Creating a virtuous cycle of digital health enterprise ... · Overview of evidence‐basedpsychosocial interventions in Breaking Free Online Strategiesin Breaking Free Online Interventions

Creating a virtuous cycle of digital health enterprise sustainability:

Lessons learnt at Breaking Free

Dr Jonathan Ward (Founder & Managing Director)Dr Sarah Elison (Research Director)

© 2016 Breaking Free Group. All rights reserved. www.BreakingFreeGroup.com


ConclusionsVirtuous cycleResearchInterventionsSustainable development and implementation of digital health technology

Key lessons to support growth of wider digital health sector

Overview of approach to research and evidence to date

Introduction to Breaking Free Online (Community and Justice)

Overview of session


• Founded in 2010

• Team of 10

• Mission: to widen access to evidence‐based psychological interventions

• Digital health platform: targets the underlying psychological and lifestyle factors that drive addictive behaviours

• Commitment to research and sustainable implementation of digital healthcare interventions

• Nominated for and won numerous awards in the last four years:

Breaking Free Group


Comprehensive digital treatment and recovery programme for substance misuse

• Evidence‐based psychosocial interventions that comply with NICE guidance

• Targets 39 substances, including NPS and prescribed medications

• Overcomes shame, stigma and other key barriers to treatment

• Used independently as self‐help or delivered as computer‐assisted therapy (CAT)

Breaking Free Online (Community)


World’s first online healthcare intervention for offenders to be implemented in prisons:

• Developed in consultation with the Ministry of Justice

• Hosted on Virtual Campus

• Provides essential continuity of care

• Commissioned by NHS England in 10 NW prisons for Gateways

Breaking Free Online (Health and Justice)

Overview of evidence‐based psychosocial interventions in Breaking Free Online

Strategies in Breaking Free Online Interventions Therapeutic approaches

Assessment Progress check

Structured assessmentSelf‐monitoring

Extended brief intervention (EBI)Standardised measures

Lifestyle balance model Generic formulationIdiosyncratic formulation

Node‐link mappingCognitive‐behavioural therapy (CBT)

Understanding your difficult situations Psycho‐education on problematic situations Psycho‐educationExtended brief intervention (EBI)

Managing your difficult situations: Recognise‐avoid cope

Recognise‐avoid‐copeSeemingly irrelevant decisions (SIDs)

Relapse prevention

Understanding your negative thoughts Psycho‐education on negative thinking patterns Psycho‐educationExtended brief intervention (EBI)

Escaping your mind traps Mind trapsCognitive restructuring

International Treatment Effectiveness Programme (ITEP)Cognitive‐behavioural therapy (CBT)

Understanding your emotions Psycho‐education on emotional regulation Psycho‐educationExtended brief intervention (EBI)

Shifting your focus Attention narrowing/attention switchingEmotional regulation

Coping strategy enhancement (CSE)Mindfulness‐based cognitive therapy

Understanding your physical sensations Psycho‐education on cravings and urges Psycho‐educationExtended brief intervention (EBI)

Surfing your cravings and urges Urge surfing Mindfulness‐based cognitive therapy

Understanding your unhelpful behaviours Psycho‐education on behavioural control Psycho‐educationExtended brief intervention (EBI)

Planning your time positively Activity schedulingBehavioural activation

Cognitive‐behavioural therapy (CBT)

Understanding your lifestyle Psycho‐education on association of lifestyle andsubstance use

Psycho‐educationExtended brief intervention (EBI)

Achieving your life goals Goal‐setting Motivational enhancement therapy (MET)Implementation intentions

Guidance for supporters Psycho‐education for practitioners, peer mentors and members of social networks

Psycho‐educationFamily therapy (FT)







• Effectiveness of BFO evaluated via mixed‐method research programme

• Based on MRC guidelines

• For complex multi‐component interventions

• Change mechanisms as important as outcomes

• Encourages continual process of research and development

• Multiple methodologies: qualitative and quantitative

• Results in data spanning the ‘hierarchy of evidence’

• Focus not only on clinical effectiveness but also on theoretical basis and processes involved in sustainable implementation

Research and evaluation


Medical Research Council 2008 www.mrc.ac.uk/complexinterventionsguidance


• Studies published in UK and US peer‐reviewed journals show BFO leads to significantly:

• Reduced substance consumption and substance dependence

• Improved mental health, quality of life and recovery progression

• Increased resilience and self‐efficacy

• Enhanced computer skills and digital inclusion

• National service providers report people using BFO alongside standard treatment:

• 50% more likely to exit services successfully

• 60% less likely to re‐present to services

Outcomes from peer‐reviewed research


• Demonstrating clinical effectiveness is not enough in digital health

• If digital health innovations are not implemented, diffused and normalised into standard practice, clinical effectiveness is irrelevant

• Therefore focussed research programme examining implementation

• Collaboration with CGL, largest treatment provider in UK

• Learnt lessons about implementation within services and sustainability

• Normalisation of BFO as standard treatment offering in services

• Commissioning enables sustainability which enables further technology development and research

Implementation and sustainability


Co‐produced implementation

Adoption and usage

Outcome data and learnings

Research and evaluation

Commissioning

Technology development

Virtuous cycle of sustainability


• Local Authorities and NHS Trusts:

• Service providers:

• Prisons in North‐West England:

Commissioning


• New treatment modality requires a new approach

• Partnership working and co‐production of implementation models are key

• Need to win ‘hearts and minds’ of all stakeholders…

• Commissioners: outcomes dashboard, needs analysis and drug trends

• Service managers: enhanced performance, resource management

• Practitioners: upskilling through training, caseload management

• Peer mentors: deliver structured interventions, increased resilience

• Service users: recovery, clinical gains, digital inclusion, 24/7 support

Implementation


Adoption and usage


• Provides powerful external validation

• But very resource‐intensive…

Accreditation


• New technology platform: scalable, adaptable, secure

• New capability: mobile‐enabled web application with companion app

• New content: recovery focused, strengths‐based

• New UI: icon driven, intuitive user journey

• New voiceover

Technology development


• Digital interventions: clinically robust, grounded in behavioural science

• Technology: continuous development, informed by feedback and research

• Research and evaluation: systematic, multi‐dimensional

• Implementation: co‐produced, engage all stakeholders

• External validity: accreditation, partnerships with public sector commissioners and/or government agencies

• We need to keep learning about diffusion, normalisation and adoption

• Creating a sustainable commercial model is very challenging

• There are no short cuts!

Key lessons


Email: [email protected] [email protected]

Office: 0161 834 4647

Websites: www.breakingfreeonline.comwww.breakingfreegroup.com

Contact details

Documents

Creating a virtuous cycle of digital health enterprise ... · Overview of evidence‐basedpsychosocial interventions in Breaking Free Online Strategiesin Breaking Free Online Interventions