A Mobile Text Approach to Measurement and Feedback for Wraparound Care Coordination

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Abstract Fifteen million children and adolescents in the U.S. experience a diagnosable mental health (MH) disorder, with approximately half (6 to 8 million) considered to experience a serious emotional disorder (SED). Integrated, multi- modal community systems to coordinate multiple helpers and provision of multiple interventions have been identified to address the complex and multifaceted problems faced by youth with SED. One such model, the Wraparound service model (WSM), has been cited in multiple major reviews of effective community treatments, and is listed in the Surgeon General's Reports on youth mental health and violence. As is the case for other evidence-based practices, the degree to which data are consistently measured and used to inform care—i.e., “measurement-based care” or MBC—accounts for a large proportion of variance in outcomes for Wraparound. The goal of this SBIR project is to develop and test the Short Message Assisted Responsive Treatment for Wraparound (SMART-Wrap) application to overcome the current barriers to measuring and using data in everyday service settings. SMART-Wrap will facilitate MBC with an SMS system and thus inform and improve both service and clinical outcomes. In Phase I, we will accomplish four specific aims. First, we will work with a diverse group of expert advisors, experienced in developing mental health applications and administering WSM services, to create prototype assessment items and program a web-based `back-end' system for deploying assessment items via customized SMS. Second, we will assess feasibility of this prototype system for youth with SED and their caregivers, as well as determine the psychometric properties of the SMS-based items. Third, we will design and program prototype WSM care team dashboard functions to provide a feasible and acceptable online system for tracking collected data, identifying key findings, and facilitating MBC. Lastly, we will conduct an initial pilot test to evaluate feasibility of SMART-Wrap in typical Wraparound service for youth with SED by having both families and Wraparound care team members use the prototype over a 2-month period. Phase I quantitative and qualitative data will be used to inform the Phase II R&D plan. The proposed SMART-Wrap product will harness the simplicity and accessibility benefits of SMS to significantly improve engagement in Wraparound services and shift current Wraparound practice toward MBC. The end result will be a rigorously tested new mobile Routine Outcome Monitoring (ROM) solution to help improve service and clinical outcomes for the over six million youth in the U.S. with SED.