Automated Mobile Phone–Based Mental Health Resource for Homeless Youth: Pilot Study Assessing Feasibility and Acceptability
Authors: Glover Angela C , Schueller Stephen M , Winiarski Dominika A , Smith Dale L , Karnik Niranjan S , Zalta Alyson K 
Published: September 2019

Background
Youth experiencing housing instability have higher rates of mental health problems than their housed peers. Few studies have evaluated technological resources for homeless youth 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 (ie, participant ratings of resources) of delivering automated mental health resources via smartphone technology.

Methods
Youth aged 16 to 25 years (N=100) were recruited through homeless shelter agencies in the Chicago metropolitan area. Eligible participants completed a baseline assessment and received a smartphone with a 3-month data plan. The phone was preloaded 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. The tips focused on coping and motivation, and the surveys assessed mood. This app also included an automated self-help system with brief cognitive behavioral interventions (5-10 min) 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%, 23/100) experienced problems with the phones (eg, theft, loss, and technological issues) throughout the study. Participant retention at the midpoint was moderate, with 48% (48/100) of youth responding to the 3-month surveys. At 6 months, only 19% (19/100) of the total sample responded to the end point survey. Overall, 63% (30/48) to 68% (13/19) 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. 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 support. The 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.

Trial Registration
ClinicalTrials.gov NCT03776422; https://clinicaltrials.gov/ct2/show/NCT03776422