Recent applications of innovative mobile health (mHealth) tools, such as text messaging (SMS), hold promise for increasing Evidence-Based Intervention (EBI) effectiveness. Our team will discuss why we choose to implement a text messaging (SMS) to improve engagement and outcomes for diverse populations and share lessons learned, effectiveness, and future directions to improve research and services that leverage mHealth tools. Dr. Adrian Aguilera and his research team originally developed the HealthySMS system to enhance effectiveness of a Cognitive Behavioral Therapy (CBT) group for depressed adults by sending daily messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (e.g., a prompt for activity completion); and personalized responses based on participants’ texts. The initial HealthySMS clinical trial (MoodText) was conducted with Spanish-speaking, Latinx clients who were referred to depression services at Zuckerberg San Francisco General (ZSFG) hospital through their behavioral health provider in 2014-2016. The results of this trial, including the ad hoc feedback received from the clients, are promising and suggested that sending text-messages to clients during treatment improved engagement (effect size for attendance r = 0.2 and time until dropout r = 0.3).
In 2018, Drs. Lauren Haack and Sabrina Darrow established a CBT group enhanced with HealthySMS at UCSF Langley Porter Mood/Anxiety Clinic (LPMAC) as the first-line service for depressed teens. Drs. Haack, Darrow and Aguilera recently received a UCSF Resource Allocation Program (RAP) digital mental health award to evaluate the effectiveness, mechanisms, and efficacy this CBT group enhanced with HealthySMS as the first-line service for depressed teens at LPMAC –and- ZSFG. Of note, LPMAC and ZSFG are staffed by mental health providers expert in teenage depression –and- serve a disproportionately high number of diverse teens. In addition, given that diverse populations can benefit from adapted treatment, our team is investigating whether HealthySMS adaptations are indicated for diverse teens (and if so, which and for whom). Our team plans to submit results as preliminary data for a National Institute of Mental Health (NIMH) proposal in response to the call: Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions (R34).
The HealthySMS system is flexible and allows researchers and clinicians to input their own content and send automated messages to participants and patients. For example, Dr. Marina Tolou-Shams is planning to utilize HealthySMS to help teens in the foster care system connect with care providers and ensure that they receive the services they need. Another group in oncology is utilizing HealthySMS to send health related messaging to patients with brain tumors. Colleagues outside of UCSF are also utilizing automated messaging to aid in CBT for insomnia. The system is continually developing as needs and technology changes. Most recently, Dr. Aguilera is developing an enhancement to the HealthySMS system by creating an app that tracks physical activity and sends that data to the HealthySMS system in order to personalize motivating messages using a machine learning algorithm. These messages are being sent to patients with depression and diabetes receiving primary care at ZSFG.
Slides: https://ucsf.box.com/s/qqlg7ywouasnm3r4a6w1xyttok76mww6 (MyAccess login required)
It would be helpful, but not necessary, for audience members to have some knowledge of evidence-based mental health services, such as Cognitive Behavioral Therapy (CBT).
Speaker Lauren M. Haack, PhD, is an assistant professor and attending psychologist with research and clinical interests focused on 1) cultural influences to mental health conceptualization, assessment, and treatment, and 2) accessible and culturally appropriate evidence-based services for vulnerable youth and families worldwide. Since being appointed UCSF faculty in 2017, Dr. Haack has been involved in numerous collaborative clinical research projects with an overarching focus on harnessing technology to improve access to and quality of evidence-based mental health care for diverse youth and families. Specifically, she collaborated on a IES/US Department of Education (DOE) funded project called : “Web-Based Professional Development for School Mental Health Providers in Evidence-Based Practices for Attention and Behavior Challenges.” The purpose of this DOE Goal 2 project is to develop a web-based professional development program for school mental health providers to gain the skills needed to implement evidence-based practices for attention and behavior problems. Her role includes attending tech-development and school district consultation meetings/focus-groups, assisting in the development of training materials, and serving as trainer and consultant during the program pilot. Dr. Haack co-wrote an R34 to NIMH and a UCSF Resource Allocation Program (RAP) Digital Mental Health Award grant with co-authors (Drs. Sabrina Darrow and Adrian Aguilera) focused on improving engagement in Cognitive Behavioral Therapy (CBT) for Depression services for diverse teens using a mobile health text message system. This work represents initial steps towards coordinating research and clinical care among the various UCSF Child and Adolescent Services (CAS) psychiatry clinics, including LPPHC and ZSFG.
Dr. Darrow is an Assistant Professor in the Department of Psychiatry at the University of California, San Francisco and the Associate Director of Research of the Department’s Young Adult and Family Center (YAFC). She is a licensed psychologist and expert in Cognitive Behavior Therapy (CBT) as well as third-wave behavior therapies (e.g., Dialectical Behavior Therapy for Adolescents (DBT-A), Functional Analytic Psychotherapy, and Acceptance and Commitment Therapy). Her research focuses on ways to improve implementation of evidence-based therapies for adolescents and young adults. I also conduct research to explore ways to personalize treatment approaches, including development of principle-based assessment approaches and hybrid implementation-effectiveness research, to improve the mental health care that youth receive. She has expertise in psychotherapy process and outcomes research, implementation science, assessment development, and the complementary statistical analyses. She also has experience harnessing new technology to improve evidence-based practices and associated research efforts for young adults and adolescents. For example, she led efforts to develop and conduct usability testing on TrakU, a mobile app developed for personalized self-monitoring during youth psychotherapy. The proposed research is made feasible by her current position as Associate Director of Research in the YAFC where she oversees clinic-based research efforts in the Langley Porter Mood and Anxiety Clinic (LPMAC), has a collaborative relationship with the clinicians, has established a procedure to recruit patients for research, and rates and monitors treatment fidelity.
Adrian Aguilera, PhD, a clinical psychologist, is an associate professor in the School of Social Welfare at UC Berkeley and in the Department of Psychiatry at UCSF. Dr. Aguilera’s research focuses on developing and testing digital health interventions for depression and chronic diseases in low-income and Latino communities. He is a licensed, practicing clinical psychologist with the Behavioral Health Team at San Francisco General Hospital, which is an integrated mental health service within primary care. He is the recipient of a Career Development Award (K23) from NIMH to study the use of automated text messaging to improve adherence to group cognitive behavioral therapy for depression in public sector settings in Spanish and English. Dr. Aguilera was also a recipient of Robert Wood Johnson’s New Connections grant which provides research and career support for junior faculty from diverse backgrounds. Dr. Aguilera has been conducting digital health research and practice since 2009 and has served as a reviewer for technology based grant proposals for NIMH and NSF. He is also a consultant on a variety of digital health grants targeting underserved populations. Dr. Aguilera developed HealthySMS, which is a platform for developing text messaging health interventions and visualizing data received from patients.