Improving adherence to evidence-based practice using an innovative and easy-to-use health IT solution

PROJECT SUMMARY/ABSTRACT Homework, or between-session practice of skills learned during therapy, is one of the most integral, yet underutilized components of high-quality, evidence-based mental health treatments (EBTs) such as Cognitive Behavioral Therapy (CBT). Many providers struggle to consistently develop, assign, and assess homework exercises with their patients, and many patients have difficulty remembering to practice skills in a correct and timely way that fosters adequate learning. Innovative health IT solutions are needed to overcome these barriers to implementing this crucial component of high quality EBTs. To meet this need, our experienced team at Adhere.ly, LLC, in partnership with the University of South Florida, the Medical University of South Carolina, and Doxy.me, LLC developed Adhere.ly, an innovative, state-of-the art, and user-friendly web-based solution to improve provider implementation and patient engagement in homework during EBTs. Adhere.ly includes engaging therapeutic exercises for providers to introduce, practice, and assign as homework to patients, who receive SMS/email reminders with links to practice those exercises during the week. Adhere.ly was initially developed for providers treating children with PTSD and their caregivers. Broadening Adhere.ly’s features and exercises will increase its clinical utility and ability to support NIMH priorities and PA-18-579 Specific Areas of Research Interest in “Tools and Platforms to Improve the Dissemination and Implementation of EBTs.” The objectives of this Phase I STTR proposal–guided by the Accelerated Creation to Sustainment model and Modified Consolidated Framework for Implementation Research–are threefold. First, we will seek to understand and prioritize key stakeholder goals, challenges, affordances, and constraints by conducting individual, semi-structured qualitative interviews with adult mental health patients, providers, and administrators (n≤20 each) and a quantitative survey of 100 providers. We will conduct a mixed methods analysis to inform the design of new Adhere.ly features and exercises and an implementation/sustainment (I/S) blueprint (Aim 1). Second, we will use participatory design methodologies (e.g., co-design workshops) with adult mental health patients and providers to iteratively design, refine, and develop new Adhere.ly features and therapeutic exercises that support a range of adult EBTs, and an I/S blueprint (Aim 2). Third, we will conduct a feasibility Optimization, Effectiveness, and Implementation (OEI) Hybrid trial with 20 community mental health providers randomized to CBT+Adhere.ly (n=10) vs. CBT alone (n=10), and 40 treatment seeking, provider-referred adult patients with clinically elevated anxiety and/or depression (outcomes), which we will assess at baseline and 3-months post-baseline. We will assess homework use by providers and adherence of patients (targets) weekly via session audio recordings and patient-report. We will optimize new features, exercises, and our I/S plan during the trial and assess implementation outcomes post-implementation (Aim 3).PROJECT NARRATIVE Mental health disorders affect 1 in 5 adults in the U.S., yet there is a gap in the quality of mental health care these patients should receive vs. what they do receive. Homework, or between-session practice of skills learned during therapy, is an integral component of high quality, evidence-based mental health care, but its implementation in “real world” clinical settings is generally lacking. This project aims to expand and preliminarily evaluate an innovative, web-based solution to improve the implementation of this crucial component of evidence-based mental health care.