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The Future of Family-Centered Care Belongs to the Robots

Posted By Matthew P. Martin, Monday, September 11, 2017

A couple years ago I was listening to one of my favorite podcasts, Planet Money, an NPR radio show that tells terrific stories about the economy, technology, and everything in between. During this particular episode, I learned about a therapist named Ellie who is a terrific listener, asks insightful questions, and requires electricity.

 Yeah, Ellie is a robot. She was developed by the military to interact with people suffering from depression and posttraumatic stress disorder. And she’s good at her job. In a series of studies, Ellie was as good, or in some cases, even slightly better than psychologists at diagnosing PTSD and depression. And, maybe more importantly, people like talking to her.

This got me thinking (and fretting a little, to be honest): can a robot do my job? Can a robot sit with a couple facing cancer and provide a therapeutic intervention? Can a robot work with parents and a teenager struggling with pediatric obesity? The answer today is probably not, so don’t hand in your license to your state behavioral health licensing board just yet.

Then I came across this recent article in the Journal of the American Medical Association about a socially assistive robot that helps patients make behavioral changes. Here’s the first line:

 

“Speaking to a group of journalists last October at the annual meeting of the American Association for the Advancement of Science, Maja Matarić, PhD, stated the problem bluntly: “There aren’t enough people for people.””

 

I believe Dr. Matarić is correct and will go even further: there aren’t enough behavioral health providers for all the patients in the world. There never will be. But are robots the answer for this problem?

Dr. Matarić would say: absolutely. Her solution is to create robots that monitor and chat with patients, coaching and motivating their human companions to do tasks they might be disinclined to do, like exercise a stroke-affected limb. She believes in the power of social influence to change behavior and plans to release the first commercially available robot in 2019.

I want one of these robots. I think they contain the potential for providing care to thousands and thousands of patients that the health care system fails to treat. Will they replace you and your amazing talents and abilities? Will they replace family caregivers and home health aides? Those are not the right questions to ask. In fact, don’t think of these metal golems as replacements for human health workers. Your mom was right: you’re irreplaceable.

Instead, think of these automatons as enhancements and supporting cast to the vital work done each day by medical and behavioral health workers like you. Imagine working seamlessly with these little helpers to assess, treat, and follow-up with many more patients that you currently help.

Recently, I worked to integrate screening and brief intervention for substance misuse prevention (SBIRT) into a large family medicine practice. We first used paper screening tools but then discovered that the medical assistants were inaccurate in scoring the results. In response, I developed a tablet version that automatically scored the screening results. Problem solved!

Then, we worked on the brief intervention service but quickly realized that the physicians were not consistently using the training we gave them. Some did a great job talking to patients about substance use but the majority either avoided the topic or reverted back to advice-giving tactics.

I solved the screening problem with technology, but what if I could solve the brief intervention problem with artificial intelligence? Imagine patients interacting with a robot that administers all the screening protocol, provides a brief motivational interviewing conversation, and then documents and transfers the responses to your computer desktop for follow-up. Now you, as the clinician, can follow up with all patients that qualify for additional support and care management. Using this robot-enhanced system, you could spend your time helping patients get what they really need.

There is enough evidence and momentum now to suggest that robots will likely begin to help with integrated behavioral health services in the next five to ten years. Will robots also help in family-centered care? Can they use a complex model like emotionally focused therapy to help a couple facing infertility issues? That future is way down the line in my mind. But here are some ways robots can help us do family-centered care in the near future:

-        Supplement home health aide services by offering 24-hour social support

-       Assess family caregiver wellbeing during a medical visit

-       Identify patients with multiple co-morbidities who may benefit from increased family support

-       Provide psychoeducation for families facing terminal illness

-       Follow-up with patients and families who recently received a serious diagnosis

These ideas may seem weird or even heretical to some. But remember what Dr. Matarić said: there will never be enough people for people. Robots can help us fill that gap. 

  Matt Martin, PhD, LMFT is Clinical Assistant Professor at Arizona State University in the Doctor of Behavioral Health Program. He is the CFHA Blog Editor. Contact him if you're interested in writing for CFHA (matt.p.martin@gmail.com) 

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