Abstract
BackgroundYouth experiencing housing instability have higher rates of mental health problems than their housed peers. Few studies have evaluated technological resources for homeless youth to determine how to effectively engage and reach them.ObjectiveThe primary aims of this pilot study were to establish the feasibility (as measured by phone retention rates) and acceptability (ie, participant ratings of resources) of delivering automated mental health resources via smartphone technology.MethodsYouth aged 16 to 25 years (N=100) were recruited through homeless shelter agencies in the Chicago metropolitan area. Eligible participants completed a baseline assessment and received a smartphone with a 3-month data plan. The phone was preloaded with several apps designed to promote mental health wellness and provide real-time resources. One app specifically designed for this study, Pocket Helper 2.0, sent participants daily surveys and tips via push notification. The tips focused on coping and motivation, and the surveys assessed mood. This app also included an automated self-help system with brief cognitive behavioral interventions (5-10 min) and access to several interactive mobile tools, including a crisis text line, a telephone hotline, a crowd-based emotional support tool, and an app providing up-to-date information on social service and mental health resources for homeless youth in Chicago. Participants completed assessments at 3 and 6 months.ResultsSome individuals (23%, 23/100) experienced problems with the phones (eg, theft, loss, and technological issues) throughout the study. Participant retention at the midpoint was moderate, with 48% (48/100) of youth responding to the 3-month surveys. At 6 months, only 19% (19/100) of the total sample responded to the end point survey. Overall, 63% (30/48) to 68% (13/19) of respondents at both time points reported benefiting from the intervention; however, participant usage and satisfaction varied with the different features. At both time points, participants reported receiving the most benefit from the daily tips and daily surveys. Daily tips that were most preferred by participants involved motivational tips related to overcoming struggles and making progress in life. Aside from the tips and surveys, the most used features were the app providing up-to-date resources and the automated self-help system. Interactive features, including the telephone hotline and crowd-based emotional support tool, were the least used features and were rated as the least beneficial.ConclusionsAutomated mental health interventions seem to be an acceptable way to engage homeless youth in mental health support. The participants preferred fully automated features and brief interventions over features requiring interaction with others or more engagement. Future research should explore ways to retain homeless youth in interventions and evaluate the clinical impact of automated technology-based interventions for improving mental health.Trial RegistrationClinicalTrials.gov NCT03776422; https://clinicaltrials.gov/ct2/show/NCT03776422
Highlights
BackgroundYouth HomelessnessEach night, thousands of young people across the United States experience housing instability
Descriptive analyses were run in SPSS 22 Premium to determine frequencies, means, and standard deviations of baseline demographic data and feedback data at the 3-month midpoint and 6-month end point of the study for participants who completed the assessments with valid data
Principal Findings Overall, our findings suggest that an automated mobile phone–based intervention can be a promising way of engaging homeless youth around mental health
Summary
BackgroundYouth HomelessnessEach night, thousands of young people across the United States experience housing instability. Most recent statistics from 2018 indicate that as many as 36,361 unaccompanied youth are counted as homeless on a given night [1]. In Chicago it was estimated that 80,384 people experienced homelessness in 2016, 11,067 of whom were unaccompanied youth aged 14 to 24 years [2]. Youth experiencing homelessness have very specific mental health needs that often go unaddressed because of barriers to accessing care. One barrier is that young people experiencing homelessness often have to focus on emergent and immediate needs—finding housing, securing their belongings, and seeking employment—so, out of necessity, mental health needs become lower priorities. Youth experiencing housing instability have higher rates of mental health problems than their housed peers. Few studies have evaluated technological resources for homeless youth to determine how to effectively engage and reach them
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