One Montana is committed to helping deliver behavior health services in rural communities across the state.
Mental and behavioral health is one of the most pressing issues facing Montanans, particularly in rural communities. One Montana has been working for three and a half years with Montana State University’s Center for Mental Health Research & Recovery (CMHRR) and MSU Extension to develop and implement Cognitive Behavior Therapy (CBT) programs for adults and teens with anxiety and depression symptoms.
Thrive for Montana
One Montana has played a lead role in helping Extension and the CMHRR to implement much of the Youth Aware of Mental Health (YAM)’s suicide prevention programs in over 20 rural high schools. Simultaneously, One Montana is working with the CMHRR in the modification and implementation of Thrive, a video-centric iCBT program for adults with depression symptoms. Due to numerous requests from Montana residents, we (One Montana, CMHRR, and Extension) are now seeking funding to develop and test a “Thrive for Adolescents” program. Current plans are to first conduct a pilot evaluation to later be followed up with a larger randomized control trial in 2020. All of this work through the CMHRR, with One Montana’s assistance, has Montana at the forefront in the rural West regarding the development and implementation of evidence-based programs for behavioral health and suicide prevention in both youth and adult populations.
One Montana was invited to help lead this effort because of our experience bringing diverse interests together and successfully addressing challenging issues. As a non-traditional partner we assist with the outreach, coordination and communication efforts necessary to move these three efforts forward.
With increased Internet accessibility, internet-based Cognitive Behavior Therapy (iCBT) programs have emerged as viable, cost effective approaches to effective care for depression, anxiety, and substance abuse, all of which are primary risk factors for suicide. Thrive for Montana, a sophisticated iCBT program, using a video-centric platform intended to enhance engagement, has been shown to significantly reduce depression and anxiety symptoms among adult Montanans. Thrive distills best practices from CBT and delivers them through a rich, structured and guided curriculum. Thrive emulates CBT through the use of didactic video segments, interactive tools, and sophisticated algorithms that dynamically adjust the individual’s course through the program. Thrive uses approximately 300 videos, averaging eighty seconds in length, to deliver content. Videos explain CBT concepts, demonstrate skills, provide feedback and recommendations, and portray actual case histories of individuals who used CBT to combat depression. An individual’s path through Thrive is guided by more than 100 algorithms that evaluate the individual’s profile to determine which instruction, feedback, or assignment to deliver next. As the individual progresses through Thrive, algorithms make increasingly specific recommendations.
Thrive also provides safeguards and guidance if the program is not working effectively. For example, if the user indicates no improvement, a scripted message will inform them to consider switching modules or to get personalized help outside the program. If the user indicates having thoughts of suicide, the program automatically asks whether the user can keep her- or him-self safe and to seek immediate help if they cannot.
Thrive is currently being studied in two randomized controlled trials, the results of which are pending publication. To date, both trials show that Thrive significantly reduces depression and anxiety symptoms and improves resilience.
THRIVE FOR ADOLESCENTS: One Montana is currently fundraising to help develop a Thrive program for Adolescents aged 11 – 18 years old. First, new video segments featuring adolescent actors and age-appropriate examples, scenarios, and feedback will be developed. The new video would replace existing Thrive video featuring content that is more relevant to an older audience. Selection of videos to be replaced and creative aspects of new video would be informed in part by focus groups. In addition, we will develop new video, interactive elements, and algorithms to address substance use and abuse. Any program enhancements targeting substance use disorder would be developed and presented in the context of co-occurring depression and anxiety. The type of program enhancements and the specifics of the videos will be informed with consultation from selected content-expert clinicians with experience treating co-occurring depression and substance abuse disorders in adolescents.
If fundraising is successful, we will execute program development and launch a trial program in Park and Gallatin counties by May 2020. A larger trial program would be implemented between September 2020 and August 2021 in selected Montana schools.
YOUTH AWARE OF MENTAL HEALTH: Youth Aware of Mental Health (YAM) is a universal intervention (delivered to all youth of a group/class) mental health promotion program that aims to raise mental health awareness about risk and protective factors associated with suicide, including knowledge about depression and anxiety, and to enhance the skills and emotional resiliency needed to deal with stress and crisis. The format of the YAM intervention empowers youth to think, verbalize, and discuss important mental health issues, such as suicide, in a context that is meaningful to them.