For years, and especially since 2020, increasing numbers of headlines warn about the burgeoning mental health crisis in the US, particularly for adolescents. And at the same time, the shortage of mental health care providers is only expected to grow, according to a report by the National Center for Health Workforce Analysis. Indeed, more than one-third of Americans live in counties identified as mental health professional shortage areas—this is especially true of rural counties.
The providers who do exist, then, are coping with ever-growing caseloads while trying to maintain a standard of care. But in the face of such challenges, mental health care providers are turning to technological solutions to reduce time spent on administrative tasks so as to concentrate more of their time on working with clients.
A Training Ground for Students and App Alike
To do just that, the licensed psychologists and clinical psychology doctoral students in the UO Psychology Clinic use Vira, a health care app created by Ksana Health. It’s a partnership that goes beyond its utility in providing better care to those who use the clinic’s services; it’s also a success story about the next generation of mental health care providers learning from the very beginning of their careers to deploy next-generation technology to improve their practice.
The UO Psychology Clinic is open to the community, with clients coming from Eugene, Springfield, Albany, and Salem. It operates on a low fee, sliding scale with the ethos that there should never be a financial barrier to receiving mental health care.
“We do evidence-based treatment, which means that all treatment services we provide have been shown by scientific research to be effective,” said Ruth Ellingsen, associate clinical professor and clinic director. “Our treatments also tend to be time-limited; clients learn skills to take into daily lives and ultimately they don’t need us anymore because they experience symptom relief and better quality of life moving forward.”
The clinic is home to 12 trainees who each have a caseload of three to four clients in addition to the research they are doing for the doctoral program. Through the Vira app, the psychologists-in-training can provide clients with regular self-reporting questionnaires that track symptoms or functioning ahead of in-person therapy sessions, which saves time and enables the clinicians to be better prepared coming into each session. Though Vira comes pre-loaded with strategies, it also allows clinicians to customize what clients receive. They can also send clients nudges throughout the week to remind them to practice throughout the week the skills they learn in therapy.
"Practicing these skills helps the patients challenge negative thought patterns and build positive habits,” Ellingsen said.Kate Kwasneski, a clinical psychology doctoral student, said that Vira has aided her in encouraging her clients to keep up with the skills they were practicing between sessions.“
In every session, we set customized reminders for the things that were most helpful to them, like starting a bedtime routine at a certain time or tracking what emotions came up throughout the day,” she said. “I noticed that clients who used it more made much faster gains between sessions. It was also great to be able to set a reminder to breathe to go out right before a big event in a client’s week, giving them that little bit of extra support in stressful moments.”
A Laboratory for New Treatment Practices
Kwasneski’s experience is exactly what Ksana Health intended when it developed Vira. Company founder Nick Allen, Ann Swindells Professor of Clinical Psychology at the UO and director of the Center for Digital Mental Health, envisioned digitally augmenting existing practices to help clinicians improve the care they provide while minimizing the time they need to spend on administrative tasks.
“Behavioral health is an area that is ripe for digital enhancement,” Allen said. “Tools like Vira work better for patients and give clinicians time back to do what they want to do, which is not scoring a questionnaire, but helping people.”
Allen acknowledged that innovation in health care is often slow because it is a highly regulated industry. But despite barriers, integrating digital applications that meet HIPAA requirements (federally mandated patient privacy protections) into therapy is the obvious next step.
“Our clinic, and other university-based clinics we’ve worked with, are training the clinicians of future, who are also people engaged in research,” he said. “New psychologists coming up are very comfortable with digital tools. Our system is not only purpose-built for the therapy context, it’s also designed to bring the clinician and the client together so they can be supported in a more ongoing way between appointments.”
Allen’s interest in developing digital tools for behavioral health builds on the research he has done on sleep amount and quality and their relationship to mental health using wearable tracking devices that provide incredibly detailed, continuous data that illuminate patterns.
“A clinician asking, ‘How was your sleep?’ and receiving a response like ‘It was OK’ is much less rich than hours of data provided by the sensors on smart watches,” he said. “When you measure patient outcomes with data, it’s better for patients. Clinicians can pivot their approaches to practice based on data, not guesses. Vira brings those capabilities in a practical way that fits into practitioners’ workflows.”
Ksana Health has partnered with numerous academic medical centers, including Columbia University, New York-Presbyterian, University of Pittsburgh Medical Center, Northwestern University’s Rush University Medical Center, Children’s Wisconsin in Milwaukee, and Brown University Health, to employ digital tools in treating a variety of patients including those at acute risk for suicide, with opioid addiction, or participating in outpatient psychiatry.
“Training clinics, like the UO’s and others, are really important drivers of innovation,” Allen said. “One way to drive innovation is not only to demonstrate these new tools, but also that the trainees become force multipliers in the world after training. People go through medical training and work in teaching hospital, where they have access to something like Vira, and then after their schooling they end up somewhere where that tool isn’t available. They advocate and push for systems to improve.
“Seeding innovation during training has multiplicative effect. These up-and-coming clinicians can help the rest of the health care system see the advantage of these tools.”