Videokonsultasjoner i psykisk helsevern ved Finnmarkssykehuset BUPA og UNN BUPA - Brukere og pårørendes erfaringer når videokonsultasjoner overtar for fysiske møter i psykisk helsevern.

The objective of this project was to provide knowledge about adolescent’s and family carers experiences with the use of Video Consultations (VC), and how the experience was compared to face-to-face meetings with therapist. The project aimed to enhance understanding of the implementation, organisation, interaction, and utilisation of VC, with the goal of delivering effective and secure mental health services at UNN and Finnmarkssykehuset BUPA. The primary focus of this initiative is to delve into the experiences of adolescence and their family carers. The research endeavored to cultivate in-depth insights into which young people experienced the use of VC, identifying suitable circumstances for its use, and recognizing situations where VC meetings are not advisable. The investigation explored the dynamics of interaction among the various parties involved in the research and treatment processes, and how these interactions were perceived. The empirical base for the study is in-depth interviews with adolescents with experiences in using VC in therapy. In addition, a questionnaire was developed and sent to earlier user of services. Individual interviews were conducted with 33 adolescents and 14 family-carers both in Finnmark and Troms. The interviews were performed by phone during the period from August 2021 to April 2022. Themes covered in the interview guide included: - Why the adolescents were in contact with a hospital unit and why they used VC - Learning and using the technology - VC sessions with mental health therapists - Cooperation meetings with other additional actors, relations and communications. In the quantitative part of the study a questionnaire with 33 questions about use of VC, technology, location, distance to BUPA, experiences with communicating on screen. This questionnaire was developed together with the competence group. Main findings (Lauvhaug et.al 2023): The results reveal that the use of VC is a complex matter, and that adolescents are a heterogeneous group with different preferences and needs. The following six themes emerged during the analysis: 1) Therapy on the screen contains the difference between therapy and communication on screen versus in a physical setting. This includes difficulty and inhibition to talk about inner thoughts, not able to fully observe body language or to have eye contact. 2) “Not for real” – The screen is based on the perception of adolescents of VC as “unreal” and “less personal”. They experienced that the screen removed something from the relation. 3) The screen as a “looking glass” describes the adolescents experiences with seeing their own image on the screen, and how this affected them during VC (distracting, challenging, triggering, etc.) The effect of your own image on the screen can be considered as the looking glass effect. 4) Emotions on the screen stems from several adolescents who told that it was difficult to show emotions on screen. They did not receive the necessary emotional support and closeness. One of the consequences was that they did not talk about difficult topics. Several of those reasons are highly intertwined with already presented themes. However, some talked more about difficult topics in a less personal medium. 5) Therapy in a physical setting is about the meaning of place, or lack thereof. Informants had experienced VC at home and/or at school. Their experiences differentiated based on surroundings at each location, for example fear that people would overhear versus feeling safe that no one would listen in. 6) Tools for therapy are about tools that are being used in a physical setting, for example a white board, which some of the informants missed during VC. Either because it could not be used, or because it was not optimal during VC. Information about the project is published on the following site: https://ehealthresearch.no/en/news/2022/videokonsultasjoner-i-psykisk-helsevern-et-samarbeid-mellom-forskere-parorende-og-brukere VC have the potential to increase the availability and flexibility of mental health services for adolescents and their caregivers, including communication between adolescents and service providers. Use of digital tools in therapy should be a topic to discuss early during treatment including the adolescent to assess the situation and the context. One of the most important issues might be to re-organise the services and develop and implement a model of blended and person-centred care. There is a need for further investigation on use of VCs, including qualitative and quantitative research, to build solid, evidence-based knowledge that can contribute to providing mental health care at a distance. Further research should focus on user experiences, organisational change, co-creation between stakeholders, and implementing VCs to offer safe and accessible services. The project is discussed both with clinical personell and researcher in UNN and Finnmarkssykehuset throughout the process. 04.12.2023 we arranged a closing work-shop together with BUP, UNN. The agenda was to present the finding and to discuss further implementation, also other opportunities for collaboration for developing evidencebasad knowledge. As an example principles for video consultations was developed in the project. This based on suggestions from the competence group. together with the youth are presented in the links below. These principles has been presented for the clinicians in BUP both at UNN and Finnmarkssykehuset. The principles are available at ehealthresearch.no: 1: Teknologien - https://ehealthresearch.no/en/videos/teknologien 2: Trygge lokaler - https://ehealthresearch.no/en/videos/trygge-lokaler 3: Informasjon og medvirkning - https://ehealthresearch.no/en/videos/trygge-lokaler 4: Når flere er involvert i møtet - https://ehealthresearch.no/en/videos/nar-flere-er-involvert-i-motet 5: Samtale og kommunikasjon - https://ehealthresearch.no/en/videos/samtale-og-kommunikasjon Presentations in conferences: 2021: Use of video consultation in specialised mental health services: a qualitative study of therapists' experiences of video consultations during the period of Covid-19 restrictions. HTAI, Manchester (Digital event). 23. juni 2021. Health Technology Assessment Annual conference Presented at EHiN 2021. 2022: - How to understand adolescences experiences of treatment in the context of video consultations with therapists – change of practice. NEON-dagene 2022. Drammen. 22. - 24. November 2022. - Barn og unges erfaringer med videokonsultasjoner i psykisk helsevern. Oslo. 8. - 9. november 2022. Ehelse i Norge (EHiN) - Digitalisation in specialised mental health services. Adolescents experiences with Video consultations. 10.-12.8 2022. Island, University of Reykjavik. Nordic Sociological Association Conference. 2023 - Adolescents Experiences with Video Consultations in Specialised Mental Health Services in Norway. Venice 24.-28.4.2023. The Fifteenth International Conference on eHealth, Telemedicine, and Social Medicine. eTELEMED 2023 - Hvordan påvirker digitalisering sosial ulikhet blant unge, og kan digitalisering bidra til økt likeverdighet? Abstract presentation. UiT, Tromsø. 24.august 2023. Social inequity and social justice conference. - Presented at EHiN 2023. Prosjektet er også presentert flere ganger ved masterutdanningen: Digitalisering og innovasjon i helse og velferdstjenester. Prosjektleder er emneansvarlig på dette kurset med 40-50 studenter på hvert kull.