Implementing and Analyzing the Advantages of Voice AI as Measurement-Based Care (MBC) to Address Behavioral Health Treatment Disparities among Youth in Economically Disadvantaged Communities
By
Yared Alemu
,
Yared Alemu
TQIntelligence, Inc.
, Atlanta, Georgia
, United States
Department of Psychiatry & Behavioral Sciences,Child and Adolescent Psychiatry Fellowship Program,
Morehouse School of Medicine
, Atlanta
, United States
Only 20% of behavioral health providers use measurement-based care [MBC].1 Two reasons for MBC’s low uptake outcomes are a need for stronger consensus regarding optimal use (in both frequency and consistency) and the absence of a widely utilized data analytics infrastructure. TQIntelligence has built and implemented a measurement-based system for community behavioral health providers, which includes the use of a novel AI-enabled voice algorithm designed to provide psychiatric decision and triaging support to pediatric populations. The success of the implementation and related outcomes varied depending on the organization and the therapist's involvement in the pilot.2 This paper will contribute to the literature on measurement care and its effectiveness. It also challenges the dominant narrative that such systems are too complicated and ineffective in community behavioral health that serve children and adolescents from low-income communities.
Tutun S, Johnson ME, Ahmed A, Albizri A, Irgil S, Yesilkaya I, et al. An AI-based Decision Support System for Predicting Mental Health Disorders. Information Systems Frontiers. 2023;25(3):1261–76.
3.
Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine. 2011;41(1):71–83.
4.
Rariden C, SmithBattle L, Yoo JH, Cibulka N, Loman D. Screening for Adverse Childhood Experiences: Literature Review and Practice Implications. The Journal for Nurse Practitioners. 2021;17(1):98–104.
5.
Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health. 2017;2(8):e356–66.
6.
Anderson AS, Siciliano RE, Henry LM, Watson KH, Gruhn MA, Kuhn TM, et al. Adverse childhood experiences, parenting, and socioeconomic status: Associations with internalizing and externalizing symptoms in adolescence. Child Abuse & Neglect. 2022;125:105493.
7.
Herzog JI, Schmahl C. Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Frontiers in Psychiatry. 9.
8.
Kerker BD, Zhang J, Nadeem E, Stein REK, Hurlburt MS, Heneghan A, et al. Adverse Childhood Experiences and Mental Health, Chronic Medical Conditions, and Development in Young Children. Academic Pediatrics. 2015;15(5):510–7.
9.
Bickman L, Athay MM, Riemer M, Lambert EW, Kelley SD, Breda C, et al. Manual of the Peabody Treatment Progress Battery [Electronic version. 2010.
10.
Riemer M, Athay MM, Bickman L, Breda C, Kelley SD, Vides de Andrade AR. The Peabody Treatment Progress Battery: History and Methods for Developing a Comprehensive Measurement Battery for Youth Mental Health. Administration and Policy in Mental Health and Mental Health Services Research. 2012;39(1–2):3–12.
11.
Graham S, Depp C, Lee EE, Nebeker C, Tu X, Kim HC, et al. Artificial Intelligence for Mental Health and Mental Illnesses: an Overview. Current Psychiatry Reports. 2019;21(11).
12.
Caulley D, Alemu Y, Burson S, Cárdenas Bautista E, Abebe Tadesse G, Kottmyer C, et al. Objectively Quantifying Pediatric Psychiatric Severity Using Artificial Intelligence, Voice Recognition Technology, and Universal Emotions: Pilot Study for Artificial Intelligence-Enabled Innovation to Address Youth Mental Health Crisis. JMIR Research Protocols. 12:e51912.
13.
Finkelhor D, Shattuck A, Turner H, Hamby S. A revised inventory of Adverse Childhood Experiences. Child Abuse & Neglect. 2015;48:13–21.
14.
Monnat SM, Chandler RF. Long-Term Physical Health Consequences of Adverse Childhood Experiences. The Sociological Quarterly. 2015;56(4):723–52.
15.
Jha MK, Grannemann BD, Trombello JM, Clark EW, Eidelman SL, Lawson T, et al. A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project. The Annals of Family Medicine. 2019;17(4):326–35.
16.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Journal of General Internal Medicine. 2001;16(9):606–13.
17.
Logroño Naranjo SI, Estrada Brito NA, Vásconez Núñez VA, Rosero Ordóñez EM. Analysis of the use of the Python programming language for statistical calculations. Espirales Revista Multidisciplinaria de investigación. 6(41).
18.
Crossing the Quality Chasm. 2001.
19.
Mongelli F, Georgakopoulos P, Pato MT. Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States. Focus. 2020;18(1):16–24.
20.
Substance Abuse and Mental Health Services Administration. 2023;
21.
Alemu Y, Chen H, Duan C, Caulley D, Arriaga RI, Sezgin E. Detecting Clinically Relevant Emotional Distress and Functional Impairment in Children and Adolescents: Protocol for an Automated Speech Analysis Algorithm Development Study. JMIR Research Protocols. 12:e46970.
22.
de Jong K, Conijn JM, Gallagher RAV, Reshetnikova AS, Heij M, Lutz MC. Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review. 2021;85:102002.
23.
Sheftall AH. The tragedy of black youth suicide. 2023;
24.
Substance Abuse and Mental Health Services Administration. 2022;
25.
Ehlman DC, Yard E, Stone DM, Jones CM, Mack KA. Changes in Suicide Rates — United States, 2019 and 2020. MMWR Morbidity and Mortality Weekly Report. 71(8):306–12.
26.
Bridge JA, Ruch DA, Sheftall AH, Hahm HC, O’Keefe VM, Fontanella CA, et al. Youth Suicide During the First Year of the COVID-19 Pandemic. Pediatrics. 2023;151(3).
27.
Hoffmann JA, Farrell CA, Monuteaux MC, Fleegler EW, Lee LK. Association of Pediatric Suicide With County-Level Poverty in the United States, 2007-2016. JAMA Pediatrics. 2020;174(3):287.
28.
Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. *JAMA Pediatrics. 2021;175*(11:1142–50.
29.
Boswell JF, Hepner KA, Lysell K, Rothrock NE, Bott N, Childs AW, et al. The need for a measurement-based care professional practice guideline. Psychotherapy. 60(1):1–16.
30.
Scott K, Lewis CC. Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice. 2015;22(1):49–59.
31.
Harding KJK, Rush AJ, Arbuckle M, Trivedi MH, Pincus HA. Measurement-Based Care in Psychiatric Practice. The Journal of Clinical Psychiatry. 2011;72(08):1136–43.
32.
Fortney JC, Unützer J, Wrenn G, Pyne JM, Smith GR, Schoenbaum M, et al. A Tipping Point for Measurement-Based Care. Psychiatric Services. 2017;68(2):179–88.
33.
Kemp K. Breaking the stigma of mental health: Improving the quality of mental healthcare through telehealth and measurement-based care. *Texas State Undergraduate Research Journal. 2021;9*(i:8–17.
34.
Chokshi S, Senathirajah Y, Yadav V, Winsberg M, O’Callaghan E, Sullivan S, et al. A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis. Cureus. 2022;
35.
Keepers BC, Easterly CW, Nora Dennis, Domino ME, Bhalla IP. A Survey of Behavioral Health Care Providers on Use and Barriers to Use of Measurement-Based Care. Psychiatric Services. 2023;74(4):349–57.
36.
Koutsouleris N, Hauser TU, Skvortsova V, De Choudhury M. From promise to practice: towards the realisation of AI-informed mental health care. The Lancet Digital Health. 2022;4(11):e829–40.
37.
Henke RM, Zaslavsky AM, McGuire TG, Ayanian JZ, Rubenstein LV. Clinical Inertia in Depression Treatment. Medical Care. 2009;47(9):959–67.
Citation
Copyright
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
