Enhancing Community Mobility in Individuals With Serious Mental Illnesses Through Peer-Facilitated Travel Training: A Two-armed Waitlist Controlled Trial
Phase: NA
Conditions: Serious Mental Illness
Sponsor: Temple University

 
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1)    Abstract of the Study 
This project proposes using a two-armed, waitlist controlled trial to test 
the effectiveness of peer-facilitated travel interventions and their ability to 
enhance community mobility and increase feelings of self-efficacy in 
individuals with serious mental illness (SMI). The first intervention arm is 
an 8-week bikeshare intervention, which consists of individual trainings on 
using a bike sharing program; the second intervention arm is an 8-week 
public transportation intervention, which consists of individual trainings for 
using public transportation in the Philadelphia area. We seek to enroll a 
total of 180 individuals from community mental health agencies in the 
Philadelphia area and expect recruitment to take 3 years. Eligible 
participants will be individuals who meet criteria indicating that they have 
an SMI, are between the ages of 18-65, and are both willing and able to 
learn to use public transportation and ride a bicycle. Data will be collected 
via face-to-face or web-based video call interviews at 3 time points: 
baseline, 2-months post-baseline, and 4-months post-baseline. 
Participants will also complete short surveys about their travel behaviors 
over the phone in the seven days after each interview. There will also be a 
subsample of participants who will provide additional GPS data- for full 
procedures related to GPS subgroups, reference the GPS protocol 
document, titled “Enhancing Community Mobility: GPS Subgroups.”   
GPS Subgroup Abstract: 
 
This project is a subset of our study “Enhancing Community 
Mobility in Individuals wit Serious Mental Illness Through Peer-Facilitated 
Travel Training: A Two-armed Waitlist Controlled Trial,” which uses a two-
armed, randomized, waitlist-controlled trial to test the effectiveness of 
peer-facilitated travel interventions and their ability to enhance community 
mobility and increase feelings of self-efficacy in individuals with serious 
mental illness (SMI). This subset of the study aims to track 20 of the 
participants in both of the study’s intervention arms by using GPS. 
Participants will be randomly assigned to the GPS subgroups after initial 
consent to participate in the main study and assignment to intervention 
arms. We seek to enroll a total of 40 individuals into GPS subgroups and 
expect recruitment to take 3 years. Eligible participants will have met the 
criteria to be in the main study. Location data will be collected via cell-
phone capable of GPS tracking through the app FollowMee. 
2) Protocol Title 
3) “Enhancing Community Mobility in Individuals with Serious 
Mental Illness Through Peer-Facilitated Travel Training: A 
Two-armed Waitlist Controlled Trial”Investigators 
Gretchen Snethen, Ph.D., CTRS, (co-PI); Temple University Department of  
Rehabilitation Sciences  
Beth Pfeiffer, Ph.D., OTR/L (co-PI); Temple University Department of  

 
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Rehabilitation Sciences 
Mark Salzer, Ph.D., Temple University Department of Social and Behavioral 
Sciences 
Matthew Federici, Copeland Center; 
Eugene Brusilovskiy, Temple University Department of Rehabilitation Sciences 
Research Assistants, Temple University Collaborative on Community Inclusion 
 
4) Objectives 
The purpose of this two-armed, waitlist controlled trial is to test the 
effectiveness of two novel peer-facilitated transportation interventions on 
community participation and mobility among individuals diagnosed with serious 
mental illnesses (SMI). This project aims to address the following hypotheses:  
1. Individuals with SMI receiving either of the two peer-mediated travel training 
transportation interventions will experience an increase in transportation 
self-efficacy and transportation skills. 
2. Participants in the intervention arms will increase their transport utilization, 
participate in significantly more activities in the community, and make 
significantly more trips in the community 
3. Individuals with SMI receiving peer-mediated travel training interventions will 
retain post-test levels of community participation and self-efficacy 2 months 
after intervention. 
 
Intervention Acceptability 
In addition to the proposed hypotheses, we will assess if peer-mediated travel 
interventions are deemed acceptable by individuals with SMI and explore the 
relationship between intervention outcomes.  
 
GPS Subgroup Objectives: 
The purpose of the GPS subgroups in this two-armed, waitlist controlled trial is to 
examine the possibility of detecting changes in mobility and participation using 
GPS data, as related to the main study’s hypotheses. Doing so will allow us to 
more closely examine participants’ transportation utilization, activity space, and 
trips in the community.  
 
5) Rationale and Significance  
Limited access to transportation is a barrier to independence and is identified by 
both individuals with SMI and service providers as a major obstacle to community 
participation. Individuals with SMI have indicated that their participation in the 
areas of social connectedness, exercise, fitness, and employment is especially 
impacted by the amount of transportation they have access to, and report that 
transportation is “an avenue to better jobs and more social involvement.” In a 
previous research study exploring the importance of access to transportation for 
individuals with SMI, Salzer et al. found that when given the opportunity to use 
‘freedom funds’ to purchase items to support recovery, individuals with SMI most 
frequently used funds to facilitate transportation.  
 

 
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Access to and use of transportation services is central to this project, which 
focuses on increasing participants’ community mobility. Community mobility can 
be defined as “moving around in the community and using public or private 
transportation, such as driving, walking, bicycling, or accessing and riding in 
buses, taxi cabs, or other transportation systems.” Public transportation includes 
transportation methods such as buses, trains, subways, and ferries which are 
accessible to the public and are designed to move groups of people. Personal 
transportation, on the other hand, involves travelling in the community using 
one’s body and/or a private vehicle. This type of transportation includes travelling 
in a private automobile, using other motorized or non-motorized vehicles, or 
walking. Both public and personal transportation offer the opportunity for greater 
personal independence but may also pose unique challenges and barriers to 
individuals with SMI. 
 
Financial limitations often act as barriers to community mobility, as they often 
make certain modes of transportation such as car ownership inaccessible to 
individuals with SMI. While there are other methods of transportation available for 
those who have financial issues, such as paratransit or reliance on members of 
one’s social support network, these alternative methods come with their own set 
of problems. Individuals with SMI may not qualify for transportation services, as 
such services often have unclear eligibility standards. Even individuals who do 
qualify for transportation services often have unmet transportation needs, as 
these services are often costly and inconvenient, include a substantial time 
commitment, and provide undesirable scheduling options. In addition, these 
transportation services are limited in their own right as they are restricted to 
specific health-related services, prohibiting individuals from participating more 
fully in their community through non-health related activities. Relying on personal 
connections for transportation is also often not a viable option for individuals with 
SMI, as they may not have support networks which affords them the ability to ask 
for transportation whenever they need it. 
 
Given that relying on others is often not satisfactory for individuals with SMI, 
personal transportation options may be more ideal for increasing independence 
and community mobility by allowing for more flexibility and autonomy in 
transportation. A subset of personal transportation is active transportation, 
defined as any form of transportation that utilizes human powered movement to 
get from one place to another. Active transportation is currently a hot topic 
among public health researchers, as it can be beneficial to the health of both 
individuals and the community. One form of active transportation that is 
increasing available and accessible across the country is bicycle sharing, as 
more than 100 cities in the United States have bikeshare programs. 
 
Bikeshares introduce a new form of active transportation into public 
transportation. Bikeshares are one an affordable form of transportation since bike 
sharing programs allowing users to sidestep the costs of buying, maintaining, or 
safely storing a bike while still gaining access to transportation and health 

 
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benefits of bike riding. In addition, 24% of bikeshare programs in the US offer an 
income-based subsidy, making them accessible to those who might experience 
financial barriers in other forms of transportation. In a study completed by the 
Temple University Collaborative on Community Inclusion of People with 
Psychiatric Disabilities (TU Collaborative), 48 individuals with SMI completed a 
survey about their interests in using bikeshare. Of these individuals, only 10% 
currently had a bicycle but 95% expressed an interest in cycling and cited a 
variety of reasons for their interest.  
 
In 2016, Americans took 10.4 billion trips on public transportation and 28 million 
rides through bikeshare programs, with both forms of transportation experiencing 
a significant increase in usage in the last 5 years. This is likely partially due to the 
high access to public transportation in major cities; in Philadelphia, 97% of 
people live within walking distance of public transportation, and it hovers around 
90% in 13 of the 28 largest cities in the United States. The growing use of public 
transportation and bike shares among the general population indicates the need 
for a parallel intervention that specifically supports individuals with SMI to use 
these forms of transportation. Research conducted by the TU Collaborative has 
demonstrated that 92% of individuals with SMI believe that using public 
transportation is important for community mobility, and among the broader 
population of individuals with disabilities research has demonstrated the positive 
outcomes of training programs to increase transportation. 
 
Regardless of how readily available transportation methods are, without training 
or experience individuals with SMI may avoid certain types of independent 
transportation, creating an additional barrier to community participation and 
mobility. In the summer of 2017, pilot work by the TU Collaborative team 
demonstrated success in travel training using bikeshare and public transportation 
for individuals with SMI. The group components of the bikeshare ensured that all 
participants were able to use bikeshare, identify destinations and routes, and ride 
safely, while the individual components of the bikeshare intervention supported 
the diverse needs of individuals with SMI, including those with physical 
disabilities. The public transportation peer-mediated travel training was piloted 
using the proposed curriculum to determine feasibility, refine the peer-
interventionist training, and develop fidelity processes. After finishing the public 
transportation intervention, all participants were able to use public transportation 
independently on targeted routes.  
 
Peer-mediated interventions are founded on social learning theories, which 
postulate both that behaviors and skills are learned when modeled and that this 
modeling enhances self-efficacy. Social Comparison Theory in particular 
suggests that people seek interactions and comparisons with others who have 
similar experiences, as upward comparison can foster the development of skills, 
an increase in hope, and a decrease in fear. It further posits that behavior 
change is more likely to occur when modeled by peers. Previous research has 
supported positive outcomes in self-efficacy for individuals with SMI in peer 

 
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support interventions, and has identified that peer support interventions as 
effective, possibly because they are reminiscent of those provided in natural 
social contexts. Further research suggests that peer support interventions 
enhance social support networks, which are a pivotal component in 
transportation training. Peers often act as intervention agents to model or 
reinforce particular skills that are essential for independent use of public or 
personal transportation. Peer-interventionists “enhance self-efficacy that one can 
change behavior,” leading to the theory that the presence of peer-interventionists 
may serve to bolster self-efficacy and thus positively impact the mechanisms of 
change needed to improve transportation skills and community mobility.  
 
This project proposes to pilot innovative peer support interventions with the 
targeted outcome of increasing independent use of either public transportation or 
bikeshare as a means to increase community participation and mobility. Since 
over 80% of the population in the United States resides in urban communities, a 
substantial portion of the population has access to both public transportation and 
bikeshare, making this research widely applicable. This project also has the 
potential to expand roles for peer support specialists and develop intervention 
strategies that better support individuals with SMI in their efforts to independently 
access transportation such as traditional public transportation and bikeshare. 
 
GPS Subgroups: 
Documenting access to and use of transportation and community mobility is 
central to this project. Community mobility can be defined as “moving around in 
the community and using public or private transportation, such as driving, 
walking, bicycling, or accessing and riding in buses, taxi cabs, or other 
transportation systems.” This project is complementary to the main study, 
“Enhancing Community Mobility Through Peer-Facilitated Travel Training: A 
Two-armed Intervention” in that it measures a subsample of participants’ mobility 
in the community using Global Positioning System (GPS) technology. The TU 
Collaborative has used GPS technology two times in the past (protocol #’s 2015-
07 and 2013-62) to successfully track individuals with psychiatric disabilities. 
During these studies there were no issues recruiting participants or with data 
privacy and confidentiality.   
 
 
6) Resources and Setting  
The interventions and data collection will be overseen by a PhD level recreational 
therapist and occupational therapist from the TU Collaborative, with assistance 
from Research Assistants, a Community Inclusion Specialist, and Certified Peer 
Support Specialists. All staff involved have completed training which includes: 1) 
the CITI social and behavioral health human subjects training, 2) the Center’s 
interviewer training, and 3) the Center’s confidentiality agreement. Beth Pfeiffer 
and Gretchen Snethen will offer guidance during ongoing weekly meetings in 
preparation for and execution of the study. Eugene Brusilovskiy will offer 
guidance for the GPS subgroups.  

 
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Recruitment will take place at mental health agencies in the Philadelphia area 
Research interviews will take place at a location agreed upon by both the 
participant and interviewer that allows for privacy. Such locations may include the 
agency where the participant receives mental health services, a community 
location, and Temple University. Otherwise, interviews will take place over a 
web-based video call (Zoom). Intervention groups will be facilitated at the 
recruiting agency or at Temple University. 
 
GPS Subgroups 
Recruitment of participants for the GPS subsample will take place within the 
participant pool from the main study and thus recruit from the same locations. If 
the participant is using a phone loaned by the research team, any meetings 
between participants and research staff for the purposes of giving or returning 
the phones used for tracking will take place at a location agreed upon by both the 
participant and research staff. Such locations may include the the agency where 
the participant receives mental health services, a community location, and 
Temple University.  
 
 
7) Prior Approvals 
IRB approvals will be requested from both Temple University and Philadelphia 
Department of Public Health.   
 
8) Study Design 
a) Recruitment Methods 
We will enroll 180 participants with serious mental illness (SMI) between the 
ages of 18 and 65. 90 participants will be randomly assigned to both groups 
(bike share and public transportation).  
 
Recruitment will occur from community mental health agencies in the 
Philadelphia area. Fliers including details on the study and study informational 
sessions will be available for agencies interested in the study or attendees 
who are interested in participating. Potential partnering agencies will be 
contacted with the recruitment massaging written in the document, 
“Transportation Recruitment Email - Providers”. A sharable summary will also 
be sent to agencies interested in the study.  
 
In working with provider agencies, we will offer a $10 coffee gift card 
(Starbucks, Wawa, Dunkin Donuts, etc.) for each staff member who commits 
to sharing study information with five potentially eligible individuals. Agency 
staff would have 1.5 months to complete this; however, additional 
opportunities may be offered in additional recruitment attempts. Agency staff 
would contact the research assistant to confirm that he/she/they shared the 
information; they will not, however, directly share the names or contact 

 
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information of the potentially eligible individuals without consent with research 
staff. Research staff will respond directly to the agency staff thanking them for 
sharing the information, confirming they will receive a gift card, and offering 
an opportunity and willingness to connect directly with the service recipient to 
discuss the study (see example staff response email). At the end of the 1.5 
months, staff will mail physical gift cards with the list of participating staff to 
the agency contact. The agency will be responsible for distributing the gift 
cards directly to staff members.   
 
An individual screening meeting will be scheduled for individuals interested in 
learning more about the transportation study. Interested individuals will 
complete a screening assessment with a research assistant which will contain 
a Travel Skills Assessment tool to assess readiness to complete a public 
transportation or bikeshare intervention program, a Bicycle Interest Survey to 
ensure they can ride a bike and are interested in using a bikeshare, and the 
MINI to confirm an SMI diagnosis. Eligible individuals will be invited to 
participate and schedule a time to consent to be in the study.  
 
When going through the consent process, participants will be asked to 
complete the UCSD Brief Assessment of Capacity to Consent (UBACC) to 
ensure that they have an understanding of the research study. As indicated 
on the UBACC, potential participants need to score a 15 or higher in order to 
demonstrate understanding of the study they are consenting to. If score a 14 
or lower, they may ask questions about the study and retake the UBACC. If 
they still cannot get a score of 15 or higher, they will not be consented and 
will not participate in the study. Once eligible participants are consented, the 
research staff will schedule the initial interview with participants. Participants 
will complete a shorter version of the UBACC at the second and third 
interview time points to ensure they maintain the capacity to consent at later 
time points. 
 
40 of the participants from the total pool of 180 participants enrolled in the 
main study will be randomly selected to participate in the GPS subgroup. 
There are no additional eligibility criteria, but participants consenting to the 
main study will be given the option to opt out of being considered for a GPS 
subgroup at the time of initial consent. Participants in the GPS subgroup will 
also be asked to complete the UBACC and score a 15 or higher during the 
consent process.  
 
 
Participant Payment 
Participants will be offered an honorarium to complete the data collection. For 
each data collection point, (baseline, post-intervention, and follow-up), 
participants will receive up to $34 in cash - $20 for completing interviews and 
$2 for each National Household Travel Survey (NHTS) completion (up to 
$14). Payment will occur at the end of each data collection period. The total 

 
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amount participants can earn from this study is $102. Payments will be made 
in cash for in-person interviews, or virtual gift cards for web-based interviews. 
 
Participants in GPS subgroups will be offered the same honoraria to complete 
the data collection as participants who are not in a GPS subgroup. In addition, 
participants in the GPS subgroups will receive $30 for returning the GPS device 
and charger (or $20 if they return only the device) at the end of each GPS data 
collection time period for a potential total of $60. Participants will not receive any 
compensation if they return the charger but not the device. Payments will be 
made in cash for in-person interviews or virtual gift cards for web-based 
interviews. 
 
 
b) Inclusion and Exclusion Criteria 
Inclusion Criteria 
Individuals will be eligible to participate in the study if they:  
• are between the ages of 18 and 65 
• are diagnosed with a SMI (confirmed via the MINI) 
• score at least an 8 on a travel skills assessment 
• indicates that they can ride a bicycle 
• have expressed interest in using a bikeshare and public transportation 
• are able to provide informed consent 
 
 
Exclusion Criteria 
Individuals will be considered ineligible to participate in the study if they: 
• score less than 8 on a travel skills assessment 
• express no interest in independent transportation 
• are non-English speaking individuals 
• are unable to provide consent 
• are living in a setting where mobility and participation is restricted 
• have a limiting physical condition that would prevent their ability to ride a 
bicycle independently  
 
The inclusion and exclusion criteria are the same for the GPS subgroup, so 
long as participants do not opt out of being considered for a GPS subgroup 
at the time of initial consent. 
 
 
c) Study Timelines 
Enrollment will begin October 2023 and is anticipated to run through April 
2025. The intervention arms will run for 4 months. Because both intervention 
arms are individualized, enrollment will be rolling for participants. The 
staggered enrollment allows us to provide booster training for intervention 
staff in the winter months and avoid facilitating the intervention when travel 

 
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may be impaired by inclement weather. The estimated date for completion of 
the study is April 2025. Individual participants will be enrolled for 4 months, 
during which they will be participating in the interventions for 8 weeks and 
placed on a waitlist for 8 weeks. Participants are expected to complete 3 
interviews at the baseline (pre-intervention), 2 month, and 4-month time 
points. They will also be expected to complete seven days of phone surveys 
following each of these interviews.  
 
Enrollment timelines for the GPS subsample run concurrent to main study 
timelines and do not disrupt any main study activities. Participants will be 
recruited, consented, and assigned to their intervention group for the main 
study before GPS consent and activities begin. After participants are recruited 
and assigned, 20 of the participants from each arm will be randomly assigned 
to a GPS subgroup. These participants will meet again with research staff to 
go over the additional duties of being in the GPS subsample, consent to being 
in the subsample, and either receive a loaned phone from the research team 
or have a research assistant download the FollowMee software to the 
participants’ personal cell phone for their first of two GPS data collection time 
periods.  
 
The first data collection period occurs for 14 days during the time period 
between recruitment and the start of the intervention arms. Because of this 
two-week time requirement, we expect for there to be around a month 
between initial main study recruitment and the start of intervention arms to 
allow for sufficient time to consent and collect data from GPS subsample 
participants. The second data collection period will occur for 14 days after the 
intervention arms have completed all activities- approximately 1 to 2 weeks 
after the intervention arms finish their 8- week courses.  
 
Participants in the GPS subgroups are expected to be enrolled for 4 months, 
the same as participants not in the GPS subsample. Participants will have to 
meet briefly with research staff at the beginning and ends of each of these 
time periods to either pick up and drop off the loaned cell phones or have the 
FollowMee software downloaded on their personal cell phones. GPS 
subsample participants are still expected to complete all interviews, surveys, 
and intervention activities as the participants not in GPS subgroups.  
 
 
d) Study Procedures and Data Analysis 
Data Collection Procedures.  
Following consent, a research assistant will administer the baseline outcome 
questionnaires and collect demographic data.  Outcome measure interviews 
will be completed via face-to-face or web-based video call interviews at three 
time points: baseline, 2-month, and 4-months follow-up. Participants will 
complete an additional outcome measure, the NHTS, over the phone for the 
seven days immediately following each interview. To complete the NHTS, 

 
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participants will be instructed to document their daily travel activities over a 
week’s period by completing a daily travel log. A research assistant will then 
call the participant the following day and write down the participant’s self- 
reported previous day travel data from their travel log. All participants will 
complete a skills evaluation related to the intervention assignment as well as 
a treatment acceptability questionnaire to assess the acceptability of the 
assessment and intervention process. Data provided by the SEPTA 
KeyCard/Monthly Pass and Indego Pass regarding trip history will also be 
collected. 
 
GPS Data Collection 
Participants in the study will either be given cellular phones or use their 
personal cell phones with GPS tracking capacity. Specifically, FollowMee 
(www.followmee.com) software will be used for tracking the locations and 
movement of study participants over the two-week period that they have the 
phones. FollowMee has been used by individuals, government agencies, 
businesses, and researchers in order to track the location of family members, 
vehicles, employees, or study participants in real time. The software has also 
been used in several published studies that have attempted to track 
individuals in space and time. The software is compatible with most modern 
cellular phones, including Android phones and iPhones, and does real time 
tracking of the cell phones’ locations, which are stored as latitude and 
longitude coordinates or even actual street addresses. The locations are sent 
to a secure online database at one minute intervals, and the location at each 
recorded time is put on a map as a point. Information on battery level is also 
obtained at every measurement point. The online database may be accessed 
from a computer or any mobile device with an internet connection for 
monitoring purposes. With FollowMee’s extended tracking plan, the data will 
be stored on the server for 45 days, and may be downloaded in KLM (Google 
Earth) or .csv format, from which it could be converted to ESRI’s shapefile 
format. 
Because we will have multiple participants using cell phones with the 
software at any given time, we will be able to track all participants in our study 
with the help of a master account that will be created. A phone can easily be 
added to the master account by entering the master account code into the app. 
This way, we will be able to view and download each participant’s data through 
the master account, regardless of whether the participant chooses to use their 
own phone or a phone provided by the research team.   
FollowMee does not require a cell phone with an unlimited data plan, 
which is offered by several cell phone providers, and in particular Mint Mobile, 
which has a reasonably priced service plan. No action is required from the 
individual being tracked other than keeping the phone on, charging it, and 
carrying it with them. FollowMee automatically starts whenever the phone is 
turned on, and runs in the background. However, if the phone is turned off the 
tracking will stop. While this may be viewed as a limitation, we believe that this 
gives the participants control and the ability to stop tracking in situations where 

 
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they do not want to be tracked. However, in order to make sure that tracking is 
taking place, we will be able to check the status of GPS data collection by 
logging into the FollowMee website. Furthermore, we will be able to set e-mail 
alerts to inform us when there has been no tracking for a certain amount of time 
(e.g., 6 hours). In order to reduce participant attrition, increase participant 
adherence, and address missing data, we will contact participants every two 
days to remind them to keep their phone turned on and to troubleshoot any 
technical problems. 
As soon as the GPS data for every individual have been collected, and prior 
to the second interview, they will be downloaded as a .csv file and sorted by time. 
We will attempt to use the GPS data to determine the participants’ destinations. 
This information is available through FollowMee, but other algorithms that study 
investigators have developed in the past decade, including those described 
below, will be used as well.  
In past studies, GPS tracking often results in a substantial amount of 
missing data due to satellite, receiver, multipath and other errors that might occur 
with data collection (Brusilovskiy et al., 2016), and this necessitates thorough 
data cleaning before various mobility constructs may be created. Data cleaning 
involved three steps. The first was deduplication: in several instances, FollowMee 
data may have more than one GPS record per minute. Because those duplicate 
points were essentially indistinguishable from one another in terms of time and 
location, and could result in scenarios where there could theoretically be more 
than 60 points per individual per hour, only one record per minute was retained 
for each individual. The second step involved removing outliers. For a small 
number of participants there were occasional problems with GPS signal, such 
that a group of points that could technically be considered a cluster (i.e., a 
destination) would include one or more points that would be temporally part of 
the group, but spatially far away. For example, if points a, b and c were temporally 
consecutive points, then point b would be considered an outlier if: 1) the time 
between b and a (or b and c) was less than 20 min and the distance between 
them was more than 200 meters, 2) the time between b and c (or b and a) was 1 
min and the distance between them was more than 200 m, and 3) the distance 
between a and c was less than 200 m. The third step involved imputing missing 
data. If two consecutive points d and e were within 20 min and 200 m of one 
another, then we imputed the locations of up to 19 new points (one for each 
missing minute) between d and e through linear interpolation of the latitude and 
longitude of d and e.  
The same steps will be taken in the current study. Then, as in previous 
studies, we will exclude participants for whom the data cleaning and imputation 
procedures did not sufficiently enhance the completeness of their data to a point 
that was believed to be representative of their mobility based on the following: 1) 
they were missing at least 50% of the possible time points over the course of the 
tracking period, or 2) fewer than half of the days in the tracking period had at least 
50% non-missing data.  
In previous studies using GPS data, a spatio-temporal data mining 
algorithm, ST-DBSCAN (Birant and Kut, 2007) was employed to identify 

 
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destinations from GPS data using a custom-written R program. The algorithm 
depends on three parameters, set by the user, which are spatial distance, eps1, 
which we set to 200 meters, temporal distance, eps2, which we set to 20 min, 
and the minimum number of points necessary to form a cluster, minpts, which we 
set to 10. The algorithm forms density-based clusters; roughly speaking, this 
means that when there are at least 10 points which are within 200 m and 20 min 
of each other, the individual is in a cluster, or at a destination. Points which don't 
fall into a cluster are considered outliers, or transit points. A detailed study has 
been conducted on how these parameters are optimal and how the algorithm 
performs (Brusilovskiy et al., 2016). Because of missing GPS data, the number 
of clusters identified through ST-DBSCAN is usually an underestimate of the total 
number 
of 
destinations 
that 
the 
person 
visited 
over 
the 
tracking 
period. Brusilovskiy et al. (2016) also describe an additional algorithm that was 
developed to correct for this bias by modifying clusters generated by ST-
DBSCAN and creating new ones in the presence of missing data; this algorithm 
was also implemented in this study (Brusilovskiy et al., 2016). The constructs 
calculated from GPS data are summarized in the table below. The same 
processes will be used here, and the same variables will be calculated for the 
current study. 
 
 
Construct 
Description 
Destination Constructs 
Total number of 
destinations 
The number of destinations over the course of 13 full days of 
tracking was determined with ST-DBSCAN and the additional 
algorithm fully described in Brusilovskiy et al. (2016). 
Total number of 
non-home 
destinations 
Destinations whose centroids were within 200 m of the individual's 
geocoded home address were considered home destinations. The 
number of non-home destinations was calculated as the number of 
home destinations subtracted from the total number of destinations. 
Total number of 
unique 
destinations 
Because a person could visit certain destinations (e.g., home, 
work) more than once over the course of the tracking period, 
unique destinations were also identified. This was done by 
subjecting the centroids of each destination cluster to the DBSCAN 
clustering algorithm. DBSCAN has two parameters: distance 
between the input points (in our case, destination cluster centroids), 
which we set to 200 m, and the minimum number of points needed 
for a cluster to be formed, which we set to 2. This way, destinations 
that occur more than once are put into a “super-cluster” which is 
indicative of a unique destination, and destinations that only occur 
once are outliers in the DBSCAN analysis, and are also considered 
unique destinations. 
% days with 0 
non-home 
destinations 
We identified non-missing days as the days that had at least half of 
the data (720 min or more), and calculated the % of non-missing 
days that had 0 non-home destinations. 
Temporal Scope of Mobility Constructs 

 
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Construct 
Description 
Missing time 
The total amount of missing data time (in minutes) for an individual 
was computed as the sum of 1) 1440 min for each day with no data 
and for each day with only transit points, and 2) the amount of time 
(in minutes) elapsed between each pair of consecutive points which 
are more than 200 m and 120 min apart on all other days. This 
variable was used to compute the time spent at home and time 
spent outside of home. 
% Time spent 
outside of home 
The total time at home was calculated as the time between the first 
and last points at each home destination. The time out of home 
variable was computed as (Total tracking time of 18,720 min) – 
(Time at home + Missing time). % of time spent outside of home 
was calculated as (Time outside of home)/(18,720 min – Missing 
time) = (Time outside of home)/(Non-missing time). 
% Days where 
time spent outside 
of home is at most 
25% 
This variable was calculated as the number of days where the 
amount of time spent outside of home was at most 25%, divided by 
the total number of non-missing days (as defined above). 
Geographic Scope of Mobility Constructs 
Total Distance 
Traveled (km) 
The sum of distances between all temporally consecutive points, 
excluding the distances between points within a destination, was 
calculated. 
Median Daily 
Activity Space 
Area (km2) 
We calculated the median of the activity space areas for each non-
missing day. The activity space was the minimum convex polygon 
containing all of the individual's GPS points during that day. This 
variable is less affected by outliers than the total activity space 
area. 
 
 
 
Group Assignment 
Following baseline assessment, participants will be randomly assigned to 
either start the intervention program immediately, or be placed on an 8-week 
waitlist. Once randomized, the participant will again be randomized into a 
treatment condition: 1) peer-mediated bikeshare training intervention; or 2) 
peer-mediated public travel training intervention.  20 participants from each 
condition who have not opted out of being in the GPS subsample will be 
randomly assigned to be invited to a GPS subgroup. 
 
Interventions 
The interventions will utilize a common supports-technology. Intervention 
components will be facilitated by a certified peer support specialist and will 
support individuals with individualized route planning, modeling transportation 
behavior, skill development, and enhancing transportation self-efficacy.. For 
each intervention arm, the interventionists will complete a log of training 

 
Page 14 of 24 
 
activities, instructional methods, problems encountered, and length of time for 
each session.  
 
Six weeks following the 8-week intervention, intervention participants will 
participate in a 2-week booster comprised of discussing challenges and 
successes with the peer-support specialist. The 1-on-1 sessions will allow 
participants to plan additional routes, practice transportation skills, and 
navigate individualized issues. The individual interventions are explained in 
greater detail below.  
 
Arm 1: Peer-Mediated Travel Training for Bikeshare 
Participants in this intervention arm will participate in an 8-week bikeshare 
training program. To facilitate this, they will receive a 3-month membership 
card (valued at $5/month) to Indego, the bike sharing service in Philadelphia. 
The membership allows for unlimited hour-long rides and tracks various 
aspect of use including station location, trip frequency, and trip duration, 
allowing staff to monitor intervention and independent pass usage.  
 
The first intervention sessions will be aimed at increasing knowledge of the 
bike share program and the procedures for utilizing it successfully. Sessions 
will review topics such as bike safety rules and cycling laws, and will include 
time for practicing cycling skills. Then participants will meet with a peer 
support specialist, who will help facilitate individualized route planning and 
independent ride support. The 1-on-1 component will utilize reflection 
questions, so the participant can evaluate their own experience, promoting 
cognitive appraisal and affective evaluation. Peer support specialists will use 
motivational interviewing during these individual sessions in order to help 
participants identify personally meaningful motivations for participation and to 
enhance their sense of self-efficacy.  
 
Information from these 1-on-1 sessions will be recorded on individual cards 
which the participant can keep and use as a reminder and motivator to 
independently use bike share. Cards will include space to write down relevant 
Indego stations, important biking laws, a bike checkout checklist, and phone 
numbers of riding pals.  
 
Table 1. Bike Share Group and Individual Intervention Components 
Intervention 
Activity 
Description 
 
Orientation to 
Using 
Bikeshare 
 Participants will be introduced to the bikeshare 
program. Topics include: bike rules & laws, safety 
issues, inspecting the bike, bikeshare program 
membership information and rules, street safety, and 
practical skills riding 
 
 

 
Page 15 of 24 
 
 
 
 
Arm 2: Peer-Mediated Travel Training for Public Transportation 
An established travel-training program developed for individuals with 
disabilities, including those with SMI, serves as the curriculum for the public 
transportation intervention arm. Participants will receive a 3-month pass (a 
Keycard, or 3 SEPTA Monthly Passes) to SEPTA, the public transportation 
provider in Philadelphia and surrounding areas. The Kennedy Center 
developed a comprehensive curriculum to teach the skills needed to be an 
independent traveler on public transportation using a sequence of basic 
competencies that are mastered through group and individualized instruction 
in real-life environments. The curriculum provides instruction in the following 
seven core areas, which are described in Table 2 below. We will offer an 8-
week intervention which will include instruction on foundational skills needed 
to travel on public transportation and 1-on-1 direct training in using public 
transportation. Participants will meet twice weekly for direct instruction and 
role-playing sessions to cover the core components and the latter weeks of 
intervention will be focused on individual travel training instruction provided by 
the peer support interventionists, with participants and peer support 
interventionists meeting for two travel trips each week.  
 
Table 2: Public Transportation Arm Group Intervention Components 
Intervention 
Component 
Description 
Facilitator-led 
Rides 
The recreational therapist will facilitate rides in order to 
increase participants’ competence using the bikeshare 
and raise awareness of community resources 
 
 
Participant-led 
Rides 
Participants who have completed 5 rides will be invited 
to help plan and lead additional rides. These rides will 
be organized around areas of interest for the 
participant, such as trips to community events or 
locations like the movies and grocery store 
 
 
Route 
Planning 
Participants will meet with the peer support specialist 
to identify key destinations. The peer support 
specialist will provide support to map bikeshare 
stations in relation to key destinations. Once key 
stations and destinations are identified, planning to 
identify safe routes will occur 
 
 
Ride Support 
Participants will receive 1-on-1 support focused on 
practicing way-finding skills and increasing their 
overall increase confidence on bike rides  
 
 

 
Page 16 of 24 
 
Interacting 
with 
Individuals in 
the 
Community 
Participants will learn to communicate with transportation 
staff and other riders. They will be taught how to act in an 
emergency including how to: 
• identify emergency workers/vehicles and strangers 
• identify situations that requires emergency help 
• contact an emergency number or 911 
• provide personal contact information in an emergency 
 
Pedestrian 
Safety & 
Awareness of 
Surroundings 
Participants will learn to identify safe behaviors necessary 
for walking in the community, near streets, and while 
crossing the streets 
 
Trip 
Preparation 
Participants will discuss topics related to trip preparation, 
including: 
• identification of transit vehicles, signs/amenities at 
stops and on vehicles 
• Identification of weather appropriate dress and items 
appropriate to carry in community when travelling. 
• Understanding and identifying basic public 
transportation rules  
 
Travel 
Practice 
Peer support specialists will take participants on 
supervised public transportation rides, focusing on 
ensuring participants know how to follow basic transit 
rules, identify transit vehicles, and practice good transit 
etiquette. 
 
Expect the 
Unexpected 
Participants will work together to identify different types of 
situations encountered during community travel and 
identify/implement strategies for problem-solving transit-
related challenges. 
 
Route 
Planning 
Participants will meet with a peer support specialist to 
identify key destinations. Once key stations and 
destinations are identified, planning to identify safe routes 
will occur. 
Individualized 
Travel 
Training 
Participants will receive individualized 1-on-1 support 
focused on what the participant’s specific public 
transportation needs are in order for them to access self-
determined community activities. The peer-interventionist 
will model skills and help in the travel planning process. 
When the participant feels confident, they will take the 
lead in travel activities with shadowing from the peer 
interventionists  
 
 

 
Page 17 of 24 
 
 
Measures 
Inclusionary Measures 
1. The Mini-International Neuropsychiatric Interview (MINI) is a short 
diagnostic interview used to determine if an individual meets the DSM 
criteria for SMI, which is one of the study’s main inclusion criteria. The 
MINI demonstrates good sensitivity and specificity for all diagnoses as 
well as inter-rater and test-retest reliability (Sheehan et al., 1998). 
 
2. The Travel Skills Assessment tool, a modified version of the Kennedy 
Center’s Pre-Screening Travel Assessment (2012), identifies pre-requisite 
and foundational skills deemed essential for safe travel. Participants with 
scores of 7 or below are considered not ready for travel training so 8 will 
be used as a cut score for study inclusion. The tool was originally used 
with a large number of individuals to determine a cut score of half the 
maximum # of points, and this scoring system has been maintained in our 
modified version, which has a reduced number of questions to reflect the 
eligibility criteria of this study. 
 
3. Additionally, a Bicycle Interest Survey will be used to assess participants’ 
bike skills and levels of interest in learning to use a bikeshare program. 
Those with no interest in using bikeshare and those who have never 
ridden a bicycle will be excluded. 
 
Treatment Arm- Transportation Usage Data 
1. Indego Membership Card Data: Each Indego membership card will be 
associated with a participant in the bikeshare intervention arm. Indego 
can generate a membership report for each bikeshare participant which 
will include trip origin location, trip destination, total number of trips taken, 
and trip durations.  
 
2. SEPTA Keycard/Monthly Pass Data:  Each SEPTA Keycard/Monthly 
Pass has a unique identifying number that will be connected to a 
participant in the public transportation arm. SEPTA will generate a report 
for each public transportation participant which will include transportation 
mode (i.e., train, bus, trolley, subway), trip origin location, and total 
number of trips taken.  
 
Outcome Measures.  
Outcome measures will focus on trips, community participation, activity 
space, and transportation self-efficacy. Trips for the whole sample will be 
assessed via the NHTS. Community participation for the whole sample will be 
assessed via the TUCP, NHTS, and through GPS for the GPS subsample.  
 
In addition to the measures identified in the parent study, participant 
location and movement will be tracked with a GPS enabled cell phone, which 

 
Page 18 of 24 
 
will enable the evaluation of community mobility and participation as pilot 
intervention outcome measures. Specifically, measures of community mobility 
and participation calculated from GPS data will include 1) the area of the 
participant’s activity space (defined as the local areas within which people 
move around during the course of their day); 2) total distance traveled; 3) 
number of destinations, number of non-home destinations, and number of 
unique destinations; and 4) amount of time spent at home, outside of home, 
and in transit. 
 
 
The study instruments will include: 
 
Primary Outcome Instruments 
 
1. The Transportation Appraisal Scale (TAS) scale measures transportation 
self-efficacy, the belief a person has that they are capable of successfully 
completing tasks needed to travel independently. The scale was 
developed for the purpose of this study based on guidelines from 
Bandura’s Guide for Constructing Self-Efficacy Scales, along with the 
Kennedy Center’s travel training curriculum. The TAS has 18 items with a 
10-point interval rating scale ranging from 0 to 100.  Rating descriptors 
range from “cannot do at all” (0) to “highly certain can do” (90-100). The 
scale provides a total raw score.  
 
2. The Temple University Community Participation Scale (TUCP) assesses 
self-reports of community participation in 26 different areas including going 
to a supermarket, participating in a community social group (like a book 
club or recreational sports team), going to a movie, or working for pay. 
Participants are asked to indicate the number of days in the past 30 days 
that they participated in each of the 26 areas, whether each participation 
area was important to them, and whether they felt they participated in 
each area enough, not enough, or too much. Several measures of 
participation may be created using the data collected with this instrument, 
including 1) total number of participation days in all 26 areas (ranging 
between 0 and 26*30=780 days), 2) total number of different areas in 
which the individual participated at least once (ranging between 0 and 26 
participation areas), and 3) total number of different areas that the 
individual considered important in which he or she participated at least 
once (ranging between 0 and 26 participation areas). Recent research has 
found the measure to be reliable and valid.  
 
3. The National Household Transportation Survey (NHTS) is a survey used 
to assess destinations an individual visited during the day, the mode of 
transportation they used, the amount of time spent in transit, the number 
of individuals they traveled with, and the primary activity at each location. 
In addition to the standard form, the research assistant will ask about 

 
Page 19 of 24 
 
instances where transportation was not available and what activities were 
prevented. Each day during the weeklong assessment period, a research 
assistant will call participants to complete the modified version of the 
NHTS. Participants will receive a NHTS travel log and will be instructed to 
document their travel on the identified days. The research assistant will 
then call the participant the next day to record the previous day’s travel. 
While not designed specifically for individuals with SMI, this measure has 
been successfully used in the pilot bikeshare project.  
 
4. The PERMA profiler assesses how an individual views their own life by 
asking questions designed to measure 5 different facets of wellbeing - 
positive emotion, engagement, relationships, meaning, and 
accomplishment. It consists of 23 questions, 15 of which are relevant to 
specific PERMA areas (3 per each domain) and 8 of which are general 
filler questions. The PERMA profiler has demonstrated acceptable validity 
and model fit to the PERMA framework. In this study, PERMA scores will 
be examined across time points to determine if travel training and 
increased mobility effect participants’ own perceived well-being. 
 
5. The UCSD Performance Skills Assessment (UPSA) is a tool designed to 
measure the functional capacity of individuals with serious mental 
illnesses. One section of the UPSA is a transportation skills assessment. 
An adapted version of the UPSA will be used to assess public 
transportation skills. Additionally, we have developed a similar measure to 
assess bicycle transportation skills. 
6. Transportation skills: Using a series of public transportation skills 
assessments and bicycle skills assessments, we have developed a 
measure to assess an individual’s perceived skills to use each mode of 
transportation.  
7. GPS: GPS devices with tracking capacity will be provided to participants. 
Specifically, the FollowMee application is used for tracking the locations 
and movement of study participants. FollowMee collects data from GPS 
satellites in ten-second to ten-minute intervals and then uses cellular data 
networks to send the information to dedicated servers. During the daily 
phone calls to administer the NHTS use survey, research staff will also 
remind the participants to charge either their phone or the loaned phone 
and keep it with them, although they will not encourage the participants to 
travel. GPS data is collected during pre-test and the 2 month post-test 
periods to ensure feasibility related to costs and burden to participants. 
 
 
Secondary Outcome Instruments: In addition to the primary outcome measures, 
a series of common assessment tools will be used to assess psychosocial and 
health related outcomes in areas such as: self-reported physical activity; self-
reported sedentary activity; quality of life; coping skills; group identity; recovery; 
loneliness; and perceived health.  

 
Page 20 of 24 
 
 
 
 
Additional Measures 
In addition to the outcome measures, we will assess factors that may influence 
treatment outcomes. These include neighborhood factors; health status; stigma; 
demographics (age, race, gender, socioeconomic status, employment); and 
motivation to change.  
 
Treatment Acceptability 
In order to assess treatment acceptability, the following measures will be used to 
assess the experimental participant’s perception of the intervention arms.  
 
1. The Treatment Acceptability Questionnaire (TAQ) will completed by 
participants in the experimental arms at the last data collection point (6-
mo). This 6-item questionnaire uses a 7-point scale and will be modified to 
reflect the peer-mediated travel training intervention. The TAQ was 
developed specifically for evaluating acceptability of behavioral health 
interventions and its internal consistency, reliability, and concurrent validity 
are all high.  
2. Open-ended questions about the intervention: Perceived effectiveness, 
recommendations, and appropriateness for others with mental health 
conditions.  
 
Data Analysis 
The following variables will be calculated for each participant: 1) total number 
of destinations, 2) total number of unique destinations, 3) total number of non-
home destinations, 4) area of the activity space (defined as the minimum 
convex polygon containing all of the individual’s destination or in-transit points 
in the study period), 5) total distance traveled, 6) total number of days on 
which the participants left the house, and 7) total number of destinations that 
are more than 1 mile away from the participant’s home address. Destination 
variables are considered a component of the community participation 
outcome, and distance traveled is grouped under the trips outcome. 
 
Participants in the GPS subgroups will be included in any data analysis that 
calculates individual variables or looks across groups in the study. In addition, 
over-time differences (baseline—follow-up #1) on each GPS variable will be 
calculated for every participant being tracked with GPS. ANOVA tests will 
then be used to compare group means on each variable.  
 
 
Treatment Outcomes 
A random effects ANOVA on repeated measures data in PROC MIXED (SAS) 
will be used to compare intervention groups on the number of trips in the 

 
Page 21 of 24 
 
community, community participation, and self-efficacy over time. ANOVA 
tests will then be used to compare group means on each variable.  
 
In addition, we will attempt to examine whether self-efficacy mediates the 
relationship between the interventions and community participation over time 
by using an enhanced version of the techniques proposed by Baron and 
Kenny (1986). Consistent with the mission of and expertise available at our 
center, we will also conduct post-hoc exploratory analyses that look at how 
the effectiveness of the intervention is impacted by environmental factors, 
such as walkability, bike-ability, and availability of transportation. While such 
data can be obtained from various secondary sources based on the 
participant's address, we will likely not have sufficient power for these 
analyses. 
 
Treatment Acceptability.  
The mean of the total TAQ scale and the means of each TAQ item will be 
calculated. Means between 6 and 7 suggest high acceptability, means between 
4 and 5 suggest moderate acceptability, and means less than 4 indicate an 
unacceptable intervention.  
 
e) Withdrawal of Subjects 
If a participant enrolls in the study and later choose to withdraw, they 
may do so without any penalty or consequences. They can withdraw 
by telling staff by phone, email, or in person that they are no longer 
interested in participating. The research coordinator will confirm the 
withdrawal request with the participant, and he or she will no longer be 
contacted about the study. Participants assigned to the transportation 
intervention arms will no longer be able to participate in the study-
related intervention but withdrawal will not affect any other services the 
person may receive. Participants may choose to withdraw from a GPS 
subgroup and still participate in the parent study. If a participant 
withdraws during a data collection time period, they will be asked to set 
up a meeting to return the device and charger. The research 
coordinator will then confirm the withdrawal request with the 
participant, and he or she will no longer be contacted about doing the 
GPS portion of the study. Data collected prior to withdrawal or removal 
of participants will be kept on file and may still be used in data 
analyses. Participants who lose the loaned device will remain part of 
the main study but will be withdrawn from the GPS subsample. 
Participants may be removed from the study if they appear under the 
influence of drugs or alcohol, or if they exhibit hostility toward others, 
including staff and peers, at any time during activities associated with 
the study, including recruitment, consent, interviews, and intervention 
classes. Data collected prior to withdrawal or removal of participants 
will be kept on file and may still be used in data analyses. This same 

 
Page 22 of 24 
 
procedure for data storage will also apply to KeyCard/Monthly Pass 
and Indego Pass data, for which data collection will occur up until the 
point of withdrawal or removal of participants and cease thereafter.  
f) Privacy & Confidentiality 
The study team has placed safeguards to maintain the confidentiality of 
participants’ personal information. Completed interviews will be labelled with a 
coded identification number and separated from any identifying personal 
information to prevent loss of confidentiality. Personal information will only be 
kept electronically in password protected files and hard copies will be stored 
in locked cabinets at the TU Collaborative on Community Inclusion, located at 
1700 N Broad Street, Philadelphia. Research staff will be the only people with 
access to personal information, with the exception of authorized 
representatives from the Temple University Institutional Review Board (IRB), 
the office for Human Research Protections, and the Philadelphia Department 
of Public Health IRB, all of whom are required to have access by law. The 
same confidentiality protocols will be followed for participants’ “Consent to Be 
Contacted About Future Research Studies” responses. Study files will be kept 
for seven years after the last publication of the data. Any information about 
child abuse or intent to harm self or others will be reported to authorities, as is 
required by law. Efforts will be made to limit personal information to people 
who have a need to review this information.  
 
For the GPS subgroup, only authorized members of the research team will 
have access to participant location information during the data collection 
period. Since the Temple University Collaborative pays for the devices, and 
participant names are not on any online payments or contracts, there is no 
way for FollowMee to connect individual participants to their GPS data. 
Neither the research team nor FollowMee will disclose location information 
without permission, unless required by law, subpoenas, warrant, or court 
order. After the end of each two-week data collection period, a member of the 
research team will download the data from the FollowMee database and store 
it in a password protected file on a Temple University computer. FollowMee 
automatically deletes location data from their online database 1 year after 
service suspension, but the data can be cleared at any time at the request of 
the research team.  
 
 
All published reports will contain data reported in aggregate form (where no 
individual responses can be identified), and individual examples will be 
presented so that identification is impossible. De-identified data may be 
shared with other researchers, research institutions, or research databases 
for use in other studies. Per funder regulations, at the completion of the study 
all deidentified data will be transferred to ICPSR 
(https://www.icpsr.umich.edu/icpsrweb/) so that data can be used by others 
for additional analysis. Participants may request to have their data destroyed, 
but are notified at consent that de-identified data that has already been 

 
Page 23 of 24 
 
shared cannot be taken back or destroyed. Since there are no clinically 
relevant research results expected from this study, researchers will not be 
disclosing research results to subjects. Participants are notified in the consent 
form that publications using data from this study can be found online or can 
be requested from the Temple University Collaborative for personal use. 
 
 
9) Risks to Subjects 
All participant information collected for this study will be treated as confidential 
and protected by study staff to the best of their ability. To prevent disclosure of 
sensitive participant information, the study staff will follow the steps to ensure 
confidentiality which have been listed out in the “Privacy and Confidentiality” 
section above.  
 
The outcome measures used ask about topics which might be distressing, 
triggering, embarrassing, or uncomfortable to some participants, including topics 
such as diagnoses, symptoms, and quality of life. Participants will be told at the 
beginning of each interview that such questions are included and that they have 
the right to decline answering any question or discontinue the interview at any 
point in time if it causes them too much discomfort. Participants who appear to be 
significantly impacted or distressed by questions will be encouraged to seek help 
from an emergency department or from their medical provider. 
 
Participants will be given study related information, materials, and bicycle items, 
which may unintentionally reveal their participation in the study. As the 
transportation interventions take place in community locations, there is also a risk 
that participants may be seen by others during group rides and classes. To 
lessen this risk, staff will limit discussion the project to the transportation training 
aspects and omit discussion of mental health aspects when in a public 
community spaces. Staff will not disclose that the project is designed for people 
with mental health diagnoses to non-staff members.   
 
Due to the inherent risks associated with riding a bike, using public 
transportation, being near traffic, and the potential for falls, there is a possible 
risk of injury for participants. Such risks will be decreased with safety classes and 
opportunities to practice skills in a safe/supervised environment. If participants 
are injured during intervention activities, intervention staff will work with the 
participant to evaluate the severity of the injury. When necessary, intervention 
staff will assist and/or encourage the participant to seek medical treatment. All 
injuries will be reported to research staff. There is no commitment by Temple 
University, Temple University Health System or its subsidiaries to provide 
compensation or free medical care to participants in the event of a research-
related injury. 
 
10) 
Potential Benefits to Subjects 

 
Page 24 of 24 
 
While benefits cannot be guaranteed, participation in the intervention arms may 
lead to increased skills and usage of public transportation and bike share, 
contributing to increased community participation, and improvement in recovery 
efforts and overall wellbeing.  
 
11) 
Costs to Subjects 
There are no required costs to participate in this study.  
12) 
Informed Consent  
Research specialists will be responsible for obtaining consent from individuals 
who wish to participate in the study. In addition to being a part of the main study, 
GPS subsample participants will go through a secondary consent process to 
become part of a GPS subgroup. Research specialists will be responsible for 
obtaining consent from individuals who wish to participate in a GPS subgroup. 
Research staff will meet with interested individuals and read over the consent 
form with them at an approved study site or over a web-based call. Interviews will 
be conducted in private rooms to ensure confidentiality. Research specialists 
from the TU Collaborative receive extensive training related to data collection 
activities including completion of the CITI online trainings and assessments, TU 
Collaborative human subjects training, and signed confidentiality agreements. TU 
Collaborative training includes ethical principles in research (including a review of 
the Nuremberg Code, Belmont Report, and HIPAA), cultural competency, and 
project management (including procedures for recruitment, data collection, data 
entry, and data storage).  
 
 
 
Our informed consent procedures make it clear that study participation is 
completely voluntary and that participants may withdraw from the study at any 
time. After reviewing the consent form, the research specialist will make an 
assessment of their ability to understand and recall the following issues: what 
participants are asked to do, data collection procedures, and the nature of 
confidentiality. Perfect recall is not expected and prompts are given to facilitate 
recall. Poorly recalled information will be targeted when reviewing the informed 
consent form and study procedures. Once the potential participant is able to 
recall pertinent information about the study without prompts they are viewed as 
being able to give informed consent. If following a review of the consent and 
study procedures and multiple prompts the participant is still unable to grasp the 
nature of the study then they will not be consented or allowed to participate in the 
study.