Using Mobile Technology to Enhance Multisystemic Therapy (MST) Outcomes
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 13 - Any |
| Updated: | 2/16/2018 |
| Start Date: | April 2014 |
| End Date: | March 2016 |
Phase I - Using Mobile Technology to Enhance MST Outcomes (VillageWhere)
The goal of the current trial is to assess the feasibility of a newly developed prototype of
a cell phone app called VillageWhere. VillageWhere is designed to improve clinical outcomes
of youth with externalizing behavioral problems by improving parental monitoring of youth
whereabouts and activities while increasing the delivery of rewards to teens for good
behavior. This Phase I Small Business Innovation Research (SBIR) proposal seeks to develop
and conduct initial feasibility testing of the VillageWhere prototype. The primary features
of the prototype include location monitoring via smartphones' global positioning system (GPS)
functionality as well as facilitating teen self-appraisal of meeting behavioral expectations.
Good behavior is rewarded with points that are tracked by the app and can be used to redeem
for real-world rewards. The investigators will conduct an 45-day open trial (N=20
caregiver/teen dyads) to assess use, feasibility and acceptability for teens involved in the
juvenile justice system or otherwise struggling with externalizing behavioral problems.
Caregivers and teens will be assessed at baseline, before receiving the app, and at the end
of the app use period (45 days). The therapist of each caregiver/teen dyad will also be
assessed at the end of the app use period. Primary outcomes include: use of app features,
monitoring of teen behavior and whereabouts, delivery of real-world rewards, and feasibility
and acceptability. Secondary outcomes include: parenting behaviors, externalizing teen
behaviors and internalizing teen behaviors.
a cell phone app called VillageWhere. VillageWhere is designed to improve clinical outcomes
of youth with externalizing behavioral problems by improving parental monitoring of youth
whereabouts and activities while increasing the delivery of rewards to teens for good
behavior. This Phase I Small Business Innovation Research (SBIR) proposal seeks to develop
and conduct initial feasibility testing of the VillageWhere prototype. The primary features
of the prototype include location monitoring via smartphones' global positioning system (GPS)
functionality as well as facilitating teen self-appraisal of meeting behavioral expectations.
Good behavior is rewarded with points that are tracked by the app and can be used to redeem
for real-world rewards. The investigators will conduct an 45-day open trial (N=20
caregiver/teen dyads) to assess use, feasibility and acceptability for teens involved in the
juvenile justice system or otherwise struggling with externalizing behavioral problems.
Caregivers and teens will be assessed at baseline, before receiving the app, and at the end
of the app use period (45 days). The therapist of each caregiver/teen dyad will also be
assessed at the end of the app use period. Primary outcomes include: use of app features,
monitoring of teen behavior and whereabouts, delivery of real-world rewards, and feasibility
and acceptability. Secondary outcomes include: parenting behaviors, externalizing teen
behaviors and internalizing teen behaviors.
VillageWhere was pilot tested with a sample of 16 youth and their primary caregiver
participating in an EST for a serious conduct problem (Mean age 14.6 years, 52% male, 56%
African American, 33% were previously arrested). After completing baseline self-report
measures, dyads used the app as desired for 4 weeks, then participated in a post-assessment
and qualitative interviews. App usage by both parents and youth was high with little
diminished use over the four weeks of the trial. All parents set and used reinforcers for
functional behavior and used the "find my teen" feature; 84% set geolocation expectations for
youth's whereabouts at specific times; and 88% set other expectations for the youth (e.g.,
finish homework), viewed notifications, and regularly used the "Find My Teen" feature. As
expected, parents interacted with the app frequently: 2.4 times per day. Youth used the app
on average four times per day. All youth earned and redeemed points for complying with their
parent's expectations and routinely viewed their behavior plans (93.3%) and feedback
notification messages (86.7%). Parents did not on average use coaching videos (20%).
Although the study was not powered to detect statistical significance, a series of paired
t-tests were conducted to examine pre- to post-changes on self-report measures. Changes for
parents and youth all were in predicted directions, with effect sizes ranging from small to
high (average d = .42, range .21-.80). Parents reported greater use of positive parenting
behaviors (i.e., rewards and praise), greater discipline consistency, lower overall perceived
stress, a higher feeling of influence over youth behavior, and greater parenting efficacy.
Youth reported increases in parent use of positive behaviors, consistency, and knowledge of
whereabouts. Parent- and youth-reported change in youth aggression and rule-breaking (as
measured by the CBCL/YSR).
Qualitative results were also positive. Using 7-point scales, parents and youth reported on
app satisfaction three times/week. Parent ratings were high (M = 6.0) across items (e.g.,
"The app was helpful today," "I have ways to intervene with my teen"). Youth satisfaction
scores were also high (M = 6.1; e.g., "My parent is noticing & rewarding my good behavior;"
"I liked getting app prompts & reminders"). Parents reported that the app helped them trust
their youth, increase their use of rewards, and made giving rewards easier; they also
reported a reduction in youths' "excuse-making." Youth perceived that the app allowed them
more freedom, because parents had an objective way of verifying their whereabouts. Nearly all
youth (89%) liked that their parent was more consistent in paying attention to their positive
behaviors and rewarding them for it (versus only being punitive). Both parents and youth
described significant improvements in their relationship.
In addition, 16 therapists working with the parent-youth dyads also gave qualitative feedback
that was highly positive. Therapists stated that they liked the extra accountability the app
afforded to teens and the reduction in parent-youth communication issues.
participating in an EST for a serious conduct problem (Mean age 14.6 years, 52% male, 56%
African American, 33% were previously arrested). After completing baseline self-report
measures, dyads used the app as desired for 4 weeks, then participated in a post-assessment
and qualitative interviews. App usage by both parents and youth was high with little
diminished use over the four weeks of the trial. All parents set and used reinforcers for
functional behavior and used the "find my teen" feature; 84% set geolocation expectations for
youth's whereabouts at specific times; and 88% set other expectations for the youth (e.g.,
finish homework), viewed notifications, and regularly used the "Find My Teen" feature. As
expected, parents interacted with the app frequently: 2.4 times per day. Youth used the app
on average four times per day. All youth earned and redeemed points for complying with their
parent's expectations and routinely viewed their behavior plans (93.3%) and feedback
notification messages (86.7%). Parents did not on average use coaching videos (20%).
Although the study was not powered to detect statistical significance, a series of paired
t-tests were conducted to examine pre- to post-changes on self-report measures. Changes for
parents and youth all were in predicted directions, with effect sizes ranging from small to
high (average d = .42, range .21-.80). Parents reported greater use of positive parenting
behaviors (i.e., rewards and praise), greater discipline consistency, lower overall perceived
stress, a higher feeling of influence over youth behavior, and greater parenting efficacy.
Youth reported increases in parent use of positive behaviors, consistency, and knowledge of
whereabouts. Parent- and youth-reported change in youth aggression and rule-breaking (as
measured by the CBCL/YSR).
Qualitative results were also positive. Using 7-point scales, parents and youth reported on
app satisfaction three times/week. Parent ratings were high (M = 6.0) across items (e.g.,
"The app was helpful today," "I have ways to intervene with my teen"). Youth satisfaction
scores were also high (M = 6.1; e.g., "My parent is noticing & rewarding my good behavior;"
"I liked getting app prompts & reminders"). Parents reported that the app helped them trust
their youth, increase their use of rewards, and made giving rewards easier; they also
reported a reduction in youths' "excuse-making." Youth perceived that the app allowed them
more freedom, because parents had an objective way of verifying their whereabouts. Nearly all
youth (89%) liked that their parent was more consistent in paying attention to their positive
behaviors and rewarding them for it (versus only being punitive). Both parents and youth
described significant improvements in their relationship.
In addition, 16 therapists working with the parent-youth dyads also gave qualitative feedback
that was highly positive. Therapists stated that they liked the extra accountability the app
afforded to teens and the reduction in parent-youth communication issues.
Inclusion Criteria:
- Teen: English speaking, between ages of 13 and 17, juvenile justice involvement and/or
externalizing behavioral problems, currently in treatment and will remain in treatment
for duration of trial
- Caregiver: English speaking, owns Android smart phone, currently in treatment with
their teen and will remain in treatment for duration of trial
Exclusion Criteria:
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