With the funding award announced today, our Canadian Institutes of Health Research (CIHR) TiC Stream 2 Team project, entitled Digitizing Stepped Mental Health Care: A Pragmatic Trial, will develop and evaluate a stepped care e-MH platform, designed to host and manage a suite of established e-MH solutions, through a 2-arm parallel-group, non-randomized, TAU controlled, staged pragmatic trial. Our ehealth partner, Greenspace, is an SME with an established customer base in mental health outcomes monitoring and ready to adapt their system to manage Stepped Care 2.0 (SC2.0) implementation and evaluation to a minimum of level-9 with our two provincial health partners within the one-year proposed development phase.

 Implementation of SC2.0 to date has not been rigorously evaluated. This e-MH solution will provide a platform not only for managing the pragmatic trial, but we expect it will also enhance SC2.0 care delivery through automation and more systematic client monitoring and clinical decision-making. SC2.0 with its rapid access, increased treatment options, focus on recovery and strengths, capacity for reaching remote areas has potential for better reaching underserved populations, including rural and remote residents, immigrants, and indigenous populations.

 This study will evaluate SC2.0 at 15 sites in Newfoundland and 15 sites in Nova Scotia. SC2.0 integrates a wide range of treatment options, including psychiatric care, individual and group counselling, online treatment programs with built in professional support, self-help resources and peer support. We predict that the e-MH management solution will make it easier and safer to offer the lowest intensity care option and step up intensity only when needed. The program, we anticipate, will also allow clients to be more involved in care planning, transitioning, and decision making. Training will be provided to care providers from many disciplines to collaborate more closely through the system. We predict that analytics will drive platform adjustments and identify treatment pathway transitions predictive of more rapid and positive outcomes. This attention to continuous improvement is expected to empower clients to be more resourceful and to encourage providers to be more innovative and flexible. We also expect that programming will be available to more people without increasing costs. In other words, we expect this approach to care to be more efficient, effective and sustainable. Finally, with a team of researchers, clients, providers and other stakeholders representing every province, it will be possible to implement across the country any of the new programming that proves effective. In summary, the pragmatic trial hypotheses are twofold:

  1. We hypothesize that SC2.0 delivered using a platform will result in statistically and clinically significant positive outcomes relative to SC2.0 delivered without a platform.
  2. We predict that SC2.0 delivered without a platform will result in statistically and clinically significant positive outcomes relative to treatment as usual (TAU).