title: Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework.
abstract: BACKGROUND
  Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups.
  
  
  OBJECTIVE
  The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities.
  
  
  METHODS
  Information about service providers' use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors' experience of training primary care service providers.
  
  
  RESULTS
  Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers.
  
  
  CONCLUSIONS
  The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation.
authors.affiliation: National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia.
authors.forename: Julia
authors.identifier: 0000-0001-9910-0455
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia.
authors.forename: Kathleen M
authors.identifier: 0000-0003-1556-0708
authors.initials: KM
authors.lastname: Griffiths
authors.affiliation: National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia ; Centre for Addiction and Mental Health Toronto, ON Canada.
authors.forename: John A
authors.identifier: 0000-0002-0668-5982
authors.initials: JA
authors.lastname: Cunningham
authors.affiliation: National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia.
authors.forename: Kylie
authors.identifier: 0000-0003-4160-492X
authors.initials: K
authors.lastname: Bennett
authors.affiliation: National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia.
authors.forename: Anthony
authors.identifier: 0000-0002-0399-4798
authors.initials: A
authors.lastname: Bennett
keywords: Internet; case management; health care technology; health promotion; primary health care; professional practice; psychotherapy; translational medical research; treatment of mental disorders