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Center for Substance Abuse Treatment (US). Using Technology-Based Therapeutic Tools in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2015. (Treatment Improvement Protocol (TIP) Series, No. 60.)

Cover of Using Technology-Based Therapeutic Tools in Behavioral Health Services

Using Technology-Based Therapeutic Tools in Behavioral Health Services.

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How This TIP Is Organized

This Treatment Improvement Protocol (TIP) is divided into three main parts:

  • Part 1: A Practical Guide for the Provision of Behavioral Health Services
  • Part 2: An Implementation Guide for Behavioral Health Program Administrators
  • Part 3: A Review of the Literature

Part 1 consists of two chapters and introduces behavioral health service providers to various technology-based treatment and prevention tools and interventions. It also explains how those technologies are applicable to various behavioral health services and settings. Part 1, Chapter 1, introduces principles to guide technology-assisted care (TAC) in the behavioral health arena. This section addresses:

  • The potential benefits and drawbacks of incorporating technology into treatment and prevention, particularly for clients with unique service needs, as both stand-alone methods and as adjuncts to face-to-face services.
  • Specific technologies with applicability to behavioral health, including emerging technologies and their potential applications in the context of behavioral health services.
  • Ways to integrate technology into existing services.
  • Issues of ethics and legality as well as cultural competence.
  • Electronic health records.

Part 1, Chapter 2 consists of vignettes that demonstrate the application of TAC in behavioral health services. Designed for maximum latitude of use by supervisors and front-line professionals, the guidelines for TAC appear in the form of master clinician notes, how-to notes, and other teaching tools that demonstrate how a given technology can be applied clinically, how to identify potential pitfalls, and how to manage problems that might arise.

Part 2 of the TIP consists of two chapters and serves as an implementation guide for behavioral health program administrators and clinicians who wish to develop or expand the use of TAC by their programs. It covers:

  • Programmatic considerations for the adoption and sustainability of TAC, including approaches administrators can use to involve staff members in the planning and implementation process.
  • Technological capacity and budgeting considerations for technology-based treatment and prevention efforts.
  • Methods for selecting technology-related vendors and consultants.
  • Data management issues involved in TAC.
  • Privacy, confidentiality, and regulatory concerns, including the establishment of relevant policies and procedures for ensuring confidentiality, managing client crises, and deciding when and how to apply electronic media in client care.
  • TAC-related management of clinical supervision of counselors, TAC-related training and staff development, and the need for personnel trained in specific technologies and methods.
  • Specific practical examples of how TAC has been incorporated into existing programs.

Part 3 of the TIP includes an analysis of the available literature on technology-based assessment and interventions targeting behavioral health, including journal articles, books, pamphlets, and electronic resources; links to select abstracts of the most cogent literature on the topic; and a comprehensive general bibliography of the relevant literature. The literature review is only available online at the Substance Abuse and Mental Health Services Administration (SAMHSA) Store (http://store.samhsa.gov).


The following terms are broad in scope and denote concepts frequently referenced throughout the TIP. Detailed definitions of terms describing specific types of technology appear throughout Part 1, Chapter 1, and are summarized in Exhibit 2.2-1.

Behavioral health. Throughout the TIP, the term “behavioral health” appears. Behavioral health refers to a state of mental/emotional being and/or choices and actions that affect wellness. Behavioral health problems include substance use disorders, serious psychological distress, suicidality, and mental illness. This includes a range of problems from unhealthy stress to diagnosable and treatable diseases like serious mental illness and substance use disorders, which are often chronic in nature but from which people can and do recover. The term is also used in this TIP to describe the service systems encompassing the promotion of emotional health, the prevention of mental and substance use disorders, substance use and related problems, treatments and services for mental and substance use disorders, and recovery support. Because behavioral health conditions, taken together, are the leading causes of disability burden in North America, efforts to improve their prevention and treatment will benefit society as a whole. Efforts to reduce the impact of mental and substance use disorders on America's communities, such as those described in this TIP, will help achieve nationwide improvements in health.

Electronic media. This term is used in the broadest sense, covering everything from technology-based therapeutic tools to the use of social media for treatment or prevention.

Prevention. Technology can be used in prevention activities to foster the SAMHSA mission, which is “to reduce the impact of substance abuse and mental illness on America's communities” (SAMHSA, 2014b, p. 4). The term “prevention” covers a broad set of services, interventions, and supportive activities that promote resilience.

Recovery. This term reflects a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA, 2012). Major dimensions that support a life in recovery, as defined by SAMHSA (2012), include:

  • Health: overcoming or managing one's disease(s) or symptoms as well as making healthy, well-informed choices that facilitate physical and emotional well-being.
  • Home: having a safe, stable place to live.
  • Purpose: engaging in meaningful daily activities, such as a job, education, volunteer work, caring for family members, or creative pursuits; having sufficient independence, income, and resources to participate in society.
  • Community: maintaining relationships and social networks that provide support, friendship, love, and hope.

Substance use disorders. Throughout the TIP, this term applies to substance use disorders of all varieties and levels of severity. Usage reflects current terminology as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013). In general, the distinction between substance abuse and substance dependence in prior DSM editions related to the requirement of tolerance to or withdrawal from alcohol or other substances as a diagnostic criterion for substance dependence but not for substance abuse. If a particular drug (e.g., cocaine, amphetamines, marijuana) did not typically produce clear signs of tolerance or dependence, a diagnosis of substance dependence still indicated high severity or intense compulsivity, whereas a diagnosis of substance abuse denoted less severe symptoms (e.g., continued use despite negative consequences and/or knowledge of detrimental social and health effects of use). The distinction between “abuse” and “dependence” thus carried a connotation of severity, which is now a codified part of the diagnosis of substance use disorder in DSM-5.

Technology-assisted care. This term and its abbreviation, TAC, are used throughout the TIP to refer to the broad range of interventions and enhancements to traditional care models possible through the use of technological tools and to the range of behavioral health service delivery settings within which technology can contribute to care delivery.


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