At the national, state, and local levels, cornerstones of modern behavioral healthcare systems include consumer and family empowerment and a focus on recovery. These tenants are in the report of the President's New Freedom Commission on Mental Health, and one needs only to review the table of contents of a few professional journals to recognize the significance of these guiding principles.
An important component of empowerment in all areas of life is access to valid and practical information. Whether learning about investing in real estate or becoming a better gardener, information about what to do, how to do it, and what to do if things don't work is key to success. The more information an individual has access to, the more empowered that person will be to achieve his/her goals.
The need for accessible, valid, practical information is just as relevant for consumers of behavioral healthcare services as it is for those interested in real estate or gardening. The more information individuals and families have concerning illnesses, recovery, housing, entitlements, legal issues, etc., the better informed they will be, the more likely they will actively participate in the recovery process, and the greater the likelihood they will experience positive outcomes.
Lack of Interactive Material
Providing information to healthcare consumers is not a new concept. Although behavioral healthcare increasingly focuses on consumer empowerment and recovery, the tools that the primary healthcare system uses to educate and empower consumers are, in many ways, well ahead of those employed in the behavioral healthcare system.
In decades past healthcare information most often was disseminated via print materials, but the Internet (and “Dr. Google”) has become a prime source of healthcare information. According to the Pew Internet and American Life Project, upward of 80% of Internet users go online to obtain healthcare and treatment information either for themselves or someone they know.
While surfing the Internet is a popular approach to obtaining healthcare information, it does not necessarily provide credible, accurate, or even useful information, and some people have trouble identifying credible sources. To combat possible disinformation, healthcare providers began building their own libraries of information. Some even have developed colorful, interactive Web-based presentations with audio narration. Research indicates that multimedia approaches to learning can be more effective than print materials alone in promoting consumer understanding.1
An example of a Web-based audiovisual (AV) library is the MedlinePlus library (http://www.nlm.nih.gov/medlineplus/tutor ial.html) of more than 170 interactive healthcare tutorials (a small subset of the nearly 600 available for a fee from the Patient Education Institute). Yet among the MedlinePlus tutorials, ranging from Abdominal Aortic Aneurysm to Warts, only one addresses behavioral health: Depression. While four presentations address various aspects of diabetes, none addresses common mental health problems such as childhood ADHD, schizophrenia, or tardive dyskinesia. The MedlinePlus library includes a presentation concerning leishmaniasis, a relatively uncommon infectious disease spread by the bites of infected sand flies, but does not include presentations addressing bipolar disorder, the mental health recovery movement, or employment issues faced by individuals with a mental illness.
The absence of behavioral healthcare topics in AV libraries motivated the Community Partnership of Southern Arizona (CPSA) to begin building in 2006 its own AV library dedicated to behavioral health topics. (CPSA is the regional behavioral health authority for funding and oversight of publicly funded behavioral health treatment services in Southern Arizona.) Our goal is to provide our members and families with practical, understandable, and applicable information in an interesting and enjoyable format.
Designing the AV Tool
In designing the AV tool we established five criteria that had to be met:
Presentations had to contain accurate, high-quality content.
The AV tool had to be easy to operate.
Graphics had to support and enhance presentations.
Narration had to be provided by content experts as opposed to professional narrators.
The AV tool and presentations had to be available in English and Spanish.
In addition to meeting these criteria, we wanted to integrate the AV library into our system of care. Toward that end, we have developed presentations pertaining to our system of care and specific to our provider network, and we are working with clinical staff to explore approaches that will enhance members' and families' access to the library. For example, we are working with our consumer-run programs and provider networks to offer computer access and assistance to members.
Each AV presentation consists of between 15 and 40 slides. Each slide contains the narrated text in a brief, easy-to-read format with colorful graphics, which are either metaphors for the content or a caricature of the narrator. The presentations are self-paced, and users can adjust the volume or turn off the narration. The user moves through the presentation using buttons that resemble those on a tape recorder. The figure is 1 of 25 slides in the presentation Being the Expert on Yourself. The graphic is a caricature of Dr. Mary Ellen Copeland, sitting on a comfortable chair as if she were having a relaxed conversation with the consumer or family member.