DOI: 10.3886/icpsr38542
title: Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT), Arkansas, Michigan, and Washington, 2016-2020
title: Archival Version

description: This study addressed whether it is better to expand the scope of collaborative care programs to treat patients with more complex psychiatric disorders or to facilitate successful referrals to specialty mental health care. The primary objective of this study is to compare Telepsychiatry Collaborative Care (TCC) and Telepsychiatry Enhanced Referral (TER) from the patient and provider perspective. The secondary objective is to determine whether patients not engaging and responding to TER, improve with Phone-Psychiatry Enhanced Referral (PER). There are four specific aims. <b>Aim #1:</b> To quantitatively compare the treatment experience, engagement, self-reported clinical outcomes, and recovery-oriented outcomes of patients initially randomized to TCC and TER. <b>Aim #2:</b> For the subset of patients randomized to TER who do not engage in treatment and are still symptomatic at 6 months, quantitatively compare treatment experience, treatment engagement, self-reported clinical outcomes and recovery-oriented outcomes of patients randomized to continued-TER or PER. <b>Aim #3:</b> To gain an in-depth understanding of patients' and providers' treatment experience, qualitatively compare those randomized to TCC, TER and PER. <b>Aim #4:</b> To examine treatment heterogeneity among subgroups of patients randomized to TCC and TER based on race/ethnicity, age and clinical severity.
description: The purpose of this study is to determine whether it is better to expand the scope of collaborative care programs to treat patients with more complex psychiatric disorders or to facilitate successful referrals to specialty mental health care.
description: 24 Community Health Center (CHC) systems located in the states of Arkansas, Michigan and Washington were chosen to participate in the study. These participating clinics screened patients for Posttraumatic Stress Disorder (PTSD) and Bipolar Disorder (BD). Adult patients who screened positive for PTSD and/or BD were enrolled. After the initial screening and recruitment, a two staged randomization was implemented. The Telepsychiatry Enhanced Referral (TER) model is an adaptive intervention and therefore, a Sequential, Multiple Assignment, Randomized Trial (SMART) design was used to compare the two treatment arms. Adaptive interventions are used to customize the treatment for patients whose needs are not being met, defined by a tailoring variable. The tailoring variable in the SPIRIT trial was whether each study participant did or did not engage in TER care as determined by intermediate clinical evaluation. First Stage Randomization: The first stage randomization was conducted at the patient level immediately after being administered the baseline research assessment. Randomization was stratified by Federally Qualified Health Centers (FQHC) (i.e., for each clinic, equal numbers of patients was allocated to Telepsychiatry Collaborative Care (TCC) and TER) to avoid bias due to site-level variation. In addition, the study team stratified by disorder to ensure that equal numbers of patients screening positive for Posttraumatic Stress Disorder PTSD and BD were randomized to each group. Because patients with BD are often at elevated risk for experiencing trauma, many patients with BD also screened positive for PTSD. For patients who screened positive for both PTSD and BD, the study team categorized them as BD for purposes of stratification. Second Stage Randomization: Patients initially randomized to the TER arm were randomized a second time if they were not engaged in TER during the first six months of the trial. Specifically, the tailoring variable (non-engagement) was defined as less than or equal to 2 interactive video encounters in the first 6 months. The number of telepsychiatry and telepsychology encounters as documented by the telepsychiatrist and telepsychologist was used to define the tailoring variable. At six months, those patients not engaged in care were randomized (a second time) to either continued TER or to Phone Enhanced Referral (PER). Randomization was again stratified by clinic and having a positive screen for PTSD or BD. For each participant, three phone/web surveys were completed: an initial baseline survey, a 6-month follow up survey and a 12-month follow up survey.
description: This study includes variables related to general demographics, health related issues, and health conditions and symptoms.
description: Response Rates: There were 1004 initial participants in the baseline survey. For the 6-month follow up survey, 720 participants were retained. For the 12-month follow up survey, 635 were retained.
description: 24 primary care clinics without on-site psychiatrists or psychologists in 3 states (Arkansas, Michigan, and Washington) were included in the sampling process. Adult patients who screened positive for posttraumatic stress disorder and/or bipolar disorder were enrolled. This resulted in a sample of 1,004 participants.
description: Datasets: DS1: Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT), Arkansas, Michigan, and Washington, 2016-2020
description: Adult primary care patients. Smallest Geographic Unit: State
description: computer-assisted telephone interview (CATI); telephone interview; web-based survey