IDDEAS- Individualised Digital Decision Assist System

I. Challenges

Close to one-half of all mental health disorders develop prior to the age of 14. In Norway, 10-20% of the child and adolescent population have impairing mental health disorders. While many of these illnesses are single episodes that resolve, they can become chronic, or even lifelong conditions. Early evaluations, diagnosis, and treatment are critical to shortening single episodes of care, reducing possible comorbidity and long-term disability. As children and adolescents are particularly vulnerable, they, along with their families, require specialized early intervention and preventive services. However, there is a high demand for care placed on a limited number of specialists. While Norway ensures a waiting period guarantee of no more than 65 days, increased support for specialists through continuous expansion and empowerment of the available workforce, including allied professionals, is essential to meet the demand.

The project is run by RKBU Central-Norway

Approximately 29% of child and adolescent mental diagnoses in Norway are Attention Deficit Hyperactivity Disorder (ADHD). It is a common disorder with high levels of comorbidity and nearly 2/3 of affected individuals have symptoms that persist into adulthood. Without proper treatment, ADHD leads to dramatic social and medical disabilities that greatly impact the individual, family, and community.

Proper professional training, additional posts, and new services can help avoid long delays in receiving specialized child and adolescent mental health care. Implementing digital health interventions (DHIs) can help to find innovative and sustainable ways to support and expand services. While DHIs are integrated within other areas of medicine, child and adolescent mental health has not yet fully benefitted from these technological advances. The addition of DHIs within the child and adolescent mental health care system is crucial to address the needs of youth affected by mental disorders in Norway. The famous Chilean poet and Nobel Laureate, Gabriela Mistral (1889-1957), once said:

“We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need, can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer ‘Tomorrow.’ His name is today.”

II. Digital Child and Adolescent Mental Health   

While still in development, digital child and adolescent mental health is an innovative and potentially sustainable approach to care. DHIs can enhance care services, improve cost efficiency, and expand the understanding of mental illness in childhood and adolescence. Current DHIs range from, remote therapeutic services held on-line, to clinical decision support systems (CDSS). CDSS are advanced DHIs, designed to enhance care by providing clinicians with step-by-step guidance for evaluation, diagnosis, and treatment. The support provided is based on evidence-based, standardized guidelines, big-data sets, and data from aggregated EHR systems. While the vulnerability of the patient population and stigmatization continue to pose challenges to digital child and adolescent mental health progression, today’s DHIs provide new and secure opportunities to address these challenges.

III. IDDEAS

The Individualised Digital DEcision Assist System (IDDEAS) is a new CDSS for child and adolescent mental health services in Norway. The CDSS focuses on preventive care, early diagnostics and early intervention, as well as treatment and case management for ADHD. This project uses the latest clinical guidelines and Norwegian health datasets along with data aggregated from EHRs to present clinicians with evidence-based support in real-time. The secure user-interface de-identifies all data from the large datasets, matches available data to the needs of a particular patient and provides service-users with optimal evidence based care. IDDEAS is designed to improve individual clinical outcomes, system level quality of care, efficiency of services, and reduce costs of care.

The IDDEAS team collaborates with service-user organizations, including the National Association of Families of Children with Mental Health Problems (LPP), ADHD Norway, and the Regional service user-led centers (Bikuben and Vårres). The IDDEAS consortium is also a multidisciplinary team, including developers, researchers, health informatics specialists, and clinicians. They represent the Regional center for child and youth mental health and child welfare (RKBU) in Middle Norway, the Norwegian University of Science and Technology (NTNU) and RKBU in Northern Norway, UiT the Arctic University of Norway (UiT), the Norwegian Association for Child and Adolescent Mental Health (N-BUP), Department of Computer Science, NTNU, the Middle Norway Regional Health Authority (HEMIT), VIVIT AS, Department of Norwegian Patient Register, Health Directorate (NPR), and international partners (USA, Germany).

IDDEAS CDSS is important in that it provides evidence-based support for practitioners in Norway in order to enhance the specialized child and adolescent mental health care available. The CDSS can reduce personal and societal costs by eliminating unnecessary testing, allowing for timely access to appropriate interventions, ultimately help prevent long-term adverse outcomes. The project is developed from a service-user perspective to provide a potential model for future CDSS implementation and can serve as an important learning opportunity for the field and the healthcare system.

Projectmembers

• RKBU Midt NTNU
• RKBU Nord, UiT
• Department of Computer Science, NTNU
• N-BUP, Landsforeningen for Pårørende innen psykisk helse (LPP)
• ADHD Norge
• Bikuben – regionalt brukerstyrt senter Nord-Norge
• Vårres regionalt brukerstyrt senter, Midt Norge; Helse Midt-Norge IT
• VIVIT AS Norge; University of California San Francisco, USA
• North Rhine-Westphalia Technical University of Aachen, Germany

Link to the description in the Project Bank of The Research Council of Norway (RCN).