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      Digital technology can revolutionize mental health services delivery: The COVID‐19 crisis as a catalyst for change

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          Abstract

          The unprecedented COVID‐19 crisis presents an imperative for mental health care systems to make digital mental health interventions a routine part of care. Already because of COVID‐19, many therapists have rapidly moved to using telehealth in place of in‐person contact. In response to this shift, Waller and colleagues compiled a series of expert recommendations to help clinicians pivot to delivering teletherapy to address eating disorders during COVID‐19. However, numerous barriers still impede widespread adoption and implementation of digital interventions. In this commentary, we aim to extend the recommendations for clinicians offered by Waller and colleagues by presenting a roadmap of the systems‐ and policy‐level requirements that are needed. We advocate for addressing barriers associated with training, licensing, safety, privacy, payment, and evaluation, as these factors have greatly limited use of these promising interventions. We also indicate that longer‐term goals should include introducing truly innovative digital mental health practices, such as stepped‐care models and simultaneously providing preventive and self‐management services in addition to clinical services, into the health care system. Now is the time to catalyze change and comprehensively address the barriers that have prevented widespread delivery of these efficacious digital services to the millions of people who would benefit.

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          Is Open Access

          Cognitive‐behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face‐to‐face meetings are not possible

          Abstract Objective The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence‐based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework. Method Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive‐behavioral therapy for eating disorders (CBT‐ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians. Results A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT‐ED methods. Discussion Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence‐based practice. These are shared to assist clinicians over the period of changed practice.
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            From Research to Practice: Ten Lessons in Delivering Digital Mental Health Services

            There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges.
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              National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: therapist and patient-level outcomes.

              The Department of Veterans Affairs (VA) health care system is nationally disseminating and implementing cognitive behavioral therapy for depression (CBT-D). The current article evaluates therapist and patient-level outcomes associated with national training in and implementation of CBT-D in the VA health care system.
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                Author and article information

                Contributors
                btaylor@stanford.edu
                Journal
                Int J Eat Disord
                Int J Eat Disord
                10.1002/(ISSN)1098-108X
                EAT
                The International Journal of Eating Disorders
                John Wiley & Sons, Inc. (Hoboken, USA )
                0276-3478
                1098-108X
                25 May 2020
                : 10.1002/eat.23300
                Affiliations
                [ 1 ] Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford California USA
                [ 2 ] Center for m2Health, Palo Alto University Palo Alto California USA
                [ 3 ] Department of Psychiatry Washington University School of Medicine St. Louis Missouri USA
                [ 4 ] Center for Behavioral Intervention Technologies, Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago Illinois USA
                Author notes
                [*] [* ] Correspondence

                C. Barr Taylor, Center for m2Health, Palo Alto University, Room E10, 5150 El Camino Real, Mountain View, CA.

                Email: btaylor@ 123456stanford.edu

                Author information
                https://orcid.org/0000-0002-4564-6548
                https://orcid.org/0000-0001-7064-3835
                https://orcid.org/0000-0002-9736-8906
                Article
                EAT23300
                10.1002/eat.23300
                7280562
                32449523
                d644cafd-7ff2-4e96-b865-a70c2c787fc7
                © 2020 Wiley Periodicals, Inc.

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 08 May 2020
                : 08 May 2020
                : 08 May 2020
                Page count
                Figures: 0, Tables: 0, Pages: 3, Words: 2045
                Funding
                Funded by: National Institute of Diabetes and Digestive and Kidney Diseases , open-funder-registry 10.13039/100000062;
                Award ID: K01 DK116925
                Funded by: National Institute of Mental Health , open-funder-registry 10.13039/100000025;
                Award ID: K08 MH120341
                Award ID: R01 MH115128
                Categories
                Commentary
                Commentaries
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:09.06.2020

                Clinical Psychology & Psychiatry
                coronavirus,covid‐19,digital technology,mental health services,telehealth

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