Automated Mobile Phone-Based Mental Health Resource for Homeless Youth: A Pilot Study Assessing Feasibility and Acceptability (Preprint)
Authors: Glover Angela C. , Winiarski Dominika A. , Schueller Stephen M. , Zalta Alyson K. , Karnik Niranjan S. 
Published: March 2019

BACKGROUND

Youth experiencing housing instability (e.g., homeless or marginally housed) have higher rates of mental health problems than their housed peers. Mobile technologies have often been touted for their potential to reduce health disparities and reach people who might not otherwise receive services. Few studies have developed and evaluated technological resources for these populations to determine how to effectively engage and reach them.

OBJECTIVE

The primary aims of this pilot study are to establish the feasibility and acceptability 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 an Android smartphone with a 3-month data plan. The phone was pre-loaded with several smartphone applications designed to promote mental health wellness, and an app designed to provide real-time resources for homeless individuals in Chicago. One app specifically designed for this study, Pocket Helper, sent participants a daily surveys and tips via push notification. Tips focused on coping and motivation, and surveys assessed mood. Pocket Helper 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, and a crowd-based emotional support tool. Participants completed assessments at 3 and 6 months to assess changes in self-reported mental health symptoms, substance use, risk behaviors, psychological resources and strengths, and life satisfaction, as well as to provide feedback on and benefit from the intervention.

RESULTS

Participant satisfaction varied with the different apps. The majority of youth preferred daily tips (40.5% at midpoint, 41.2% at endpoint) and surveys (48.6% at midpoint, 41.2% at endpoint). At midpoint, participants least preferred the Illinois Warm Line and daily surveys (29.7% and 21.6%, respectively), though Koko was close behind (18.9%). At endpoint youth least preferred the Illinois Warm Line and Koko (35.3% and 23.5%, respectively). Overall, over 70% of respondents both time points reported benefiting from the intervention. Participants reported a preference for daily push features like the daily survey and tips, but reported lower engagement with other tools, such as those requiring them to open certain apps themselves interact with other users.

CONCLUSIONS

This set of 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 involved engagement. We plan to conduct focus groups with youth who participated to better understand their attitudes toward various components of the intervention. Future research should explore ways to retain homeless youth in these types of interventions, or evaluate whether briefer interventions are more feasible in this population.

CLINICALTRIAL

ClinicalTrials.gov Identifier: NCT03776422