers) regarding telemental health services (Aim 1). Results will be used to refine the intervention. Our team will then compare telemental health versus in-person START services in a randomized control trial (Aim 2). To our knowledge, this will be the first trial of a telemental health crisis program for the IDD population. The final goal is to understand if outcomes vary across subpopulations (Aim 3) and to identify potential disparities. If found, the investigators will work with service users, families and providers to develop a strategy to address identified disparities in outcomes. The study will be executed by an interdisciplinary team of experts engaged with stakeholder partners. Understanding the benefits of specific telemental health methods has important implications to the design of interventions, within and outside of START. This telemental health study offers promise to address disparities in access to mental health care for people with IDD.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Telehealth Mental Health Support for Developmental Disabilities?

Research shows that crisis intervention programs, like those in hospitals, can reduce the need for inpatient psychiatric admissions and save costs. Additionally, involving family in crisis resolution can lead to better outcomes, as seen in a study where patients with family involvement were more likely to be discharged quickly. ^{1 2 3 4 5}

Is telehealth mental health support for developmental disabilities generally safe for humans?

Research on crisis intervention services, which include telehealth mental health support, suggests they are generally safe for humans. These services are designed to provide immediate help during mental health crises and have been used effectively in various settings, indicating a good safety profile. ^{6 7 8 9 10}

How is the 24-hour urgent crisis response and intervention treatment unique for mental health support in developmental disabilities?

This treatment is unique because it offers immediate, around-the-clock crisis support through telehealth, ensuring accessibility and continuous contact until the crisis is resolved, which is different from traditional mental health models that may not provide such immediate and ongoing support. ^{9 11 12 13 14}

Eligibility Criteria

This trial is for young individuals aged 14-35 with intellectual and developmental disabilities who live at home with family. They must be new enrollees in the START program within 90 days of joining, and able to give informed consent.

Inclusion Criteria

I am between 12 and 45 years old.

Enrolled at an eligible START site

Lives in family setting

Exclusion Criteria

N/A

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Refinement and Stakeholder Feedback

Refinement of telemental health practices based on stakeholder feedback to meet the needs of persons with IDD and mental health needs, their family caregivers, and providers.

8 weeks

Multiple virtual feedback sessions

Randomized Control Trial

Comparison of the effectiveness of in-person START practices versus START telemental health using a randomized control design.

12 months

Regular virtual and in-person sessions

Follow-up

Participants are monitored for changes in mental health stability, crisis service use, and quality of care.

12 months

Continuous monitoring with assessments at enrollment, 6 months, and 1 year

Treatment Details

Interventions

• 24-hour urgent crisis response and intervention (Behavioural Intervention)
• Consultation & coping skills coaching (Behavioural Intervention)
• Intake and quarterly assessment (Behavioural Intervention)
• Service linkages, referrals, outreach, & training (Behavioural Intervention)

Trial Overview The study tests telemental health services versus in-person care within the START model, focusing on crisis prevention and intervention for those with IDD. It includes stakeholder feedback, a randomized control trial, and analysis of outcomes across subpopulations.

Participant Groups

Group I: Telemental health START Experimental Treatment 4 Interventions

Telemental health START will deliver two components via telephonic or other communication technology (e.g., Zoom). This includes component #2 (consultation and coping skills coaching) and component #4 (service linkages, referrals, outreach, \& training). START components #1 (intake and quarterly assessment) and #3 (24-hour urgent crisis response and intervention) will continue to be provided in-person.

Group II: In-person START Active Control 4 Interventions

In-person START will deliver all model components in-person. This is the established model.

24-hour urgent crisis response and intervention is already approved in United States for the following indications:

🇺🇸 Approved in United States as 24-hour Urgent Crisis Response and Intervention for:

• Mental health crisis intervention for individuals with intellectual and developmental disabilities

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

NC West Concord, NC

Who Is Running the Clinical Trial?

University of New Hampshire Lead Sponsor

University of Florida Collaborator

Georgetown University Collaborator

Hugo W. Moser Research Institute at Kennedy Krieger, Inc. Collaborator

Patient-Centered Outcomes Research Institute Collaborator

References

1. United States pubmed.ncbi.nlm.nih.gov

Psychiatric crisis intervention in the general emergency service of a Veterans Affairs hospital. [2018] An after-hours crisis intervention program staffed by psychiatric residents between 5 p.m. and 11:30 p.m. on weekdays was developed in the general emergency room at a Veterans Affairs hospital to reduce inpatient psychiatric admissions. The program offered medication, family interventions, and referrals to outpatient services. In the programs's first year, inpatient admissions during the hours covered by the program decreased by 34 percent, for a net savings of nearly $400,000 in inpatient treatment costs.

2. India pubmed.ncbi.nlm.nih.gov

Three day crisis resolution unit. [2021] This paper describes a three day crisis resolution unit within the confines of the psychiatric emergency service of a general hospital. It utilizes a crisis model of acute intervention, time limited psychotherapeutic approach combined with family therapy, and psychotropic meditation when indicated. One hundred thirty six consecutive admissions were rev ie.wed. 19% were discharged within 72 hours, and 51% required further hospitalization. Seventy seven percent of the patients discharged had involved families (significant others) in the treatment process, in comparison with only 28% family involvement with those patients who needed further hospitalization. This may be even more significant for psychotic patients who were discharged (14/18 family involvement) versus those who needed long hospitalization (13/50 family involvement).

3. India pubmed.ncbi.nlm.nih.gov

Three day crisis resolution unit. [2021] This paper describes a three day crisis resolution unit within the confines of the psychiatric emergency service of a general hospital. It utilizes a crisis model of acute intervention, time limited psychotherapeutic approach combined with family therapy, and psychotropic medications when indicated. 136 consecutive admissions were reviewed, 49% were discharged within 72 hours, and 51 % required further hospitalization. 77% of the patient's discharged had involved families (significant others) in the treatment process,-in comparison with only 28 % family involvement with those patients who needed further hospitalization. This may be even more significant for psychotic patients who were discharged (14/18 family involvement) versus those who needed long hospitalization (13/50 Family involvement).

4. England pubmed.ncbi.nlm.nih.gov

The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial. [2022] As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity.

5. United States pubmed.ncbi.nlm.nih.gov

The psychiatric emergency/crisis disposition and community networks. [2019] Recent advances in techniques of rapid neuroleptization have enabled psychiatric emergency/crisis intervention staff to stabilize many acutely ill patients in a brief time period, frequently less than 24 hours. This has resulted in less need for hospital admissions and has challenged the mental health field to develop alternative disposition options. These options can be classified through a "hierarchy of crisis placements." From least to most restrictive in dispositional context these are: (1) the patient's family, (2) emergency housing, (3) a foster home, (4) the crisis hostel, (5) the 24-hour holding bed facility or intensive observation apartment, (6) the crisis bed unit, and (7) inpatient hospitalization. The psychiatric emergency/crisis intervention unit serves as a gateway for these dispositions following emergency treatment. Thus, a primary function of the unit is the advocacy for, and coordination of, dispositional services, including those provided by a variety of community resources. The unit serves as a networking center that plays a central role in facilitating dialogue between mental health and social assistance agencies, which in turn leads to better follow-up planning and care for the mentally ill while avoiding unnecessary hospitalization and institutionalization.

6. United States pubmed.ncbi.nlm.nih.gov

Crisis intervention for community-based individuals with developmental disabilities and behavioral and psychiatric disorders. [2011] When individuals with a developmental disability experience a behavioral or psychiatric crisis, their community placement may be threatened. A model crisis intervention program for individuals with dual diagnoses was discussed and performance and outcomes of such a service for 267 children and adults reviewed. Analysis indicated that 69% of the individuals required only one crisis intervention. Of the 31% requiring two or more, nearly all were re-referred earlier than 2 years post initial crisis intervention. The central, gulf-bridging role of a crisis intervention service in a comprehensive, coordinated, community-based mental health system for dually diagnosed individuals was discussed.

7. Germany pubmed.ncbi.nlm.nih.gov

[Psychiatric emergency care and crisis intervention--concepts, experiences and results]. [2018] Psychiatric emergencies and life crises are located at opposite ends of a broad scale of stages requiring acute help: Emergency cases need immediate medical care in order to prevent danger to life. For the same reason, immediate hospital admission and additional treatment of risks of internal medicine have to be provided, if necessary. Crises often have not only mental but also social aspects. The immediate urgency of treatment is determined by the psychiatric (suicidal) or the physical risk. Emergency cases and severe crises require a 24-hour medical service. Social aspects cannot be settled in the night-time, even if they are urgent. Emergency and crisis intervention services with a multidisciplinary staff therefore ascribe different roles to physicians, nurses and social workers. Since 1976, the Central Institute of Mental Health provides a 24-hour crisis intervention and emergency service both at the Institute and at the emergency ward of the Mannheim University General Hospital. Within few years, the number of treated episodes has increased to 1,800-1,900 per year. The distance between the place of work or residence is a decisive factor of service utilization. Over 50% of the users of the emergency and crisis intervention service are mentally ill. Only a small part are contacts for crises without psychiatric disorder. Suicidal attempts or intentions account for about 30% of the service users, marriage crises for about 25% and alcohol problems also for about 25%. The development of complementary care in Mannheim has led to a parallel increase in the proportion of chronically mentally ill living in complementary facilities. This clearly indicates that a 24-hour emergency and crisis intervention service is a compulsory prerequisite for the implementation of an efficient system of complementary care for the mentally ill.

8. United States pubmed.ncbi.nlm.nih.gov

Home assessment and treatment in a community psychiatric service. [2019] The work of a new community-based crisis intervention team is described. 326 psychiatric emergencies were seen over a period of 3 years. An increasing proportion of these were acutely psychotic at the time of assessment. Home treatment was effective for a significant number of patients, including those with a previous history of hospital admission. Some practical and theoretical aspects of the service are discussed.

9. England pubmed.ncbi.nlm.nih.gov

Clinical management special: mental health. Right on time. [2016] Early intervention and crisis teams aim to prevent admission to inpatient services. Early intervention is often far removed from the traditional mental health model--accessibility is key. Crisis teams should be mobile, multidisciplinary and remain in contact with users until the crisis is resolved.

10. England pubmed.ncbi.nlm.nih.gov

A crisis recovery model for adolescents with severe mental health problems. [2013] A model of intervention at the interface and for the in-patient phase for adolescents with severe mental health crises was developed to reduce length of stay while maintaining quality of service consonant with the 'recovery model'. The model is described, and discussed in the context of the limited literature on both crisis intervention with adolescents and families, and 'recovery' in this age-group. The model may be suitable also for use by community teams dealing with adolescents in crisis.

11. Ireland pubmed.ncbi.nlm.nih.gov

Emergency conversion to telehealth in hospital-based psychiatric outpatient services: Strategy and early observations. [2021] Balancing public health physical distancing guidelines and the need to provide critical mental health services for risky and psychiatrically complex patient populations without disruption, many systems swiftly pivoted to telehealth to provide care during COVID-19. Leveraging technology, Yale New Haven Psychiatric Hospital's ambulatory services designed and deployed virtual intensive outpatient (IOP) and outpatient (OP) group-based services rapidly. Strategies for rapid deployment of group-based services, including action steps transitioning to telehealth, clinical protocols, and remote workforce training, early observations and challenges to implementation are described as helpful tools for clinical settings with similar needs to prevent infectious spread while addressing the mental health needs of patients.

12. England pubmed.ncbi.nlm.nih.gov

Telehealth service delivery in an Australian regional mental health service during COVID-19: a mixed methods analysis. [2022] COVID-19 required mental health services to quickly switch from face-to-face service delivery to telehealth (telephone and videoconferencing). This evaluation explored implementation of a telehealth mental health response in a regional public mental health provider.

13. Canada pubmed.ncbi.nlm.nih.gov

Virtual Partnership Addressing Mental Health Crises: Mixed Methods Study of a Coresponder Program in Rural Law Enforcement. [2023] A mental health crisis can create challenges for individuals, families, and communities. This multifaceted issue often involves different professionals from law enforcement and health care systems, which may lead to siloed and suboptimal care. The virtual crisis care (VCC) program was developed to provide rural law enforcement with access to behavioral health professionals and facilitated collaborative care via telehealth technology.

14. United States pubmed.ncbi.nlm.nih.gov

Adapting to the COVID-19 Pandemic: A Psychological Crisis Support Call Service Within a Community Mental Health Team. [2023] To mitigate potential mental health crises within a Community Mental Health Team (CMHT) the psychology department implemented a short-term, rapid access, crisis telephone support service for clients during the COVID-19 pandemic. We aimed to evaluate the feasibility and acceptability. Data was collected on who the service was offered to and whom engaged. Demographic information, referral and crisis support call information was collected from the service's electronic database. Forty-four participants were referred to the service. Seventy seven percent of participants engaged in one or more telephone sessions. Participants rated the service as highly useful, with simply 'talking to someone' seen as the most important aspect of the calls. A number of age differences were noted regarding the content that was discussed in sessions. The psychological crisis telephone support service was feasible and acceptable to service users during the COVID-19 pandemic.