Smart Technologies for Apartments

Background and Importance

The Smart Technologies for Apartments Project will establish and evaluate the use of a smart homes concept to assist people with mood and psychotic disorders. It is well known that housing instability is associated with mental illness, but adequate housing alone is not enough to support mental well-being. Individuals with mental illness experiencing cognitive and functional impairment may require additional support to maintain housing and address their unique mental health needs. These impairments may result issues such as missed medications and forgotten appointments with health care providers (HCPs). This study will evaluate the use of smart technologies within transitional apartments at two psychiatric inpatient facilities. These technologies will assist with self-assessment of symptoms, appointment and medication reminders, as well as increase communication with HCPs. Examples of the types of technologies that will be used in this study include smartphones, tablets, smart TVs and touch-screen monitors, and USB/wireless-enabled health monitoring devices (where appropriate) such as blood pressure monitors, wearable heart rate activity trackers, glucometers and weigh scales. These health monitoring devices account for comorbidities that may be present and will support chronic illness management. Clients will be offered the opportunity to choose which devices they want/need and can add or change devices during their time in the apartment.

The overall aim of the study is to create a smart technology solution that could lead to a more effective and affordable health care system for those with mental illness. This study will harness significant collaboration with technology design experts, mental health clinicians, and clients. Evaluation of these new technologies will provide further insight into how to adequately assist individuals with mental health concerns. Upon completion of this pilot study, it is envisaged that this study will provide information to enhance the intervention before wide scale adoption of the technology in the community.

Methods

Two hospital apartments at Parkwood Hospital (London, ON) and the Southwest Centre for Forensic Mental Health Care (St. Thomas, ON) will be used to further develop and test these technologies as well as provide support and teaching. Up to 20 participants (aged 18-85) who are inpatients at these two psychiatric facilities and meet inclusion criteria will be eligible to participate. Clients must also be able to understand, read, and speak English to the degree necessary to consent to participation, read information on the electronic devices, and complete interviews. Upon consenting to participate in the study, the client will be provided training on the devices they have selected. For HCPs to participate, they must be a team member on a program referring patients to the apartments. Upon a one week minimum stay in the apartment, participants will complete a semi-structured interview with research staff. This will be followed up with a 6-month interview post-discharge. In addition, focus groups with HCPs will be held to further ascertain the usefulness of the technologies as well as the impact on HCPs and how the intervention influenced their practice.

Outcomes

The primary quantitative outcome for this study will be the total score from the Community Integration Questionnaire, which measures an individual’s level of integration into the home and community. Quantitative analysis will also assess previous housing history (Housing History Survey), self-reported health status (EQ-5D, and Short Form-36), and use of health, social, and justice services (Health, Social, and Justice Service Utilization tool). Effectiveness, economic, ethical, and policy analyses will be used to evaluate the study.

Technologies

Using their smartphone, tablet, touch-screen monitor or smart TV, clients will be able to access the Collaborative Health Record (CHR), an online electronic medical record that allows for both synchronous and asynchronous communication between clients and HCPs. Clients will be able to conduct video-conferences (Virtual Visits), send instant messages, and send self-completed questionnaires (Qnaires) and mood monitors to their HCPS through the CHR. Likewise, HCPs will be able to send questionnaires, schedule virtual visits, and monitor client progress on their Qnaires.

Data from the CHR and health monitoring devices will be exported and backed-up to the Lawson Integrated DataBase (LIDB). The LIDB is an information management platform that collates and manages client health information collected from multiple community agencies and HCPs. The LIDB is currently based on Lawson Health Research Institute's informatics platform, behind the St. Joseph’s Health Care hospital firewall. HCPs will be able to log-in to the LIDB through a secure portal and will be able to see all the data in one place; allowing for ease of access to all the collected data as well as greater monitoring of the client’s physical and mental health.

In addition, the LIDB can be programmed to transmit prompts and reminders (e.g. take medication at n 8am) that coincide with the client’s care plan directly to the client via SMS text messaging.

Future Directions

At present, Smart Technology is not included in the Assistive Devices Program in Ontario. We hope this study and the subsequent Community Phase will be able to revise that so that individuals in the community will receive the support they need at little cost to them.

Furthermore, this study could enable mental health care strategies and inform health policy & decision makers to adopt more smart technologies into mental health care and/or treatment plans.

Additional funding has been sought to establish “smart apartments” throughout London as part of the Community-Prototype and Community Phases.

Future studies will aim to implement the intervention in 128 community homes.

Funder

Partners

  • InputHealth Systems Inc. (Vancouver, BC)
  • City of London (Ontario)
  • Thunder Bay Regional Health Sciences Center (Thunder Bay, ON)
  • Institute for Clinical Evaluative Sciences – Toronto
  • Canadian Mental Health Association (London Branch)
  • St. Joseph’s Health Care London – Parkwood Institute
  • London and Middlesex Housing Corporation
  • St. Michael’s Hospital (Toronto)
  • Richard Ivey School of Business (London, Ontario)
  • Universite de Sherbrooke (Quebec)

Contributors

  • Cheryl Forchuk
  • Jan Richardson
  • Jodi Younger
  • Bessam Abdulrazak
  • Richard Booth
  • Deb Corring
  • Lorie Donelle
  • Amit Garg
  • Jeff Hoch
  • Wanrudee Isaranuwatchai
  • Dan Lizotte
  • Naghmeh Mokhber
  • Sujata Ojha
  • Jeffrey Reiss
  • Abraham Rudnick
  • Puneet Seth
  • Xianbin Wang
  • Dariusz Gozdzik
  • Rupinder Mann

Principal Investigator

Cheryl Forchuk, RN, PhD

The Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, Parkwood Institute Research;
Distinguished University Professor, Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University;
Assistant Director and Scientist, Lawson Health Research Institute

Mental Health Nursing Research Alliance
Lawson Health Research Institute
Parkwood Institute – Main Building
550 Wellington Road, B3-110C
P.O. Box 5777, STN B
N6A 4V2

Tel: (519) 685-8500, ext. 77034
Email: cforchuk@uwo.ca

Research Coordinator

Jonathan Serrato, MSc

Mental Health Nursing Research Alliance
Lawson Health Research Institute
Parkwood Institute – Main Building
550 Wellington Road, B3-110
P.O. Box 5777, STN B
N6A 4V2

Tel: (519) 685-8500, ext. 75802
Email: jonathan.serrato@lhsc.on.ca