NORTH: Developing a mobile health intervention to support treatment seeking in early psychosis

 

A long duration of untreated psychosis (DUP) is linked with poorer long-term outcomes and recovery. Despite frequent reluctance to seek services, young adults with EP often engage with mental health resources through online and mobile technologies. There are few available digital health tools designed for young adults with EP who are not connected to in-person care. Mobile health interventions appear particularly well suited to this population given the fact that mobile devices are the primary media source for most young adults and can provide individualized, real-time, real-place support to introduce users to psychosocial interventions involved in CSC. It remains unclear at present, however, whether and how remotely delivered mHealth can be leveraged to increase engagement in treatment for young adults with EP.

 

The proposed research project proposes to develop and test an mHealth intervention, Normalizing Orientation to Treatment and Help-Seeking (NORTH). This intervention will be designed to reduce DUP through providing support and impacting help-seeking beliefs. It will take a user-centered design approach with individuals who are both engaged and unengaged in treatment, including (1) a contextual inquiry to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) development, refinement and usability testing, and (3) a pilot randomized controlled trial assessing feasibility, acceptability and preliminary efficacy compared to an active control mHealth intervention providing only stress management.

 

Funded by the National Institute of Mental Health (K23MH122504)

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Deploying a Texting Intervention for Early Psychosis; From Research to Real-World Practice

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The vast majority of young adults with early psychosis own mobile phones, identify texting as their preferred communication modality, and report an interest in messaging-based treatments. Researchers in the BRiTE Center developed a texting intervention for people with psychosis called the Mobile Interventionist. Treatment is conducted via daily recovery-oriented text conversations between patients and a trained messaging practitioner. This novel form of engagement produces an asynchronous but continuous form of treatment and combines the advantages of digital health (i.e., accessibility, reach beyond the brick-and-mortar clinic, low intensity), with the flexibility, personal tone and sensitivity of a clinician. Several studies have demonstrated that our texting intervention approach is feasible, acceptable, engaging and effective. This initiative will help translate this promising research into real-world clinical practice by implementing the Mobile Interventionist texting model at the University of Washington’s Specialized Treatment Program for Early Psychosis (STEP).

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Clinically, the intervention may improve the illness management of young adults with early psychosis participating in the pilot, improving their long-term trajectories. Programmatically, the pilot bridges the research/practice gap by providing training and guided clinical experience to a real-world clinical team.

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Funded by the Garvey Institute for Brain Health Solutions

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Bolster: Developing a caregiver-facing mHealth intervention to reduce duration of untreated psychosis

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Caregivers often play a pivotal role in treatment-seeking, making first contact with providers, persuading the affected relative to make such contacts, or ensuring that the affected individual remains engaged in care. However, caregivers often lack accurate information about psychosis, treatments and recovery, or feel overwhelmed and unable to help or communicate with their affected relative. Caregivers report that they are frequently use digital resources to support caregiving and treatment facilitation, but few report satisfaction with resources available to them. Early work examining web-based platforms has demonstrated that digital health technologies are feasible, acceptable, and have potential to improve caregivers’ psychosis-related knowledge and appraisals. Mobile health interventions are particularly well-suited to this task, as they can provide individualized, real-time, real- place support. It remains unclear at present, however, whether and how remotely delivered mHealth can be leveraged to increase engagement in treatment for young adults with EP.

 

The proposed research project aims to develop and test an mHealth intervention designed to improve caregivers’ illness knowledge and caregiving skills through interactive cognitive-behavioral modules, and through these improvements, reduce distress, improve coping, improve family communication, increase caregiver treatment facilitation and reduce duration of untreated psychosis. This proposal will involve (1) needs assessment and user co-design sessions with EP caregivers to understand their needs, interests and preferences in a caregiver-facing mHealth intervention, (2) a one-week usability field trial of this new intervention to determine feasibility and functionality, and (3) a remote pilot randomized controlled trial comparing this new intervention to existing online caregiving support resources.

 

Funded by the National Institute of Mental Health (R34MH124878)

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