A few months ago, I wrote a column “There’s an App for That,” in which I described the promise of evidence-based mental and behavioral interventions that are delivered through smartphone Apps (and sometimes computers). An even deeper dive into this research has left me even more convinced of its promise. This is because mentoring programs need evidence-based interventions and apps work best when they are supported by coaches or mentors. In other words, it may just be a match made in heaven. Hear me out.
Youth who are referred to mentoring programs, school counselors, juvenile diversion programs and other services often struggle with significant mental health, behavioral, and academic challenges and would likely benefit from targeted, evidence-based care. Unfortunately, widespread shortages of providers within youth-serving systems make it difficult to meet the growing needs of youth. Technology-delivered interventions (TDI), delivered through mobile applications, are expanding the reach of health, mental health, behavioral, academic, and career services to youth with outcomes that rival those of face-to- face approaches, often at no cost.
TDI’s have several advantages over typical care and may hold particular promise for young people, the vast majority of whom have ready access to smartphones and are already in the habit of checking their phone many times a day.
Many young people appreciate the autonomy, privacy and reduced stigma that technology-delivered interventions can afford. They are typically offered as a series of structured, interactive, youth-serving lessons, quizzes, and games.
Likewise, rural youth or those with physical disabilities find them easier to access and they can address the needs of underserved and marginalized groups who often rely on their smartphones more heavily than their more privileged counterparts and fewer resources to access programs.
They can be adopted for use across racial and ethnic groups, helping to spread linguistically and culturally acceptable interventions more broadly while reducing waitlists in overburdened mental health systems.
Many evidence-based approaches have been carefully developed and evaluated by federally-funded investigators who can offer the resulting interventions to the public at little or no charge. For example, Northwestern University’s Center for Behavioral Intervention Technologies offers a free evidence-based app, Intellicare, with a suite of thirteen freely-available evidence-based modules that cover a range of topics related to addressing depression and anxiety, thoughts and feelings, activities and emotions, social support, and more
And, once developed the, marginal costs of scaling such interventions to new users and/or reusing the training are trivial.
Technology-delivered interventions can also provide real-time assessments of moods and behaviors, dashboards and other opportunities which can help mentors to track and recognize efforts and improvements.
Despite these benefits, there’s a big drawback
Many studies point to low adherence and high rates of dropout among adolescents, particularly in the absence of face-to-face and other support. Low rates of completion, in turn, reduce intervention effects.
This is where mentoring programs come in.
The major solution to problem of low engagement has been to provide users with coaches. Indeed, a growing body of research suggests that TDI’s are far more effective when youth are provided with ongoing coaching and support. Psychologist Colleen Conley and her colleagues recently conducted a meta-analysis on the use of technology-delivered interventions for providing preventive mental health services to college students.
Those students whose use of the App-delivered intervention was supported by a helper, either in person or through online contact, showed more gains than those who self-administered their interventions. In fact, supported interventions yielded near double the effects of self-administered indicated interventions (Effect Size= 0.55 versus 0.28). As the authors note, “support from paraprofessionals or even peers might enhance participant goal setting, expectations, accountability, and motivation, and thus improve intervention engagement, adherence, and outcomes.”
Other studies and systematic reviews have highlighted the importance of weekly coaching sessions, finding positive associations between coaching and engagement, number of logins, and the use of interactive tools compared to those using the interventions unsupported. Although the addition of coaching puts constraints on scalability, and adds costs to TDI’s implementation, it is necessary to ensure TDI success.
It’s important to note, however, that this coaching and support need not be delivered by highly trained professionals. In a recent study, researchers found that clinician- and peer-led groups led to similar levels of participants’ engagement, usability, or mental health outcomes. These findings align with previous studies that found no difference in technology-delivered outcomes that were supported by clinicians versus non-professionals.
Taken together, these findings may be a game-changer for mentoring program that are looking to become more intentional and evidence-based. They suggest that well-trained mentors may be able provide the coaching that is necessary for effective App-based interventions. Trained mentors can work directly with youth in programs that are offering technology-delivered interventions or can be dispatched to school mental health clinics, after-school programs, and other settings that are doing so. They can work through the lessons with the youth, helping youth to stay engaged and providing contexts for them to practice what they are learning.
The science of this sort of “supportive accountability” is still new, and will need to be tested with mentors and refined further. For example, research suggests that it is most effective when coaches (or mentors) are clear about goals from the start, that monitoring and check-ins are framed as helpful, and that the mentor is perceived as trustworthy, benevolent, and helpful, and as having the necessary expertise. It is also helpful when expectations are focused on the process (i.e., gaining mastery) as opposed to simple adherence, which can lead to more perfunctory engagement.
Additionally, there is some evidence that simply checking on usage helps with engagement but additional support is needed to actually learn and master the skills. Mentors and youth can use part of their meeting time for this practice.
More generally, the universe of technology-delivered interventions is in constant flux and only a small set have been empirically tested. Security and privacy are also concerns and not everyone has access to the internet or smartphones. Resources like Cyberguide have simplified this process.
Yet, even with these caveats in mind, psychologist Bethany Teachman, a leading proponent of evidence-based skills-training, sees the promise of technology-delivered interventions in meeting mental health needs and closing the gaps in service that exist. She writes: “The ubiquity of access to the internet and mobile phones, combined with the reduction in barriers that follow from using this delivery method, including reduced cost, no need to access a human provider, and ability to access care on your own schedule from the privacy of your own home, raise the prospect that technology can revolutionize how we disseminate evidence-based care.” Mentors who can provide helpful, supportive accountability and opportunities to practice developing new skills are likely to extend these benefits even further.