title: Coordinated Technology-Delivered Treatment to Prevent Rehospitalization in Schizophrenia: A Novel Model of Care.
abstract: Despite advances in schizophrenia treatment, symptom relapses and rehospitalizations impede recovery for many people and are a principal driver of the high cost of care. Technology-delivered or technology-enhanced treatment may be a cost-effective way to provide flexible, personalized evidence-based treatments directly to people in their homes and communities. However, evidence for the safety, acceptability, and efficacy of such interventions is only now being established. The authors of this Open Forum describe a novel, technology-based approach to prevent relapse after a hospitalization for psychosis, the Health Technology Program (HTP), which they developed. HTP provides in-person relapse prevention planning that directs use of tailored, technology-based treatment based on cognitive-behavioral therapy for psychosis, family psychoeducation for schizophrenia, and prescriber decision support through a Web-based program that solicits information from clients at every visit. Technology-based treatments are delivered through smartphones and computers.
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Brunette
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Rotondi
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Dror
authors.initials: D
authors.lastname: Ben-Zeev
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Gottlieb
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Delbert G
authors.initials: DG
authors.lastname: Robinson
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Achtyes
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Susan
authors.initials: S
authors.lastname: Gingerich
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marcy
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Schooler
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: Piper
authors.initials: P
authors.lastname: Meyer-Kalos
authors.affiliation: Dr. Brunette and Dr. Ben-Zeev are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (e-mail: mary.f.brunette@dartmouth.edu ). They are also with the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Dr. Rotondi is with the Clinical and Translational Sciences Institute, Department of Critical Care Medicine, University of Pittsburgh, and with the Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation and with the Department of Occupational Therapy, Boston University. Dr. Robinson and Dr. Kane are with the Feinstein Institute for Medical Research, Manhasset, New York, and with the Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York. Dr. Achtyes is with Cherry Street and the Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania. Ms. Marcy is with Northwell Health, Great Neck, New York, and Vanguard Research Group, Glen Oaks, New York. Dr. Schooler is with the Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, and with the Zucker Hillside Hospital, Glen Oaks, New York. Dr. Meyer-Kalos is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul.
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005196:Family Therapy / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods*; D010359:Patient Readmission; D011618:Psychotic Disorders / Q000517:prevention & control / Q000628:therapy*; D012559:Schizophrenia / Q000517:prevention & control / Q000628:therapy*; D055502:Secondary Prevention / Q000379:methods*; D017216:Telemedicine / Q000379:methods*