- Email: [email protected]
21.4 SPARX: NATIONAL IMPLEMENTATION OF AN EMENTAL HEALTH SERVICE
CLINICAL PERSPECTIVES 21.4 – 21.6
Results: Diagnostic agreement between NODA and IPA in the full sample was 88.2 percent (k ¼ 0.75) and 85 percent (k ¼ 0.58) in the subsample. Sensitivity was 84.9 percent in both, whereas specificity was 94.4 percent in the full sample and 85.7 percent in the subsample. k coefficients for inter-rater reliability indicated 85 to 90 percent accuracy between raters. Conclusions: Results indicate that ASD can be identified accurately based on information conveyed through clinically guided in-home recordings for most cases.
ASD NIMH TVM Supported by NIMH R44MH099035 Autism Speaks http://dx.doi.org/10.1016/j.jaac.2016.07.559
21.4 SPARX: NATIONAL IMPLEMENTATION OF AN EMENTAL HEALTH SERVICE Sally Merry, MD, Department of Psychological Medicine, University of Auckland, Private Bag, Auckland, New Zealand; Karolina Stasiak, PhD Objectives: The goal of this session is to describe the first two years of implementation of a national asynchronous, computerized, gamified CBT program called SPARX. Methods: SPARX is a computerized CBT (cCBT) program for adolescents aged 12–19 years with mild to moderate symptoms of depression. It uses an interactive fantasy gaming environment to facilitate engagement and immersive learning. SPARX was designed with input from young people and includes culturally relevant design features to appeal to Maori and Pacific youth. Evidence of effectiveness comes from two randomized controlled trials and two open trials. SPARX was launched as a national self-help program in April 2014, and through funding from the Ministry of Health, it is provided free of charge 24 hours/seven days per week in New Zealand. The information technology infrastructure is provided by the National Institute of Health Innovation (NIHI), and support services (telephone and text counseling) are provided by Lifeline and Youthline. Ongoing functions are monitored by an independent clinical advisory group and a steering group, including members from the Ministry of Health. Results: By the end of 2015, there were 6,406 registered users, including 4,160 young people and 1,220 health professionals. Of the users, 66 percent was female; 33 percent was in the age range of 12–14 years, 38 percent was in the age range of 13–17 years, and 11 percent was in the age range of 18–19 years. Young people (60 percent) completed at least one module, and 14 percent completed four or more modules (i.e., half of the intervention). Although these figures compare well with other online self-help tools available to the public, they highlight the difficulties with adherence common to online self-help tools. Conclusions: SPARX is one of the world’s first evidence-based computerized youth depression programs to be rolled out nationally. Implementation of evidence-based computerized interventions requires careful thought with a number of challenges, including the time taken to develop, test, and implement programs; sustaining engagement with the target audience; and keeping up with technology.
EBP Supported by the Ministry of Health, New Zealand Government http://dx.doi.org/10.1016/j.jaac.2016.07.560
21.5 ASYNCHRONOUS ETHERAPY FOR ABORIGINAL COMMUNITIES: EXPERIENCES FROM NUNAVUT Yvonne Bohr, PhD, Department of Psychology, York University, 4700 Keele St., 5022E TEKL Building, Toronto, ON M3J 1P3, Canada; Sally Merry, MD Objectives: This presentation provides an overview of a pilot trial of computer-based e-therapy offered to youth in remote northern communities who are at risk for depression and suicidality. There is a need for accessible resources to address the unique risk factors facing Inuit youth suffering from depression in Nunavut where suicide rates are 10 times higher than in the rest of Canada. CBT has been identified as an effective approach for youth depression and is widely used. Many Inuit communities, however, are remote and lack trained staff who could provide CBT. Thus, it is imperative to explore innovations in the delivery of evidence-based interventions.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Methods: SPARX, an interactive computer game based on CBT principles and designed to boost resilience in youth at risk for depression, was administered to 75 youth in 25 communities in collaboration with the Government of Nunavut. SPARX has been shown to be effective in reducing symptoms of depression, enhancing problem-solving skills, managing symptoms of depression, and teaching relaxation techniques with Aboriginal teenagers in New Zealand. By use of a quasi-randomized design, pre- and postintervention measures included the following: the Center for Epidemiologic Depression Scale, the Hopelessness Scale for Children, the Cognitive Emotional Regulation Questionnaire, and the Child and Youth Resilience Measure. In addition, exit interviews were administered to participating youth, and the community workers who facilitated and monitored the game play. Results: Significant and continuous modifications were required to the study design during the implementation of the pilot study. Adaptations are discussed in the context of the unique and challenging conditions under which community facilitators are operating, and youth are living in the far North. Paired t-tests and qualitative data are yielding promising results with regard to a reduction in depressive symptoms and increase of resiliency. Recommendations are made for the next phase of the study, which addresses cultural specificity. Conclusions: E-therapies offer a potentially viable solution for the provision of evidence-based mental health interventions to youth in remote communities. The implementation of these therapies, however, must be flexible and culture informed.
ADOL CC SP Supported by the Government of Nunavut http://dx.doi.org/10.1016/j.jaac.2016.07.561
21.6 BRAVE-ONLINE: INTRODUCING ONLINE THERAPY FOR CHILDREN AND ADOLESCENTS AFFECTED BY A NATURAL DISASTER Karolina Stasiak, PhD, Dept. of Psychological Medicine, University of Auckland, Room 12.005 Level 12, Private Bag 92019, Auckland, 1142, New Zealand; Stephanie Moor, MBChB Objectives: The goal of this session is to discuss the role of an online anxiety program for children and adolescents in the context of a postnatural disaster environment. BRAVE-ONLINE is an evidence-based Australian-developed computerized CBT program for children and adolescents with anxiety. It uses child/youth-friendly flash animations, sound clips, and interactive quizzes and games. The program consists of 10 child/youth modules supported by parent sessions. This program is supported by a therapist via weekly emails. We introduced BRAVE-ONLINE in the Canterbury region of New Zealand after the devastating earthquakes in 2011. Methods: We carried out a pragmatic open trial (n ¼ 42) in the 18 months after the earthquakes. We designed the trial to allow us to compare the results with previously carried out RCTs in Australia. After the trial, we rolled out the program via the regional primary care services and continued to monitor the preand post intervention outcomes using self-ratings of anxiety symptoms (Spence Child Anxiety Scale) collected by phone and/or electronic means. Results: At six months postintervention, more than half (55 percent) of the 33 participants assessed no longer met criteria for their primary anxiety disorder. The mean number of anxiety diagnoses dropped from 2.76 (SD ¼ 0.85) at baseline to 1.06 (SD ¼ 1.25) at follow-up (z ¼ 4.51, P < 0.001). Participants’ anxiety symptoms reduced significantly, and the effect size on the Spence Child Anxiety Scale (parent-rated) was 1.32. Mood symptoms and quality of life also improved. On average, children and adolescents had completed six of 10 sessions. The regional roll-out (with funding for up to 500 families) continues into 2016, and the results will be presented at the meeting. Conclusions: The initial trial demonstrated that provision of an online intervention was both feasible and acceptable to families affected by a natural disaster. The effectiveness of the program was comparable with previous RCTs. The roll-out presented unforeseen challenges related to real-life uptake, engagement, and data collection.
ANX CBT COMP Supported by the Oakley Mental Health Research Foundation and Christchurch Rotary Earthquake Charitable Trust (New Zealand) http://dx.doi.org/10.1016/j.jaac.2016.07.562
www.jaacap.org
S33
Results: Diagnostic agreement between NODA and IPA in the full sample was 88.2 percent (k ¼ 0.75) and 85 percent (k ¼ 0.58) in the subsample. Sensitivity was 84.9 percent in both, whereas specificity was 94.4 percent in the full sample and 85.7 percent in the subsample. k coefficients for inter-rater reliability indicated 85 to 90 percent accuracy between raters. Conclusions: Results indicate that ASD can be identified accurately based on information conveyed through clinically guided in-home recordings for most cases.
ASD NIMH TVM Supported by NIMH R44MH099035 Autism Speaks http://dx.doi.org/10.1016/j.jaac.2016.07.559
21.4 SPARX: NATIONAL IMPLEMENTATION OF AN EMENTAL HEALTH SERVICE Sally Merry, MD, Department of Psychological Medicine, University of Auckland, Private Bag, Auckland, New Zealand; Karolina Stasiak, PhD Objectives: The goal of this session is to describe the first two years of implementation of a national asynchronous, computerized, gamified CBT program called SPARX. Methods: SPARX is a computerized CBT (cCBT) program for adolescents aged 12–19 years with mild to moderate symptoms of depression. It uses an interactive fantasy gaming environment to facilitate engagement and immersive learning. SPARX was designed with input from young people and includes culturally relevant design features to appeal to Maori and Pacific youth. Evidence of effectiveness comes from two randomized controlled trials and two open trials. SPARX was launched as a national self-help program in April 2014, and through funding from the Ministry of Health, it is provided free of charge 24 hours/seven days per week in New Zealand. The information technology infrastructure is provided by the National Institute of Health Innovation (NIHI), and support services (telephone and text counseling) are provided by Lifeline and Youthline. Ongoing functions are monitored by an independent clinical advisory group and a steering group, including members from the Ministry of Health. Results: By the end of 2015, there were 6,406 registered users, including 4,160 young people and 1,220 health professionals. Of the users, 66 percent was female; 33 percent was in the age range of 12–14 years, 38 percent was in the age range of 13–17 years, and 11 percent was in the age range of 18–19 years. Young people (60 percent) completed at least one module, and 14 percent completed four or more modules (i.e., half of the intervention). Although these figures compare well with other online self-help tools available to the public, they highlight the difficulties with adherence common to online self-help tools. Conclusions: SPARX is one of the world’s first evidence-based computerized youth depression programs to be rolled out nationally. Implementation of evidence-based computerized interventions requires careful thought with a number of challenges, including the time taken to develop, test, and implement programs; sustaining engagement with the target audience; and keeping up with technology.
EBP Supported by the Ministry of Health, New Zealand Government http://dx.doi.org/10.1016/j.jaac.2016.07.560
21.5 ASYNCHRONOUS ETHERAPY FOR ABORIGINAL COMMUNITIES: EXPERIENCES FROM NUNAVUT Yvonne Bohr, PhD, Department of Psychology, York University, 4700 Keele St., 5022E TEKL Building, Toronto, ON M3J 1P3, Canada; Sally Merry, MD Objectives: This presentation provides an overview of a pilot trial of computer-based e-therapy offered to youth in remote northern communities who are at risk for depression and suicidality. There is a need for accessible resources to address the unique risk factors facing Inuit youth suffering from depression in Nunavut where suicide rates are 10 times higher than in the rest of Canada. CBT has been identified as an effective approach for youth depression and is widely used. Many Inuit communities, however, are remote and lack trained staff who could provide CBT. Thus, it is imperative to explore innovations in the delivery of evidence-based interventions.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Methods: SPARX, an interactive computer game based on CBT principles and designed to boost resilience in youth at risk for depression, was administered to 75 youth in 25 communities in collaboration with the Government of Nunavut. SPARX has been shown to be effective in reducing symptoms of depression, enhancing problem-solving skills, managing symptoms of depression, and teaching relaxation techniques with Aboriginal teenagers in New Zealand. By use of a quasi-randomized design, pre- and postintervention measures included the following: the Center for Epidemiologic Depression Scale, the Hopelessness Scale for Children, the Cognitive Emotional Regulation Questionnaire, and the Child and Youth Resilience Measure. In addition, exit interviews were administered to participating youth, and the community workers who facilitated and monitored the game play. Results: Significant and continuous modifications were required to the study design during the implementation of the pilot study. Adaptations are discussed in the context of the unique and challenging conditions under which community facilitators are operating, and youth are living in the far North. Paired t-tests and qualitative data are yielding promising results with regard to a reduction in depressive symptoms and increase of resiliency. Recommendations are made for the next phase of the study, which addresses cultural specificity. Conclusions: E-therapies offer a potentially viable solution for the provision of evidence-based mental health interventions to youth in remote communities. The implementation of these therapies, however, must be flexible and culture informed.
ADOL CC SP Supported by the Government of Nunavut http://dx.doi.org/10.1016/j.jaac.2016.07.561
21.6 BRAVE-ONLINE: INTRODUCING ONLINE THERAPY FOR CHILDREN AND ADOLESCENTS AFFECTED BY A NATURAL DISASTER Karolina Stasiak, PhD, Dept. of Psychological Medicine, University of Auckland, Room 12.005 Level 12, Private Bag 92019, Auckland, 1142, New Zealand; Stephanie Moor, MBChB Objectives: The goal of this session is to discuss the role of an online anxiety program for children and adolescents in the context of a postnatural disaster environment. BRAVE-ONLINE is an evidence-based Australian-developed computerized CBT program for children and adolescents with anxiety. It uses child/youth-friendly flash animations, sound clips, and interactive quizzes and games. The program consists of 10 child/youth modules supported by parent sessions. This program is supported by a therapist via weekly emails. We introduced BRAVE-ONLINE in the Canterbury region of New Zealand after the devastating earthquakes in 2011. Methods: We carried out a pragmatic open trial (n ¼ 42) in the 18 months after the earthquakes. We designed the trial to allow us to compare the results with previously carried out RCTs in Australia. After the trial, we rolled out the program via the regional primary care services and continued to monitor the preand post intervention outcomes using self-ratings of anxiety symptoms (Spence Child Anxiety Scale) collected by phone and/or electronic means. Results: At six months postintervention, more than half (55 percent) of the 33 participants assessed no longer met criteria for their primary anxiety disorder. The mean number of anxiety diagnoses dropped from 2.76 (SD ¼ 0.85) at baseline to 1.06 (SD ¼ 1.25) at follow-up (z ¼ 4.51, P < 0.001). Participants’ anxiety symptoms reduced significantly, and the effect size on the Spence Child Anxiety Scale (parent-rated) was 1.32. Mood symptoms and quality of life also improved. On average, children and adolescents had completed six of 10 sessions. The regional roll-out (with funding for up to 500 families) continues into 2016, and the results will be presented at the meeting. Conclusions: The initial trial demonstrated that provision of an online intervention was both feasible and acceptable to families affected by a natural disaster. The effectiveness of the program was comparable with previous RCTs. The roll-out presented unforeseen challenges related to real-life uptake, engagement, and data collection.
ANX CBT COMP Supported by the Oakley Mental Health Research Foundation and Christchurch Rotary Earthquake Charitable Trust (New Zealand) http://dx.doi.org/10.1016/j.jaac.2016.07.562
www.jaacap.org
S33