Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation

Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case-study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services.