R03 – Designing and Evaluating an Asynchronous Remote Communication Approach to Behavioral Activation with Clinicians and Adolescents at Risk for Depression
Principal Investigators
Julie Kientz, PhD, Associate Professor, Human Centered Design and Engineering
Jessica Jenness, PhD, Acting Assistant Professor, Psychiatry and Behavioral Sciences
Project Description
National data indicate 7.5-12% adolescents are diagnosed with depression (MDD) each year. Adolescents across the spectrum of MDD severity are at risk for lifelong negative outcomes such as increased odds for MDD recurrence into adulthood. Despite the rise in MDD in adolescence, only 1% of U.S. youths receive outpatient care for MDD each year with low engagement among those treated. Furthermore, uptake of evidence-based approaches into usual care has been slow given training and implementation challenges. Innovations capitalizing on the near ubiquitous use of technology platforms among adolescents may be critical for improving the usability of evidence-based psychosocial interventions (EBPI). This research aims to address critical barriers in EBPI usability by engaging patient and clinician target users to adapt an EBPI, Behavioral Activation (BA), to a novel technology platform that uses asynchronous remote communities (ARC) to optimize patient engagement, improve access to care, and lower clinician burden.
| Setting | Outpatient mental health care settings and technology-mediated platforms |
| Population | Adolescents at risk for depression, primary care physicians, and mental health specialists |
Intervention and/or Implementation Strategy Designed or Redesigned
| Intervention | Development of an asynchronous remote communities (ARC) platform for Behavioral Activation (BA) delivery with adolescents. ARC uses technology-mediated groups on private internet-based platforms to deliver weekly tasks in a lightweight, accessible, and low-burden format that capitalizes on technology’s reach while providing support and social interactions. |
| Implementation Strategy | Three-phase approach: 1) discover target user needs, design constraints, and experiences with ARC; 2) design and build an ARC platform for BA delivery with adolescents; and 3) test the feasibility and usability with groups of adolescent and clinician target users. |
Impact
This research addresses the critical gap where only 1% of U.S. youths receive outpatient care for depression annually despite 7.5-12% being diagnosed each year. The ARC approach has potential to improve access to evidence-based depression treatment for adolescents by leveraging their ubiquitous technology use, reducing barriers to care, and providing a supplement to in-person therapy. The intervention could significantly impact adolescent mental health outcomes by making behavioral activation more accessible and engaging for teens who face transportation, parental, and other barriers to traditional in-person treatment.
This pilot project directly led to a follow on grant, “Evaluation of an Asynchronous Remote Communities Approach to Behavioral Activation for Depressed Adolescents” (R34MH128387; PI: Jenness).
Project Publications
Lessons learned from designing an asynchronous remote community approach for behavioral activation intervention for teens
Behaviour Research and Therapy 151(April 2022) · PubMed · Publisher
Authors
Jessica L. Jenness, Arpita B, Julie A. Kientz, Sean A. Munson, Ria R. Nagar
Abstract
Adolescent depression is common; however, over 60% of depressed adolescents do not receive mental health care. Digitally-delivered evidence-based psychosocial interventions (EBPIs) may provide an opportunity to improve access and engagement in mental health care. We present a case study that reviews lessons learned from using the Discover – Design – Build – Test (DDBT) model to create, develop, and evaluate a high-fidelity prototype of an app to deliver an EBPI for depression, behavioral activation (BA), on an Asynchronous Remote Communities (ARC) platform (referred to as ActivaTeen). We review work at each stage of the DDBT framework, including initial formative work, iterative design and development work, and an initial feasibility study. We engaged teens with depression, mental health clinicians, and expert evaluators through the process. We found that the DDBT model supported the research team in understanding the requirements for our prototype system, ActivaTeen, and conceiving of and developing specific ideas for implementation. Our work contributes a case study of how the DDBT framework can be applied to adapting an EBPI to a new, scalable and digital format. We provide lessons learned from engaging teens and clinicians with an asynchronous approach to EBPIs and human centered design considerations for teen mental health.
Designing Asynchronous Remote Support for Behavioral Activation in Teenagers With Depression: Formative Study
JMIR Formative Research 2021;5(7) · PubMed · Publisher
Authors
Arpita B, Ria Nagar, Jessica Jenness, Sean A. Munson, Julie A Kientz
Abstract
Background: Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based on behavioral activation (BA) help teens understand the relationship between mood and activity, help them practice goal-directed behaviors to improve mood, and may be particularly well-suited to delivery via internet-based platforms.
Objective: This study aims to understand the needs and challenges that teens and mental health clinicians face in depression management and involve them in the design process of a remote intervention that uses asynchronous remote communities. Our goal is to understand the benefits and challenges of adapting BA to an internet-based platform that supports the asynchronous remote community approach as a delivery tool for teen depression management.
Methods: We enrolled mental health clinicians (n=10) and teens (n=8) in separate, private, internet-based groups on Slack. They participated in 20-minute design activities for 10 weeks and were then invited to interviews about their experiences in the study.
Results: Both teen and clinician participants wanted internet-based support for BA as a supplement to in-person therapy. Although participants perceived the asynchronous format as conducive to supporting accessible care, teens and clinicians raised concerns about safety, privacy, and the moderating of the internet-based group. Design decisions that address these concerns need to be balanced with the potential benefits of learning coping skills, increasing access to mental health care, and promoting asynchronous human connection to support teens.
Conclusions: We discuss considerations for balancing tensions in privacy and safety while designing and selecting internet-based platforms to support remote care and integrating evidence-based support when designing digital technologies for the treatment of teens with depression.
Engaging Teenagers in Asynchronous Online Groups to Design for Stress Management
IDC ’19: Proceedings of the 18th ACM International Conference on Interaction Design and Children · PubMed · Publisher
Authors
Arpita B, Calvin Liang, Emily Y Zeng, Kanishk Shukla, Miguel E R Wong, Sean A Munson, Julie A Kientz
Abstract
Teenagers have unique needs for mental wellbeing that can be supported by interactive technologies. Teens also have valuable input in the design of technology, so designers and researchers must seek new methods for involving them in the design process. We enrolled 23 unacquainted teenagers in an Asynchronous Remote Communities (ARC) study consisting of two private online groups. Teens participated in 10 weekly design activities on stress management across three months. We found that teens sought support from technology tailored to their perception of control in stressful contexts, developing sense of self, and varying social needs, including asking for no intervention from others. Teens appreciated that the ARC design experience allowed for flexibility in participation and supported selective disclosure. However, there were limited interactions between teenagers online. Reflecting on our study, we provide design implications for tools to support teenager mental health and discuss how the ARC method can be adapted for designing with teenagers.