Clinical trial NCT02320903: Using Mobile Technology to Enhance Multisystemic Therapy (MST) Outcomes
Official title: Phase I - Using Mobile Technology to Enhance MST Outcomes (VillageWhere)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Child Behavior Disorders
Keywords: Criminal Justice
Juvenile Delinquency
Lead sponsor: Evidence-Based Practice Institute, Seattle, WA
Sponsor class: INDUSTRY
Collaborators: name: National Institute of Mental Health (NIMH)
name: Medical University of South Carolina
First posted: 2014-12-19
Enrollment: 88
Sex: ALL
Minimum age (years): 13
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The goal of the current trial is to assess the feasibility of a newly developed prototype of a cell phone app called VillageWhere. VillageWhere is designed to improve clinical outcomes of youth with externalizing behavioral problems by improving parental monitoring of youth whereabouts and activities while increasing the delivery of rewards to teens for good behavior. This Phase I Small Business Innovation Research (SBIR) proposal seeks to develop and conduct initial feasibility testing of the VillageWhere prototype. The primary features of the prototype include location monitoring via smartphones' global positioning system (GPS) functionality as well as facilitating teen self-appraisal of meeting behavioral expectations. Good behavior is rewarded with points that are tracked by the app and can be used to redeem for real-world rewards. The investigators will conduct an 45-day open trial (N=20 caregiver/teen dyads) to assess use, feasibility and acceptability for teens involved in the juvenile justice system or otherwise struggling with externalizing behavioral problems. Caregivers and teens will be assessed at baseline, before receiving the app, and at the end of the app use period (45 days). The therapist of each caregiver/teen dyad will also be assessed at the end of the app use period. Primary outcomes include: use of app features, monitoring of teen behavior and whereabouts, delivery of real-world rewards, and feasibility and acceptability. Secondary outcomes include: parenting behaviors, externalizing teen behaviors and internalizing teen behaviors.

Detailed description: VillageWhere was pilot tested with a sample of 16 youth and their primary caregiver participating in an EST for a serious conduct problem (Mean age 14.6 years, 52% male, 56% African American, 33% were previously arrested). After completing baseline self-report measures, dyads used the app as desired for 4 weeks, then participated in a post-assessment and qualitative interviews. App usage by both parents and youth was high with little diminished use over the four weeks of the trial. All parents set and used reinforcers for functional behavior and used the "find my teen" feature; 84% set geolocation expectations for youth's whereabouts at specific times; and 88% set other expectations for the youth (e.g., finish homework), viewed notifications, and regularly used the "Find My Teen" feature. As expected, parents interacted with the app frequently: 2.4 times per day. Youth used the app on average four times per day. All youth earned and redeemed points for complying with their parent's expectations and routinely viewed their behavior plans (93.3%) and feedback notification messages (86.7%). Parents did not on average use coaching videos (20%).

Although the study was not powered to detect statistical significance, a series of paired t-tests were conducted to examine pre- to post-changes on self-report measures. Changes for parents and youth all were in predicted directions, with effect sizes ranging from small to high (average d = .42, range .21-.80). Parents reported greater use of positive parenting behaviors (i.e., rewards and praise), greater discipline consistency, lower overall perceived stress, a higher feeling of influence over youth behavior, and greater parenting efficacy. Youth reported increases in parent use of positive behaviors, consistency, and knowledge of whereabouts. Parent- and youth-reported change in youth aggression and rule-breaking (as measured by the CBCL/YSR).

Qualitative results were also positive. Using 7-point scales, parents and youth reported on app satisfaction three times/week. Parent ratings were high (M = 6.0) across items (e.g., "The app was helpful today," "I have ways to intervene with my teen"). Youth satisfaction scores were also high (M = 6.1; e.g., "My parent is noticing \& rewarding my good behavior;" "I liked getting app prompts \& reminders"). Parents reported that the app helped them trust their youth, increase their use of rewards, and made giving rewards easier; they also reported a reduction in youths' "excuse-making." Youth perceived that the app allowed them more freedom, because parents had an objective way of verifying their whereabouts. Nearly all youth (89%) liked that their parent was more consistent in paying attention to their positive behaviors and rewarding them for it (versus only being punitive). Both parents and youth described significant improvements in their relationship.

In addition, 16 therapists working with the parent-youth dyads also gave qualitative feedback that was highly positive. Therapists stated that they liked the extra accountability the app afforded to teens and the reduction in parent-youth communication issues.

Eligibility criteria: Inclusion Criteria:

* Teen: English speaking, between ages of 13 and 17, juvenile justice involvement and/or externalizing behavioral problems, currently in treatment and will remain in treatment for duration of trial
* Caregiver: English speaking, owns Android smart phone, currently in treatment with their teen and will remain in treatment for duration of trial

Exclusion Criteria:

* N/A

Primary outcomes:
measure: App Usage - Parent Set up / Modified an App-based Behavior Plan for the Teen
timeFrame: up to 45-days
measure: App Usage - Set up and Allocated / Earned Points (Rewards) for Positive Teen Behavior
timeFrame: up to 45-days
measure: App Usage - Parent Set Geolocation Expectations for the Teen.
timeFrame: up to 45-days
measure: App Usage - Viewed Notifications Regarding Behavioral Expectations Met/Not Met
timeFrame: up to 45 days
measure: App Usage - Viewed Parent Coaching Videos
timeFrame: up to 45 days
measure: App Usage - View Progress Graph (Points Earned Over Time)
timeFrame: up to 45 days
measure: App Satisfaction Rating - the App Was Helpful Today
timeFrame: up to 45 days
measure: App Satisfaction Rating - I Have Ways to Intervene With my Teen.
timeFrame: up to 45 days
measure: App Satisfaction Rating - Overall Satisfaction
timeFrame: up to 45 days
measure: App Satisfaction Rating - Parent is Noticing and Rewarding Good Behavior
timeFrame: up to 45 days
measure: App Satisfaction - I Like Getting Prompts and Reminders
timeFrame: up to 45 days
Secondary outcomes:
measure: Achenbach System of Empirically-Based Assessment, Aggression Subscale
timeFrame: Baseline and Post assessment (end of 45-day app use period)
measure: Achenbach System of Empirically-Based Assessment, Depression Subscale
timeFrame: Baseline and Post assessment (end of 45-day app use period)
measure: Achenbach System of Empirically-Based Assessment, Rule-breaking Subscale
timeFrame: Baseline and Post assessment (end of 45-day app use period)
measure: Loeber Parental Supervision Scale
timeFrame: Baseline and Post assessment (end of 45-day app use period)
measure: Loeber Positive Parenting Scale
timeFrame: Baseline and Post assessment (end of 45-day app use period)
measure: Loeber Parental Consistency Scale
timeFrame: Baseline and Post assessment (end of 45-day app use period)
measure: Loeber Parental Effectiveness Scale
timeFrame: Change over 30 days of app usage (baseline to post-assessment)
measure: Perceived Stress Scale (PSS)
timeFrame: Change over 30 days of app usage (baseline to post-assessment)
measure: Parental Locus of Control Scale
timeFrame: Change over 30 days of app usage (baseline to post-assessment)
measure: Loeber Parental Knowledge Scale
timeFrame: over 30 days of app usage
Other outcomes:
Locations:
city: Seattle
country: United States
facility: Evidence-Based Practice Institute
state: Washington
Study officials:
affiliation: Evidence-Based Practice Institute
name: Linda A. Dimeff, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Maryland, Baltimore
name: Cindy M Schaeffer, PhD
role: PRINCIPAL_INVESTIGATOR
References: