Mobile Health Solutions for Behavioral Skill Implementation Through Homework
Condition: Mental Health Wellness 1
Study type: Interventional

Summary: 
      The goal of this two-year R34 treatment development grant is to develop a mobile health
      (mHealth) application that will both advance theory in and clinical practice of homework (HW)
      implementation.

      HW can be described as between-session exercises where the client practices specific skills
      learned within-session in order to promote skill acquisition, which ultimately leads to
      improved acute- as well as longer-term therapeutic benefits on targeted outcomes,
      generalization of treatment effects and maintenance of treatment gains. Despite data
      demonstrating that HW is critical to achieving maximal benefits from evidence-based
      treatments, very little theory-driven approaches have been conducted focusing on improving
      the HW process. Through utilizing self-determination theory as a guiding framework and
      integrating principles from the field of "gamification" and goal-setting, the aim is to
      develop a two-component mHealth HW application (My MFG).

      The first component focuses on delivering HW via a highly engaging, multiplayer, interactive,
      cooperative, and skill-building game platform aimed at improving the "Design" and "Do"
      process of HW. The second component focuses on targeting factors putatively related to poor
      HW implementation within the "Do" process.

      The process of the development of My MFG will be guided by the clinic and community
      development model and iterative software development process to maximize the feasibility and
      sustainability of My MFG within practice settings often characterized by limited resources.
      Findings from this study have broad implications for evidence-based treatments for youth and
      adult mental health disorders that emphasize HW as the link between treatment and
      improvements in targeted outcomes.
    

Detailed description: 
      The aim of the proposed study is to develop a theory-informed mobile health (mHealth)
      application for urban caregivers attempting to improve their children's oppositional and
      conduct related difficulties (i.e., disruptive behavior disorders; DBDs). The majority of
      evidence-based treatments (EBTs) targeting youth DBDs emphasize change in specific
      parenting/family-level processes empirically linked to the maintenance of DBDs. Existing EBTs
      frequently include at-home-practice-exercises (i.e., homework; HW) to reinforce parent skill
      acquisition and maximize use of new skills with children at home. Poor quantity and quality
      of HW completed by parents significantly attenuates the effect of EBTs. This is a significant
      limiting-factor in many EBTs attaining full public health impact. Given the robust effect of
      HW on outcomes from EBTs across a range of behavioral health difficulties and populations,
      there is a call for moving beyond the question of whether HW is important to questions such
      as what processes are involved in HW implementation and how best to support these processes.
      Minimal investigation has been focused on these critical questions.

      A model of HW has recently been proposed to better understand the process of HW
      implementation, as well as guide critically needed supports for at-home practice exercises.

      This model proposes four HW processes:

        1. Designing;

        2. Assigning;

        3. Doing, and;

        4. Reviewing.

      The DADR model proposes that specific social, cognitive and behavioral factors related to the
      HW task, as well as to the provider and the adult caregiver may affect the quality of each
      phase and ultimately to the quantity and quality of HW completed. Methods to better
      understand, support, and impact these processes are essential to advancing theory and
      offering solutions to HW completion.

      Through features available on smartphones (e.g., camera/video/voice recording; simple message
      service; internet-access; global positioning system), there are novel methods to interface
      with and support clients outside of defined treatment sessions. Through the use of these
      features, mHealth applications can be used to engage, educate, connect, track, and remind
      clients. These applications can use push (send communications) or pull (client's access tools
      on their own) mechanisms to engage the client in behavioral change activity. mHealth
      applications that integrate push and pull methods offer a significant opportunity to enhance
      outcomes across a range of health and behavioral health challenges and populations.

      The goal of this two-year R34 treatment development grant is in response to RFA-MH-13-061
      (Harnessing advanced health technologies to drive mental health improvement) to develop a
      mHealth application that will both advance theory in and clinical practice guided by the DADR
      model of HW implementation. Specifically we aim to utilize mHealth to improve the "Design"
      and "Do" process of HW within the context of the Family Groups for Youth with Behavioral
      Difficulties (MFG) intervention, an EBT for DBDs in youth and their families who seek
      assistance at outpatient mental health clinics in urban communities. To date, efforts at
      utilizing mHealth within the context of HW have been minimal and have not taken a systematic,
      theory-driven approach, thereby limiting the advance of knowledge and clinical application.
      Through utilizing self-determination theory as a guiding framework and integrating principles
      from the field of "gamification" and goal-setting, the aim is to develop a two-component MFG
      mHealth HW application (My MFG). The first component focuses on delivering MFG HW via a
      highly engaging, multiplayer, interactive, cooperative, and skill-building game platform
      aimed at improving the "Design" and "Do" process. The second component focuses on targeting
      factors putatively related to poor HW implementation within the "Do" process.

      The process of the development of My MFG will be guided by the clinic and community
      development model and iterative software development process to maximize the feasibility and
      sustainability of My MFG within practice settings often characterized by limited resources.
      The specific aims of this project are to:

        1. Develop My MFG through an iterative process informed by the perspectives of key
           stakeholders

        2. Determine the impact of MFG plus My MFG relative to MFG-alone on the DADR process and HW
           quantity and quality. It is hypothesized that the MFG plus My MFG will result in:

             1. Greater quality of the "Design" and "Do" process rated by therapists, parents, and
                independent coders

             2. Greater quantity and quality of HW assignments rated by therapists and parents

             3. Greater quality of the "Review" process as rated by therapists, parents, and
                independent coders as a function of improved HW quantity and quality

             4. Greater satisfaction with treatment as rated by the parent, target child, and
                therapists NIMH has specifically called for acceleration of research to maximize
                the ability of current treatments to reduce symptoms, improve adherence and
                functioning while improving quality of and lowering the cost of care. The mHealth
                application and methods proposed herein serve as systematic, theory-driven
                approaches to significantly advance understanding of how best to support the HW
                process-a common element of many EBTs across various disorders and
                populations-ultimately resulting in greater effectiveness of EBTs, maintenance and
                generalization of behavioral skills learned during EBTs.
    

Intervention name(s): MFG plus MyMFG
Intervention type(s): Behavioral
Intervention description(s): Specific aim is to utilize mHealth to improve the "Design" and "Do" process of HW within the context of the Family Groups for Youth with Behavioral Difficulties (MFG) intervention, an EBT for DBDs in youth and their families who seek assistance at outpatient mental health clinics in urban communities.
The first component focuses on delivering HW via a highly engaging, multiplayer, interactive, cooperative, and skill-building game platform aimed at improving the "Design" and "Do" process of HW. The second component focuses on targeting factors putatively related to poor HW implementation within the "Do" process.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mental Health Services