Poster #29 - Advancing the Digital Mental Health Field: A Novel Approach to Clinical Service Quality Measurement

• In Event: Friday Poster Reception

Abstract

Introduction: Quality measurement is foundational to the provision of any health services. The Institute of Medicine and World Health Organization, among other leading organizations, have long emphasized that quality is essential to assessing population impact and driving improvement. Yet, in the rapidly expanding field of digital mental health – a field increasingly supporting traditional mental health systems in addressing the United States’ worsening mental health crisis – there is no comprehensive practice for clinical service quality measurement that looks beyond policy compliance. Comprehensive and continuous quality measurement enables the generation of insights that can guide policy, practice, and funding. Crisis Text Line has spent several years attending to quality improvement in order to provide the best clinical service to its texters. Recently, we codified this effort, developing a first-of-its-kind Clinical Service Quality Index (CSQI) that aligns with global standards and assesses a broader range of system attributes. The CSQI is a multidimensional composite indicator of quality for a digital crisis and mental health intervention. 
Approach: The CSQI was developed through a rigorous, multi-stage process: leveraging the World Health Organization’s Seven Domains of Quality in Health Care to construct an organizational clinical quality framework; identifying relevant metrics; and, through iterative expert stakeholder engagement, standard index development methodology (calibration, weighting, and aggregation of these metrics into a single, actionable composite score). Psychometric testing is currently underway; it will be followed by application of the CSQI to Crisis Text Line’s Aquí Estoy service, which serves 20+ Spanish-speaking countries (expected completion in early Fall 2026). This presentation will walk attendees through the CSQI’s development, share psychometric findings, and invite feedback on its broader applications in the digital mental health field. 
Contribution: The CSQI represents both an innovative measurement tool and a contribution to an underdeveloped field of research, and its significance extends well beyond Crisis Text Line. The CSQI offers the digital mental health field a blueprint: a systematic process that can be adapted to measure and continuously improve other mental health services. Sharing the CSQI with policymakers, researchers, and practitioners is key to advancing the digital mental health field, and provides a unique opportunity to catalyze cross-sector discussion on organizational quality standards to drive continuous improvement in service delivery and related policies and practices.

Authors

• Tracy E Costigan, Crisis Text Line
  Non-Presenting Co-Author

• Priya Gandhi, Crisis Text Line
  Presenting Author