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Mental health services are rooted in relationships. When it comes to delivery, and specifically community-based and outpatient services, connection and communication between the individual and care provider need to be the focus. 

When we think of youth in particular, technology is a regular form of communication for them. 

“Our research team at Lawson is looking at how technology can assist in the delivery of mental health services for youth in a way that still supports the important components of treatment,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson. “In our work with youth, they’ve talked about wanting the technology they are already using integrated into their care.”

In the health care sector, the use of technology needs to be carefully tested and implemented, to ensure it is not only meeting the needs of those using it but also that it complies with the standards for privacy and security. 

On February 7, 2019, Lawson Health Research Institute and InputHealth welcomed community members and stakeholders for the announcement of a new health care technology solution that is being researched by Dr. Forchuk and her team, with generous contributions from the provincial government.

TELEPROM-Y is a mobile-based TELEMedicine and Patient-Reported Outcome Measurement Youth study aiming to improve access to specialized services and reduce inpatient mental health admissions for youth. The initiative is one of 11 that received funding from Ontario’s second round of the Health Technologies Fund (HTF), a program of the Ontario Ministry of Health and Long-Term Care administered by Ontario Centres of Excellence.

TELEPROM-Y received $395,109 in provincial funding with $494,630 in matching contributions for a total investment of $889,739. 

InputHealth’s CEO Damon Ramsay and Chief Medical Officer Puneet Seth, along with Jennifer Moles from the Ontario Centres of Excellence were on hand with Dr. Cheryl Forchuk to hear more about how the technology and funding will help support youth. Project contributors Woodstock General Hospital and Youth Opportunities Unlimited (Y.O.U.) also attended the announcement. 

This project is taking a unique approach to creating connections with youth. Researchers will use an electronic Collaborative Health Record (CHR) developed by InputHealth, an innovative Canadian digital health software company, which allows for secure communication. Patients will have access to virtual visits, prompts and reminders, text or email messages, and educational materials delivered by phone. 

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InputHealth's Puneet Seth and Damon Ramsay provided a demonstration of the software being used in the study. 

Dr. Forchuk explains that “the study is focusing on an important transitional period. The majority of mental illnesses occur between the ages of 16 to 25 years old.” The research team is recruiting participants between these ages who have symptoms of anxiety and/or depression, and are receiving outpatient services from a hospital-based mental health care program at London Health Sciences Centre, St. Joseph’s Health Care London and Woodstock General Hospital, or community-based services from partner organizations. 

A key aspect is to assess whether the technology is effective and efficient, while acceptable to both the staff and youth using the app. 

“Careful evaluation is essential to make sure we are doing the right things for the people we serve,” adds Dr. Forchuk, who is also the Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery. 

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The mobile software will also be evaluated on its ability to improve the ease of access to care; monitor mood and behaviour changes for earlier intervention; enhance information exchange between patient and health care provider; and, support the overall experience for the youth. 

Other project contributors include St. Michael’s Hospital Centre for Excellence in Economic Analysis Research, The Forge (McMaster University), Thunder Bay Regional Health Sciences Centre and Western University.  

The study extends previous findings from the Youth Mental Health Engagement Network study (Y-MHEN), which developed, delivered and evaluated an interactive web-based personal health record, the Lawson SMART Record (LSR), to assist mental health patients in managing their care and connecting with care providers.

The Health Technologies Fund is a program of the Ontario Ministry of Health and Long-term Care and is administered by the Ontario Centres of Excellence. Program supports the development of made in Ontario health technologies by accelerating evaluating, procurement, adoption and diffusion within the Ontario health system. 
 

Researchers at Lawson Health Research Institute are the first in Canada to develop clinical practice guidelines for managing neuropathic pain with patients who have experienced a spinal cord injury (SCI).

Neuropathic pain is complex and chronic, and is the most common complication reported by people following SCI. The research team worked with care providers at Parkwood Institute, part of the St. Joseph’s Health Care London family, and an international panel to address the complex and unique challenges for managing pain during recovery and rehabilitation.

In 2003, Dan Harvey sustained a spinal injury after falling off a trampoline. Using his personal experience, as well as his experiences meeting with newly injured people, Harvey contributed to the development of the new guidelines.

“Neuropathic pain – and pain in general – affects every person with a spinal cord injury very differently. Some people have it, some people don’t. But for those who do have it, it can make rehabilitation and recovery much more difficult,” explains Harvey.

“On top of just learning how to use your body again, you also have to deal with various forms of physical pains, which can make it challenging to mentally adapt to an injury.”

For those with chronic pain, it may be hard to just get out of bed in the morning, feel well enough to leave the house, or even fall asleep. “I have fairly extensive neuropathic pain, so I’m well aware of how difficult it can be to get a full night’s sleep, or show attentiveness at work or at school when it literally feels like your legs are on fire,” says Harvey.

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Dr. Eldon Loh, Lawson Researcher and Physical Medicine and Rehabilitation Specialist at St. Joseph’s, and his team recognized that pain can be an overlooked part of a spinal cord injury and plays a major factor in the success of rehabilitation. It’s difficult for someone in pain to participate fully in their own recovery, and so long-term disability becomes more likely. Pain is difficult to manage and it often takes multiple approaches to find something that works for each person.

“This is a starting point for us to standardize how we approach pain in the clinic. We have identified gaps and offered recommendations to not only manage the pain, but also ensure that our patients can fully benefit from rehabilitation,” says Dr. Loh.

The results of the three-year process led to recommendations for screening and diagnosis, treatment and models of care. Important clinical considerations accompany each recommendation.

“For those in hospital following an injury, it’s about making sure they can be as independent as possible before discharge. Over time, we want to keep pain levels under control so that they are able to live life to the fullest,” adds Dr. Loh.

The research will inform new tools and resources for care providers and patients.

Harvey believes the guidelines will have a tremendous impact for patients whose pain may have been overlooked. “Pain can be created through many different avenues and the effects can snowball after a person is discharged and sent home. If you don’t check all of the boxes, you might be missing a very important item.”

The new guidelines have been published in the international journal Spinal Cord. The Ontario Neurotrauma Foundation and Rick Hansen Institute provided funding for the research study. 

A special thanks to individuals from St. Joseph's who were involved in the project: Steve Orenczuk, Patrick Potter, Keith Sequiera, Lindsey Guilbault, Robert Teasell, Anna Kras-Dupuis, Dalton Wolfe, Alba Casalino and Dwight Moulin.  

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