Telephone-based Mental Health Triage is complex clinical role, often performed in time-critical, crisis situations, in at risk populations. Research suggests that inaccurate or inappropriate triage can place patients at greater risk, result in poorer health outcomes, and reduce the likelihood of early intervention.

In addition to understanding how to use  mental health triage scales, it is imperative that clinicians hold the requisite knowledge and skills to provide a competent, safe, and high quality service.   This requires clinician training in evidence-based frameworks for practice, and methods for assessing competence to practice.

Until recently there has been no evidence-based method for assessing clinicians’ competence to perform telephone-based mental health triage. From the quality and patient safety perspective, it is critical that robust competency assessment tools are available to provide a consistently high standard for mental health triage clinical practice.

Mental Health Tele-Triage Competency Assessment Tool  (MHTT-CAT)

Background 

The MHTT-CAT is an interactive  web-based application designed to support clinician training, ongoing professional development  and competency assessment in telephone-based mental health triage. The impetus behind the development of this program was the need to address the lack of standardised competency frameworks for telephone-based mental health triage (MHT), and the lack of evidence based, sustainable training programs.  

Overview of MHTT-CAT

The MHTT-CAT is an interactive web based application that can be used in all browsers.  The program contains an evidence-based  framework for telephone-based MHT consisting of core competencies and related elements and standards.

The program can be used for training and assessment so that it has the dual function of preparing clinicians through training (embedding the framework) and assessing competence to practice.

The program is used by the Observer (trainer, peer, mentor) to record observations made of the Clinician (trainee, student, novice, peer) performing telephone-based MHT. Using a Dual Headset, the Observer listens to the telephone consultation and records observations (mostly by mouse click with some drop down boxes for multiple options) of ‘tasks’ completed into the program.  The Observer may observe several phone calls/occasions of triage during a training or assessment ‘Session’. On completing the session, the ‘Submit’ button is used to submit the assessment data into the MHTT-CAT to be collated and analysed. The MHTT-CAT tracks Clinician decision-making and will then produce a brief Summary Report and qualitative feedback in the form of brief comment or suggestions, which can then be discussed with the Clinician undertaking the assessment in the context of professional development. The qualitative feedback provided by the program is the form of suggested screening questions derived from the World Health Organisation’s Composite International Diagnostic Interview, World Health Organisation’s International Classification of Diseases 10^th Edition (ICD-10).

By way of example and to demonstrate how this interactive component of the program works we provide the following example: If a Trainee takes a call from a person with a history of depression, there are a number of standard screening questions that should be asked to confirm the provisional diagnosis of depression and facilitate risk assessment and intervention. Questions about history of attempted suicide, psychiatric history, appetite, sleep, and concentration are some examples of standard screening questions for depression. If the Trainee omits to ask standard/expected questions during the consultation, at the end of the Session the MHTT-CAT will provide feedback in the form of brief suggestions for screening questions for the overlooked items. The feedback can then be discussed with the Trainer and used to assist practice development.

The program also includes a two-part video training tutorial that incorporates instructions on how to use the tool, and an overview of the core competencies of telephone-based mental health triage.

This tool contributes to the advancement of evidence-based practice in tele mental health triage by providing innovative solutions to gaps in evidence and practice that have important implications for patient safety.

Specific  benefits of the program include:

• A core set of evidence-based standards for practice that can be used for benchmarking purposes;
• A method and framework for practice development activities;
• An evidence-based technological application designed to facilitate competency assessment training and testing that can be implemented into routine clinical practice.

Additional benefits and value:

• The technology runs on portable technologies (ie tablets), increasing its accessibility for health services, especially facilities with limited computer infrastructure;
• Economic benefits associated with peer to peer based training that is undertaken in clinical practice, rather than taking staff ‘offline’ with the associated costs of backfilling their positions;
• Unlike simulation technologies where ‘scenarios’ need constant updating and refreshing, the MHTT-CAT is sustainable into the future as it is used in everyday ‘real time’ practice

Read the research article describing the development and testing of MHTT-CAT here: MHTT-CAT Research article

For more information on  MHTT-CAT
Please contact:

Natisha Sands RN PhD, Australia

Email: natisha.sands@ukmentalhealthtriagescale.org

Stephen Elsom RN PhD, Australia

Email: stephen.elsom@bigpond.com