A Novel Blended Transdiagnostic Intervention for Youth Psychosis and Borderline Personality Disorder: the eOrygen Pilot Study (Preprint)

Abstract

Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings associated with both face-to-face and online mental health services. However, despite young people’s preferences and calls for integration of these services, current mental health services rarely offer blended models of care.

This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for young people with youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes on key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice.

Thirty-three young people (15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Australia: (1) the EPPIC clinic, an early intervention service for first-episode psychosis and; (2) the HYPE clinic, an early intervention service for borderline personality disorder in young people. The feasibility, acceptability and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measured t-tests assessed changes on clinical and psychosocial outcomes between pre- and post-intervention (3 months). Interviews with 8 young people and 15 clinicians were also conducted post-intervention.

eOrygen was found to be feasible, acceptable and safe. Feasibility was established due to a low refusal rate of 25% and by exceeding our target of young people recruited to the study per clinician, despite challenges with clinician recruitment. Acceptability was established, as 92% (28/30) of young people recommended eOrygen to others, and safety was established as no adverse events or unlawful entries were recorded. In terms of potential clinical effects, significant improvements were observed on 9 out of 12 clinical and psychosocial outcomes between pre- to post-intervention, with Cohen d effect sizes ranging from 0.56-0.89. Most young people reported using eOrygen in a blended way, describing using it both within sessions and between sessions with their clinician, but some young people shared concerns at the prospect of their clinician viewing their activity on the platform. Clinicians reported that eOrygen complemented their work and acted as a facilitator of engagement and communication within sessions with young people. Familiarity with the platform was seen as necessary for successful integration, but this was perceived by clinicians as time-consuming.

eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, intensity and, ultimately, effectiveness. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimise the implementation such models into specialised services.