Technology Enabled Clinical Care (TECC): Protocol for a Prospective Longitudinal Cohort Study of Smartphone-Augmented Mental Health Treatment

Abstract

Background Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision—Technology Enabled Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP. Objective TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design. Methods The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations. Results The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction. Conclusions TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations. International Registered Report Identifier (IRRID) PRR1-10.2196/23771

Increasing the value of digital phenotyping through reducing missingness: a retrospective review and analysis of prior studies

“…While the studies differed in their clinical populations (patients with schizophrenia or depression/anxiety; college students with stress/anxiety), they all collected two common digital phenotyping data streams: geolocation (GPS) and accelerometer data. Each study presented participants with a symptom survey at least every 3 days 12–16. All participants in each study (including those who were discontinued for non-adherence to protocol) were included in this analysis.…”

“…Each study presented participants with a symptom survey at least every 3 days. [12][13][14][15][16] All participants in each study (including those who were discontinued for nonadherence to protocol) were included in this analysis. Study details can be found in table 1.…”

Increasing the Value of Digital Phenotyping Through Reducing Missingness: A Retrospective Analysis

“…While the studies differed in their clinical populations (patients with schizophrenia; college students with stress, anxiety, and depression; patients with depression using mindLAMP to augment therapy), they all collected two common digital phenotyping data streams: geolocation and accelerometer data. Each study presented participants with a symptom survey at least every three days [13][14][15][16] . For completeness, all participants in each study (including those that were discontinued because of non-adherence to protocol) were included in this analysis.…”

Digital literacy in contemporary mental healthcare: online assessments and mobile health apps

“…They have potential to increase access to care, and can provide a low-cost intervention with little staff training or presence required, increasing access to those geographically isolated. It has been proposed that apps could help redress ethnic disparities in the uptake of mental health services, as well as reduce stigma of accessing mental health services (Rauseo-Ricupero 2021). Novel apps for nursing staff can allow them to record observations and physical health monitoring data, food and fluid charts and sleep charts, minimising time spent in front of computers and taking better advantage of the capabilities of the tablet computers already available on the wards.…”