Adapting Behavioral Activation to Technology Platform

An estimated 3.1 million adolescents are diagnosed with depression (MDD) each year (SAMHSA,
2016), and adolescent onset MDD is associated with chronic physical, mental and psychosocial
disability (Birmaher et al., 1996). However, over 60% of adolescents with MDD do not receive
mental health care, and, among those who do, treatment engagement is low (SAMHSA, 2016;
Olfson et al., 2003). Behavioral Activation (BA) is an evidence-based psychosocial
intervention (EBPI) for individuals with MDD (Dimidjian et al., 2006). While BA holds promise
as an effective treatment with adolescents (McCauley et al., 2015, 2016), previous research
approaches have found that adolescents may be better reached and engaged through social
media, mobile technologies, and other technology platforms (Boyd, 2007; Park & Calamaro,
2013). In addition, BA requires frequent interaction from patients over time, which can be
difficult and costly for clinicians to administer directly. Thus, there is an opportunity to
improve usability and engagement of EBPIs via new technology-based tools. Asynchronous Remote
Communities (ARC) is a promising technology-based approach for engaging adolescents that
capitalizes on the reach of technology while also providing support, social interactions, and
motivation to engage. ARCs are technology-mediated groups that use private online platforms
to deliver weekly tasks to participants and gather information about perceptions in a format
that is lightweight, accessible, usable, and low burden. The investigators aim to use ARC
both to discover the design requirements for adapting BA to ARC as well as design/build an
ARC platform for administering BA. The investigators will test the feasibility of our
approach in a small feasibility study with clinicians and adolescents. The investigators
propose the following specific aims:

Aim 1: Use the ARC approach with adolescents, primary care physicians, and mental health
specialists to discover target user needs, design constraints and to observe their experience
with ARC: The investigators will first use ARC to collect target user (i.e., primary care
providers (PCP) and mental health specialists, adolescents at risk for depression) data to
understand their needs and the facilitators and barriers to adapting BA to ARC.

Aim 2: Design & build an ARC platform for BA delivery with adolescents: Once the
investigators have a strong understanding of the facilitators and barriers, the investigators
will design a platform to use the ARC approach for BA delivery via Slack. The investigators
will use an iterative design approach to understand the technical feasibility of the
approach, whether and how to automate parts of the BA intervention using chatbots and other
custom applications within Slack. The investigators will conduct small, informal usability
testing with target users during this stage.

Aim 3: Test feasibility and usability with small pilot groups of adolescent and clinician
target users: Once the investigators have a robust enough prototype of the ARC delivery
platform for BA, the investigators will conduct a small pilot study with adolescents at-risk
for depression and clinicians to assess the feasibility and usability of the approach. The
investigators will collect data on the feasibility, usability, user burden, acceptability,
and symptom outcomes.

Inclusion Criteria:

- Adolescents with PHQ-9 scores between 5 and 15 (Mild to Moderate Range) who do not
report current suicidality (Pine et al., 1999) will be recruited from clinician target
users' practice settings.

Exclusion Criteria:

- Current suicidal ideation or PHQ-9 scores that are below or above the cutoff described
above for adolescents.