Karen Fortuna

Karen Fortuna
Geisel School of Medicine at Dartmouth | DMS · Department of Psychiatry

PhD LICSW

About

140
Publications
21,515
Reads
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1,160
Citations
Introduction
Dr. Fortuna is an Assistant Professor of Psychiatry at Dartmouth College. Dr. Fortuna works in equal partnership with peer support specialists in the United States, Canada, Europe, Australia, and New Zealand in co-producing and empirically testing digital peer support technologies and trainings.  Dr. Fortuna serves on the APAs Expert Advisory panel on smartphone app development and PCORI's Advisory Panel on Patient Engagement.  She serves as editor of the Journal of Participatory Medicine.

Publications

Publications (140)
Article
Full-text available
Background Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life. Objective The purpose of the present study was to evaluate positive organization...
Article
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One in five older adults experience symptoms of depression and anxiety. Digital mental health interventions are promising in their ability to provide researchers, mental health professionals, clinicians, and patients with personalised tools for assessing their behaviour and seeking consultation, treatment, and peer support. This systematic review l...
Article
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Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train pee...
Article
Full-text available
Background: The United Nations has called for wide-scale community mental health psychoeducation; however, few programs currently exist. Emotional Connecting, Empowering, Revitalizing (eCPR) is a community education and training program developed by individuals with a lived experience of mental health challenges or trauma. It is designed to provid...
Preprint
BACKGROUND Digital peer support may show longevity past the COVID-19 era. In April 2020, a survey of 180 peer support specialists from 23 states found a 95% increase in peer support specialists offering digital peer support and a 90% increase in peer support specialists’ confidence in digital peer support. OBJECTIVE The purpose of this study is to...
Article
Full-text available
Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train pee...
Article
Objective: Individuals with serious mental illness (SMI) experience a 10–25-year reduced life expectancy when compared to the general population that is due, in part, to poor health behaviors. Yet, in spite of the development of health promotion and self-management interventions designed for people with SMI to promote health behavior change, the mo...
Article
Full-text available
To examine the feasibility, acceptability, and initial validity of using smartphone-based peer-supported ecological momentary assessment (EMA) as a tool to assess loneliness and functioning among adults with a serious mental illness diagnosis. Twenty-one adults with a diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disor...
Preprint
BACKGROUND Social distancing and lockdown measures due to the COVID-19 pandemic has transformed the delivery of mental health care from in-person to remote services supported through the use of technologies. When the COVID-19 pandemic lockdown measures were instituted, wide scale necessity for remote mental health care emerged not only for professi...
Article
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Adults with serious mental illness commonly experience comorbid chronic physical conditions and experience a reduced life expectancy of 10-25 years compared to the general population (Saha et al. in Arch Gen Psychiatry 64(10):1123–31. 2007; Hayes et al. in Acta Psychiatr Scand 131(6):417–25. 2015; Walker et al. in JAMA Psychiatry 72(4):334–41. 2015...
Article
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The purpose of this article is to delineate the current state-of-the-knowledge of peer support following the framework employed in the 2004 article (Solomon, Psychiatr Rehabil J. 2004;27(4):392–401 1). A scoping literature was conducted and included articles from 1980 to present. Since 2004, major growth and advancements in peer support have occurr...
Article
Objective: Individuals with mental health challenges are at particularly high risk of experiencing negative outcomes (e.g., worsening of mental health, increased risk of mortality) due to the coronavirus disease (COVID-19) pandemic. Peer specialists may have the benefit of several protective factors, including higher levels of social support and b...
Article
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Background: Suboptimal adherence to data collection procedures or a study intervention is often the cause of a failed clinical trial. Data from connected sensors, including wearables, referred to here as biometric monitoring technologies (BioMeTs), are capable of capturing adherence to both digital therapeutics and digital data collection procedur...
Article
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As the digitalization of mental health systems progresses, the ethical and social debate on the use of these mental health technologies has seldom been explored among end-users. This article explores how service users (e.g., patients and users of mental health services) and peer support specialists understand and perceive issues of privacy, confide...
Article
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Objective: To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention ("PeerTECH") for adults with a serious mental illness. Methods: Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disor...
Article
Full-text available
Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of middle-aged and older adults. An emerging workforce of certified older adult peer support specialists aged 50 years or above...
Article
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Older adults with serious mental illness (SMI) have complex care needs across medical, psychiatric, cognitive, and social domains. This growing population exhibits high levels of medical comorbidity and sedentariness. Innovative interventions that promote holistic recovery for this group are needed, especially in the context of the COVID-19 pandemi...
Article
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Functional decline in older adults can often be mitigated by physical activity. As older adults increasing adopt wearable technology, an understanding of how remotely monitored activity is associated with clinical outcomes is needed. Data was analyzed from two cohorts of older adults with obesity (□65 years, BMI (□30kg/m2)) who completed weekly die...
Article
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Rural older adults aged ≥65 years with obesity (body mass index (BMI) ≥30 kg/m2) showed an overall favorable response to a six-month, technology-based weight-management intervention. Our objective was to characterize how friends or family support for eating and exercise behaviors at baseline was associated with baseline weight and intervention resp...
Article
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Community of Practice, a community-engagement method that encourages a group of people to interact regularly towards a common goal, may promote satisfying experiences in patient-outcomes research among marginalized populations. Peer support specialists are increasingly being involved in peer-informed mental health research due to their lived experi...
Book
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This encyclopedia brings together a comprehensive collection of work highlighting established research and emerging science in all relevant disciplines in gerontology and population aging. It covers the breadth of the field, gives readers access to all major sub-fields, and illustrates their interconnectedness with other disciplines. With more than...
Article
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Peer support specialists (i.e., lay interventionists representing one of the fastest-growing mental health workforce) are increasingly using technologies to support individuals with mental health challenges between clinical encounters. The use of technology by peers has been significantly increased During COVID-19. Despite the wide array of technol...
Conference Paper
Full-text available
Serious mental illness (SMI) is a leading disability worldwide. Partnering with people with SMI to co-produce smartphone apps to support mental health outcomes throughout the software development lifecycle may support patient engagement with smartphone health app interventions. Partnering with this community is often challenging and requires a high...
Conference Paper
Full-text available
Community of Practice, a community-engagement method that encourages a group of people to interact regularly towards a common goal, may promote satisfying experiences in patient-outcomes research among marginalized populations. Peer support specialists are increasingly being involved in peer-informed mental health research due to their lived experi...
Preprint
BACKGROUND Older adults who engage in physical activity can reduce their risk of mobility and disability. Short amounts of walking can improve their quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues...
Article
Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation co...
Preprint
BACKGROUND Sub-optimal adherence to data collection procedures and/or a study intervention is often the cause of a failed clinical trial. Data from biometric monitoring technologies (BioMeTs) can measure adherence to both digital therapeutics and digital data collection procedures, thereby providing the opportunity to identify the determinants of a...
Article
Full-text available
This study aimed to test the validity and reliability of the Kessler Psychological Distress Scale-6 (K6) with a nationally representative clinical sample with various mental health disorders. The cross-sectional, nationally representative, and publicly available data were extracted from the 2014 Health Center Patient Survey (HCPS), which was sponso...
Article
Full-text available
Background: For digital tools to have high usability and fit service users' health needs and socio-environmental context, it is important to explore usability with end-users and identify facilitators and barriers to uptake. Objective: To conduct user testing of the smartphone health application, PeerTECH, in a Norwegian community mental health s...
Preprint
BACKGROUND The United Nations has called for wide-scale community mental health psychoeducation; however, few programs currently exist. Emotional Connecting, Empowering, Revitalizing (eCPR) is a community education and training program developed by individuals with a lived experience of mental health challenges or trauma. It is designed to provide...
Article
Full-text available
Individuals with serious mental illness (SMI) experience a 10- to 25-year reduced life expectancy compared with the general population. Early mortality for people with SMI has mainly been attributed to unhealthy behaviors (e.g., poor diet, sedentary lifestyle), which has led to the development of health promotion and self-management interventions s...
Article
Older adults with serious mental illness (SMI) experience increased medical comorbidities, disability, and early mortality, but little is known about how they perceive the process of aging. This study explored attitudes and beliefs about aging among n=20 middle aged and older adults (M = 59.8 years; range 47-66) with SMI in a state psychiatric hosp...
Article
Full-text available
With Internet connectivity becoming increasingly accessible and mobile, more people are turning to the Internet for news. With this has come concern about partisan echo chambers, misinformation, and online filter bubbles which silo users into separate, often disparate media universes shaped by culture, confirmation bias, and personalized content. T...
Article
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Peer specialists, or individuals with lived experience of mental health conditions who support the mental health recovery of others, often work side-by-side with traditional providers (non-peers) in the delivery of treatment groups. The present study aimed to examine group participant and peer provider experiences with peer and non-peer group co-fa...
Article
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The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50 years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with...
Preprint
UNSTRUCTURED As digital peer support is quickly expanding across the globe in wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice such as social work, psychiatry, and psycholog...
Article
Full-text available
Background: As digital peer support is quickly expanding across the globe in wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice such as social work, psychiatry, and psycholog...
Article
Full-text available
Mounting scientific evidence over the past decades in the field of psychiatry has shown community engagement in research produces more relevant research, increased uptake of research findings, and better clinical outcomes. Despite the need for the integration of community engagement methodologies into the scientific method, doctoral and master's le...
Article
The app evaluation framework of the American Psychiatric Association (APA) has emerged as an adaptable tool for those seeking to navigate the ever-growing space of mental health apps. The authors describe a meeting convened in December 2019 to refine the APA framework. The expert panel comprised 16 individuals across health care fields, with repres...
Article
Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association o...
Article
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Unstructured: One of the most at-risk groups during the COVID-19 crisis are older adults, especially those who live in congregate living, seniors' care facilities, are immune-compromised, and/or have other underlying illnesses. Measures used to contain the spread of the virus are far-reaching and older adults were amongst the first groups to have...
Article
Schizophrenia is a serious illness and one of the most expensive psychiatric disorders.It is anticipated that the number and proportion of older patients with schizophrenia will continue to increase. By 2025, it is anticipated that patients 55 and older with schizophrenia will comprise 25% of all patients with schizophrenia. This research symposium...
Article
Full-text available
With the emergence of the COVID-19 vaccine, we have the potential to live longer and healthier lives through the reduction of the transmission of the virus and bring this pandemic to an end. Yet, not all groups will achieve the promise of healthier lifespans—including older adults who represent racial and ethnic disadvantaged groups, rural resident...
Article
Background: Resistance-based exercises effectively enhance muscle strength, which is especially important in older populations as it reduces the risk of disability. Our group developed a Bluetooth-enabled handle for resistance exercise bands that wirelessly transmits relative force data through low-energy Bluetooth to a local smartphone or similar...
Article
Full-text available
Background: Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for p...
Preprint
Full-text available
BACKGROUND Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for peo...
Article
Full-text available
To explore the association between loneliness and efficacy to engage in health behaviors that are known to reduce the risk of early mortality in people with serious mental illness (SMI). This secondary data analysis was based on a cross-sectional study of 113 participants with SMI residing in New Hampshire. Ordinary Least Squares regressions were u...
Article
Full-text available
Purpose: The purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses. Methods: This is a cross-sectional correlational design study. Our partic...
Article
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Introduction: The immediate impact of COVID-19 on morbidity and mortality has raised the need for accurate and real time data monitoring and communication. The aim of this study is to document initial observations from multiple digital services providers during the COVID-19 crisis, especially those related to mental health and wellbeing. Materials...
Chapter
Individuals with serious mental illness (SMI) have a reduced life expectancy of approximately 10–25 years. Early mortality in persons with SMI is frequently related to unhealthy lifestyle behaviors (i.e., smoking, poor diet, poor sleep habits, sedentary lifestyle) and psychiatric disorders impact on aging biology. The accelerated aging theory of SM...
Article
Full-text available
PeerTECH is older peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by older adult peer support specialists. Older adult peer support specialists are older adults with a lived experience of a mental health condition, who are trained and accredited to provide support services to others wi...
Article
Full-text available
Recovery narratives are an effective healing art medium that support individual development by virtue of the shared human experience transmitted through each story. Older adult recovery narratives are unique as they share their experiences of aging with a mental health conditions to support others with similar difficulties. Older adult recovery nar...
Article
Full-text available
As increasingly more older adults in the general population utilize smartphones to access health services, the digital divide between older adults with serious mental illness (SMI) and the general older adult population continues to widen. The purpose of this study was to examine older adult peer support specialists’ and older people with SMI’s per...
Article
Full-text available
As health indicators such as life expectancy have improved for many older adults, some older adults experience a disproportionate amount of preventable disease, death, and disability. The causes of health disparities among older adults are multidimensional in that disparities are due to multiple, interacting factors such as socioeconomic status, di...
Article
Full-text available
PeerTECH is a peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by peers. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation wil...
Article
Objective Despite recent concerns over the increase in opioid misuse among aging adults, little is known about the prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older patients with psychiatric disorders. This study aims to determine the lifetime prevalence of nonmedical opioid use among underserved, vulnera...
Article
Adherence research commonly happens in a silo, focused on a particular disease state or type of therapy. Learning from outside disciplines can bring new insights and ideas. This article presents adherence research as related to people with a diagnosis of a serious mental illness (SMI) and medication adherence through smartphone applications (apps)....
Article
Full-text available
This study examined certified peer specialists’ perceptions of the barriers and facilitators to mobile health (mHealth) engagement. A total of 267 certified peer specialists from 38 states completed an online survey. Of this sample, 74 certified peer specialists completed open-ended questions. Data were analyzed from the 74 respondents who responde...
Article
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As use and availability of mobile health apps have increased, so too has the need for a thorough, accessible framework for app evaluation. The American Psychiatric Association’s app evaluation model has emerged as a way to critically assess an app by considering accessibility, privacy and security, clinical foundation, engagement, and interoperabil...
Article
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Background: Peer support specialists offering mental health and substance use support services have been shown to reduce stigma, hospitalizations, and health care costs. However, as peer support specialists are part of a fast-growing mental health and substance use workforce in innovative integrated care settings, they encounter various challenges...
Article
Full-text available
This study explored the association between loneliness and psychiatric hospitalizations, functioning, and physical health conditions in people with serious mental illness. Data were included from 349 individuals with serious mental illnesses, aged 18+ years, who participated in two consecutive crosssectional survey studies conducted between 2013 an...
Preprint
BACKGROUND Older adults with mental health conditions experience co-morbid physical health conditions, premature nursing home admissions, and an earlier mortality compared to the general population of older adults. Older adult peer support specialists are increasingly using technology to deliver peer support services related to addressing both ment...
Article
Full-text available
Background Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older...
Article
Full-text available
Background: Prior to the outbreak of coronavirus disease (COVID-19), telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. For the first the time in history, peer support specialists...
Preprint
UNSTRUCTURED One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first g...
Article
Full-text available
Gerontological Social Work education has been substantially altered by the advancement of today’s digital technologies, influencing both the training and tools required to ensure student success in social work research, policy, and practice. The goal of this paper is to present the state of the science on gerontological digital social work educatio...
Preprint
UNSTRUCTURED Prior to COVID-19, telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. However, for the first the time in history, peer support specialists are offering Medicaid reimb...
Preprint
UNSTRUCTURED Our manuscript discusses the importance of designing the digital mental healthcare ecosystem through the combinational approach of user-centered design and community engaged research. As the world is redesigning their mental health care due to COVID-19, this manuscript will offer a roadmap on how to use important elements of design to...
Article
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-bas...
Article
Full-text available
Background Engaging peer support to augment and enhance traditional mental health services presents novel opportunities to improve service engagement and delivery. However, there has not been an in-depth analysis of the processes and methods behind the coordination of physical health and mental health care by peer support specialists.Study aimTo ex...
Article
Full-text available
The purpose of this study was to explore the relationships between self-reported hopelessness and risk factors for premature mortality in people with serious mental illness (SMI). Data were extracted from the 2014 Health Center Patient Survey (N = 5,592). Having a diagnosis of SMI was significantly associated with self-reported hopelessness. Hypert...
Preprint
BACKGROUND Individuals often turn to the internet seeking answers to their mental health problems. In 2014, Mental Health America (MHA) began the online program MHA Screening, including the PHQ-9, and since then has collected data from nearly 2.5 million people. Among those who complete a depression screening online, 83% report moderate to severe d...
Article
Schizophrenia is a serious illness and one of the most expensive psychiatric disorders.It is anticipated that the number and proportion of older patients with schizophrenia will continue to increase. By 2025, it is anticipated that patients 55 and older with schizophrenia will comprise 25% of all patients with schizophrenia. This research symposium...
Article
Full-text available
Background: Peer support is recognized globally as an essential recovery service for people with mental health conditions. With the influx of digital mental health services changing the way mental health care is delivered, peer supporters are increasingly using technology to deliver peer support. In light of these technological advances, there is...