JMIR Publications

ABSTRACT

Background:

Youth experiencing housing instability have higher rates of mental health problems than their housed peers. Mobile technologies have shown promise to reduce health disparities and reach people who might not otherwise receive services. Few studies have evaluated technological resources for this population to determine how to effectively engage and reach them.

Objective:

The primary aims of this pilot study were to establish the feasibility (as measured by phone retention rates) and acceptability (i.e., participant ratings of resources) of delivering automated mental health resources via smartphone technology.

Methods:

Youth aged 16-25 (N=100) were recruited through homeless shelter agencies in the Chicagoland area. Eligible participants completed a baseline assessment and received a smartphone with a 3-month data plan. The phone was pre-loaded with several apps designed to promote mental health wellness and provide real-time resources. One app specifically designed for this study, Pocket Helper 2.0, sent participants daily surveys and tips via push notification. Tips focused on coping and motivation, and surveys assessed mood. This app also included an automated self-help system with brief cognitive-behavioral interventions (5-10 mins) and access to several interactive mobile tools including a crisis text line, a telephone hotline, a crowd-based emotional support tool, and an app providing up-to-date information on social service and mental health resources for homeless youth in Chicago. Participants completed assessments at 3 and 6 months.

Results:

Some individuals (23%) experienced problems with the phones (e.g., theft, loss, technological issues) throughout the study. Participant retention at the midpoint was moderate with 48% of youth responding to the 3-month surveys. At 6 months, only 19% of the total sample responded to the endpoint survey. Overall, 62.5-68.4% of respondents at both time points reported benefiting from the intervention; however, participant usage and satisfaction varied with the different features. At both time points, participants reported receiving the most benefit from the daily tips and daily surveys. Daily tips that were most preferred by participants involved motivational tips related to overcoming struggles and making progress in life. Aside from the tips and surveys, the most used features were the app providing up-to-date resources and the automated self-help system (used by 77.1-79.2% of participants at 3 months and 73.7-78.9% of participants at 6 months). Interactive features including the telephone hotline and crowd-based emotional support tool were the least used features and were rated as the least beneficial.

Conclusions:

Automated mental health interventions seem to be an acceptable way to engage homeless youth in mental health treatment. Participants preferred fully automated features and brief interventions over features requiring interaction with others or more engagement. Future research should explore ways to retain homeless youth in interventions and evaluate the clinical impact of automated technology-based interventions for improving mental health. Clinical Trial: ClinicalTrials.gov Identifier: NCT03776422