Getting mental health services to youth facing homelessness can pose a host of access challenges. But a new study published in JMIR found that smartphone-based mental health programs could be a viable approach to reaching this vulnerable population.
In a small pilot, researchers found that more than half of the participants were engaging with the technology. While clinical improvements were scarces in the study, patients did report overall satisfaction with the phone-based system.
Participants were given a mobile platform that included therapy coaching sessions, texting validity and support apps. The study found that 57% of participants completed all three of their phone therapy sessions as instructed. Over the course of the pilot participants sent an average of 15.06 tests messages to the coach. In return, coaches sent 19.34 messages.
The most common mental health topics covered in these sessions included interpersonal issues and stress management. Researchers also reported that goal setting, emotion regulation and family conflict were popular topics.
In terms of feasibility, researchers found that 71% of participants already had their own mobile phone. However, 20% did report not having access to WiFi throughout the day.
All 23 participants said reported that they would recommend the service to a friend, and 52% said they were very or extremely satisfied with the program. However, less than half (43%) reported that the intervention was helpful.
Additionally, the researchers wrote that they found “very little change on clinical outcomes with small effect sizes for symptoms of depression” over the course of the one-month period.
HOW IT WAS DONE
The study included a total of 35 participants aged an average of 19.06 years. A majority of the study participants were women (65%) and African American (66%). Researchers noted that the sample reflected national trends, disproportionately representing ethnic minorities as well as members of the LGBTQ community.
Participants were given a mobile phone and a web-based intervention dubbed Stepping Stone, which included three mental health apps that were developed at the Center for Behavioral Intervention Technologies. It also offered three 30-minute coaching sessions with a therapist, as well as texting services with that coach.
WHAT'S THE BACKGROUND
People living with homelessness have often faced access obstacles when seeking mental health care. The researchers wrote that living with homelessness can have a negative impact on both physical and mental health among young adults.
“Unfortunately, the vast majority of homeless individuals have little or no access to comprehensive healthcare and virtually no access to mental health services,” they wrote. “Many of the realities of homelessness make receiving mental health care, especially traditional face-to-face services, more challenging.”
However, not providing that care can lead to negative results. A study published in Medical Care found that hospitalization rates among adults living with homelessness have increased sharply in recent years with mental health and substance use disorders acting as the main driver for acute hospitalizations among this population.
However, the conversation around supplementing services with a technology-based approach has recently begun.
“One complement to traditional mental health services that could help overcome some of these barriers would be technology-based treatment options,” the researchers wrote. “Such options include resources such as teletherapy, text messaging, and mobile apps. Technology may be an especially promising strategy to engage hard-to-reach populations.”
“Our findings demonstrated promising results regarding the feasibility and acceptability of such an intervention,” the authors of the study wrote. “Most participants engaged with the program and reported they were satisfied with their participation, although less than half reported that they found the program helpful. Our goal in this study was to establish whether it would be possible to consider digital interventions as a means to bridge individuals until they are ready for care or act as adjunctive elements to more traditional treatment.”