Behavioral Health Clinicians Research Articles

Attachment-Based Relationship Satisfaction in Deployed and Non-Deployed Military Veterans with Prevalent PTSD, Anxiety, and Depression

After almost two decades of war, unprecedented operational tempos have remained high for the American military. This has left those on the home front (non-deploying veterans) a little behind since scholarship has mostly focused on veterans who have deployed. This study used a voluntary treatment-seeking sample of veterans who have not deployed (<em>n</em> = 49) and veterans who have deployed (<em>n</em> = 68) to address this gap in the literature. This study examines the associations between attachment avoidance, attachment anxiety, mental health constructs (i.e., generalized anxiety, depression, and posttraumatic stress disorder), and relationship satisfaction. Independent samples <em>t</em>-test comparisons, correlational analyses, and two hierarchical regressions were conducted. The variables that were significantly correlated with relationship satisfaction for both samples were attachment avoidance and attachment anxiety. In the non-deployed sample, the regression was not statistically significant. However, in the deployed sample the regression was statistically significant. In the final step of the hierarchical regression, only attachment avoidance and attachment anxiety were significant predictors of relationship satisfaction. Implications for social work and other behavioral health clinicians are highlighted, including the benefits of practitioners working to help veterans develop and maintain supportive partners and other relationships, particularly through using the attachment theory-based approach of Emotionally Focused Therapy.

A-168 The Role of Executive Functioning, Processing Speed, and Working Memory on the TMT-B in ADHD Populations

Abstract Objective: Trail-Making Test B (TMT-B) is a measure of attention and processing speed (PS), with sensitivity to executive functioning (EF; Reimers, 2019). The impacts of these domains on TMT-B are not well-understood, especially in those with Attention-Deficit/Hyperactivity Disorder, who experience deficits in EF, PS, and attention (Kramer et al., 2020, Theiling &amp; Petermann, 2016). We examined the contributions of EF, PS, and attention on TMT-B performance. Method: This study included archival data of 64 adults diagnosed with ADHD at a midwestern multidisciplinary behavioral health clinic. Commonality analyses were used to identify the predictive capacity of performance on measures of EF, attention, and PS on TMT-B. EF was measured using perseverative errors of Wisconsin Card Sort Test (WCST). Weschler Adult Intelligence Scale (WAIS) index scores of working memory (WMI), and processing speed (PSI) were used to examine attention and PS. Results: Data was analyzed using a series of block-wise hierarchical regression analyses, with each predictor variable entered in alternating sequence. Results indicated that the processing speed domain accounted for 10.8% (R2 change = .108, F(1, 60) = 8.407, p &amp;lt; .01) of the variance in TMT-B performance after controlling for variability accounted for by other domains. EF was a significant predictor after accounting for variability in other domains, but accounted for only 5% (R2 change = .05, F(1, 60) = 4.179, p &amp;lt; .045) of the variance. WMI was not a significant predictor in this clinical sample. Conclusion: TMT-B is affected by both PS and EF. Implications and limitations of this study will be discussed.

Field applauds investments in school‐based MH staff, community BH services

Moving forward with a national strategy unveiled during the State of the Union address in January, and the recent signing into law of the Bipartisan Safer Communities Act, the Biden Administration is pouring millions of new funding into strengthening system capacity by supporting behavioral health workforce investments, school‐based mental health supports and expansion of Certified Community Behavioral Health Clinics (CCBHCs).

Barriers and Potential Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities.

Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site. There was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described. The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers.

Congress Passes First Significant Gun Safety Bill in Decades

Congress Passes First Significant Gun Safety Bill in Decades

APA Pleased Over Recent Legislative Wins but Must Keep Pushing

APA Pleased Over Recent Legislative Wins but Must Keep Pushing

Optimizing the Beck Scale for Suicide Ideation: An Item Response Theory Approach Among U.S. Military Personnel.

The Beck Scale for Suicide Ideation (BSS) is one of the most used and empirically supported suicide risk assessment measures for behavioral health clinicians and researchers. However, the 19-item BSS is a relatively long measure and can take 5 to 10 minutes to administer. This study used Item Response Theory (IRT) techniques across two samples of mostly U.S. military service members to first identify (n1 = 1,899) and then validate (n2 = 757) an optimized set of the most informative BSS items. Results indicated that Items 1, 2, 4, 6, and 15 provided a similar-shaped test information curve across the same range of the latent trait as the full-length BSS and showed reliable item functioning across participant characteristics. The sum score of these five items showed a linear score linkage with the full-scale score, ρ > 0.87, and was equally as sensitive as the full scale for prospectively predicting near-term suicidal behavior at 74% with a cut score ≥1 (equivalent to full-scale score ≥6). Results are consistent with those from civilian samples. In time- or length-limited assessments, using these five BSS items may improve administration efficiency over the full BSS, while maintaining classification sensitivity.This study suggests that summing Items 1, 2, 4, 6, and 15 of the Beck Scale for Suicide Ideation (BSS) is an acceptable approach for shortening the full-length measure.

Standardized Versus Tailored Implementation of Measurement-Based Care for Depression in Community Mental Health Clinics.

Measurement-based care (MBC) is an evidence-based practice that is rarely integrated into psychotherapy. The authors sought to determine whether tailored MBC implementation can improve clinician fidelity and depression outcomes compared with standardized implementation. This cluster-randomized trial enrolled 12 community behavioral health clinics to receive 5 months of implementation support. Clinics randomized to the standardized implementation received electronic health record data captured with the nine-item Patient Health Questionnaire (PHQ-9), a needs assessment, clinical training, guidelines, and group consultation in MBC fidelity. Tailored implementation support included these strategies, but the training content was tailored to clinics’ barriers to MBC, and group consultation centered on overcoming these barriers. Clinicians (N=83, tailored; N=71, standardized) delivering individual psychotherapy to 4,025 adults participated. Adult patients (N=87, tailored; N=141, standardized) contributed data for depression outcome analyses. The odds of PHQ-9 completion were lower in the tailored group at baseline (odds ratio [OR]=0.28, 95% CI=0.08–0.96) but greater at 5 months (OR=3.39, 95% CI=1.00–11.48). The two implementation groups did not differ in full MBC fidelity. PHQ-9 scores decreased significantly from baseline (mean±SD=17.6±4.4) to 12 weeks (mean=12.6±5.9) (p<0.001), but neither implementation group nor MBC fidelity significantly predicted PHQ-9 scores at week 12. Tailored MBC implementation outperformed standardized implementation with respect to PHQ-9 completion, but discussion of PHQ-9 scores in clinician-patient sessions remained suboptimal. MBC fidelity did not predict week-12 depression severity. MBC can critically inform collaborative adjustments to session or treatment plans, but more strategic system-level implementation support or longer implementation periods may be needed.

Selection and Use of Firearm and Medication Locking Devices in a Lethal Means Counseling Intervention.

Background: While some suicide prevention initiatives distribute locking devices for firearms and medication, little evidence exists to guide the selection of devices. Aims: This study aimed to describe safety standards for locking devices and compare parental acceptance rates for different types of devices. Method: As part of the larger SAFETY Study, behavioral health clinicians provided free locking devices to parents whose child was evaluated in the emergency department (ED) for a suicide-related or behavioral health-related problem. For logistical reasons, we changed the specific devices offered midstudy. Data on device use came from follow-up interviews with 226 parents. Results: Few effective standards exist for locking devices for home use; we could easily break into some. At follow-up, twice as many gun-owning parents were using ED-provided handgun lockboxes as cable locks (28% vs. 14%, p = .02). Overall, 55% of parents reported using an ED-provided medication lockbox, with more using the drawer-sized lockbox than the larger, steel toolbox (60% vs. 42%, p < .01). Limitations: Storage outcomes are from parents' self-report and from one state only. Conclusion: Parents appeared to prefer some devices over others. Our findings suggest the need for (a) effective safety standards, (b) affordable devices meeting these standards, and (c) further research on consumer preferences to ensure use.

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

Use of PHQ-9 for monitoring patients with depression in integrated primary care practices.

The PHQ-9 is a validated, short self-report questionnaire designed to be used in primary care for diagnosis and management of depression. We wished to assess its use for monitoring symptoms in patients being treated for depression. To measure the use of the PHQ-9 in 12 months following an elevated score in adult patients in primary care practices. Retrospective cohort study with descriptive analysis of use of PHQ-9 for follow up; stratified by age category, gender, severity and chronicity of symptoms, and whether referred to integrated behavioral health. EMR data including dates and results of PHQ-9, patient demographics, and referral data. Adults aged 18 and older with a PHQ-9 score of 10 or higher during calendar year 2018. No one was excluded. Primary outcome measure was the number of PHQ-9's done in 12 months following the initial elevated score (index score). Secondary outcome measures are a set of quality measures for depression care related to monitoring with PHQ-9 at 6 and 12 months following index score. Among all patients, mean number of PHQ-9 following index score was 2.1. This was increased for those with chronic symptoms (defined as having an elevated score at least once in calendar year 2017. It was increased slightly as severity of index symptoms increased. It was increased substantially for those referred to integrated behavioral health clinicians in the practices. The PHQ-9 is underutilized as an instrument for monitoring patients who are being treated for depression in primary care. Measurement based care has a strong evidence base and interventions to improve utilization of the PHQ-9 for monitoring are likely to improve depression outcomes in primary care.

Caring for Young Adults With Diabetes in the Adult Care Setting: Summary of a Multidisciplinary Roundtable.

A multidisciplinary team of clinicians and researchers, patients and family members, and representative from national advocacy groups and research organization met to review the literature, highlight gaps, and identify best practices to improve adult care delivery for young adults (YA) with diabetes. The participants prepared presentations in advance, rotated through sessions, and contributed to group discussions in three areas: physical health, mental health, and quality of life (QoL). Session moderators and scribes used thematic analysis to summarize discussions for each topic. Thematic analysis revealed four foci for addressing physical health, mental health and QoL: 1) best practices to facilitate the process of transfer; 2) age-specific curricula and guidelines for prevention and management of comorbidities and complications; 3) collaboration with behavioral health clinicians to address diabetes distress and mental health disorders; and 4) research on the impact of diabetes on QoL in YA. There was substantial interest and need among adult clinicians to work in concert with pediatric and mental health professionals to identify best practices and future directions to improve healthcare process and diabetes-related outcome measures in YA with diabetes.

Conceptualizing culture in (global) mental health: Lessons from an urban American Indian behavioral health clinic

The movement for global mental health (GMH) has brought perennial questions about human diversity in mental health to the fore through heightened debates over if and how established knowledge, institutions, and practices should be altered for ethical and effective interventions with diverse peoples around the world. Kirmayer and Pedersen (2014) encouraged dialogue between GMH scholars and communities considered for intervention to address differences and concerns about colonialism. American Indian mental health offers an instructive site for global mental health inquiry to understand frameworks that might facilitate this desired dialogue. Here, we draw from a clinical ethnography in urban American Indian behavioral health conducted between September 2014 and February 2015 to glean insights into a popular response to these differences: Incorporating Indigenous cultural forms into clinical practice. Our findings highlight a predicament this response presents to mental health professionals. They can either eschew their clinical training and its cultural assumptions to take up new lives enabling their representation of Indigenous cultural forms, or they can hold onto their professional training and modify what is clinically familiar to appear culturally different. Rather than a purposeful decision, in the clinic contextual factors—tacit assumptions, clinic structures, and popular culture concepts—powerfully shaped clinical practice and reconfigured Indigenous cultural forms to support familiar clinical processes (e.g., treatment-planning). Although potentially therapeutic, culturally repackaged mental health practices are not the therapeutic alternatives called for by many Indigenous communities, and when advertised as such, risk harmful appropriations and misleading reticent people into participating in culturally prescriptive interventions. Lessons for global mental health point away from incorporating Indigenous cultural forms into clinical practice, which is likely to result in cultural repackaging, toward ethnographically-informed dialogue of differences to inform models for medical and epistemic pluralism providing interested communities more culturally commensurate mental health services alongside well-supported Indigenous therapeutic alternatives.

Clinicians\u2019 perceptions of barriers to cervical cancer screening for women living with behavioral health conditions: a focus group study

BackgroundWomen with behavioral health (BH) conditions (e.g., mental illness and substance abuse) receive fewer cervical cancer (CC) screenings, are diagnosed at more advanced cancer stages, and are less likely to receive specialized treatments. The aim of this study was to identify barriers that healthcare providers face in providing CC screening to women with BH conditions.MethodsGuided by the Consolidated Framework for Implementation Research, we conducted four focus groups in North Florida with 26 primary care and BH clinicians and staff to examine perceived barriers to CC screening among their patients with BH conditions to guide the future development of a tailored cervical cancer screening and follow-up intervention. Thematic analysis was used to analyze verbatim transcripts from audiotaped focus groups.ResultsThree main themes of barriers emerged from the data: 1) BH conditions related barriers included a history of trauma, stigma and discrimination, and uncontrolled comorbid conditions, 2) System level barriers related to lack of integration between BH and primary care, and 3) Similar barriers to the general population including lack of health insurance, insufficient processes to send out reminders, and challenges with communicating with patients.ConclusionsTailored CC screening interventions that address the unique needs of women with BH conditions are needed. Strategies that address improving trust between patients and healthcare providers, identifying avenues to improve receipt of screening during time-limited clinical visits, connecting BH and primary care providers, and addressing the social determinants of health have potential to improve CC screening rates for women with BH conditions.

Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?

Medicaid is a public health insurance program in the United States that serves low-income individuals. Medicaid beneficiaries have elevated risk of opioid use disorder (OUD), yet face barriers to receiving medications for OUD (MOUD). To inform efforts to increase MOUD receipt among Medicaid beneficiaries, this study: (1) estimated Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and (2) estimated the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Retrospective study of North Carolina, USA licensed physicians, physician assistants and nurse practitioners. Licensure data from 2018 were merged with 2019 US Drug Enforcement Administration (DEA) data to identify clinicians who received the DEA waiver required to prescribe buprenorphine (n = 1714). Medicaid claims data were used to characterize clinician engagement in OUD care delivery. Outcomes were indicators of any Medicaid professional claims and any Medicaid prescription claims for buprenorphine and/or naltrexone. Predictors included clinician characteristics (e.g. gender and race) and characteristics of clinicians' practice location (e.g. area opioid overdose death rate). Most waivered clinicians delivered services to Medicaid beneficiaries, ranging from 67.0% of behavioral health clinicians to 82.9% of specialist physicians. Among waivered clinicians with Medicaid professional claims, prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians. The probability of prescribing MOUD to Medicaid beneficiaries was higher among waivered clinicians identifying as male compared with female (8.5 percentage points, P = 0.004) or black compared with white (9.9 percentage points, P = 0.007), older clinicians (0.5 percentage point increase per year, P < 0.001) and clinicians in counties with a higher opioid overdose death rate (5.0 percentage point increase per additional death per 10 000 residents, P = 0.010). Among clinicians in North Carolina, USA who are authorized to prescribe buprenorphine, 67-83% (depending on type of specialist) deliver services to Medicaid beneficiaries, but only 30-52% of those prescribe medications for opioid use disorder (OUD) to Medicaid beneficiaries. Engagement in OUD care delivery to Medicaid beneficiaries varies by clinician demographic and area characteristics.

Acoustic and Facial Features From Clinical Interviews for Machine Learning-Based Psychiatric Diagnosis: Algorithm Development.

BackgroundIn contrast to all other areas of medicine, psychiatry is still nearly entirely reliant on subjective assessments such as patient self-report and clinical observation. The lack of objective information on which to base clinical decisions can contribute to reduced quality of care. Behavioral health clinicians need objective and reliable patient data to support effective targeted interventions.ObjectiveWe aimed to investigate whether reliable inferences—psychiatric signs, symptoms, and diagnoses—can be extracted from audiovisual patterns in recorded evaluation interviews of participants with schizophrenia spectrum disorders and bipolar disorder.MethodsWe obtained audiovisual data from 89 participants (mean age 25.3 years; male: 48/89, 53.9%; female: 41/89, 46.1%): individuals with schizophrenia spectrum disorders (n=41), individuals with bipolar disorder (n=21), and healthy volunteers (n=27). We developed machine learning models based on acoustic and facial movement features extracted from participant interviews to predict diagnoses and detect clinician-coded neuropsychiatric symptoms, and we assessed model performance using area under the receiver operating characteristic curve (AUROC) in 5-fold cross-validation.ResultsThe model successfully differentiated between schizophrenia spectrum disorders and bipolar disorder (AUROC 0.73) when aggregating face and voice features. Facial action units including cheek-raising muscle (AUROC 0.64) and chin-raising muscle (AUROC 0.74) provided the strongest signal for men. Vocal features, such as energy in the frequency band 1 to 4 kHz (AUROC 0.80) and spectral harmonicity (AUROC 0.78), provided the strongest signal for women. Lip corner–pulling muscle signal discriminated between diagnoses for both men (AUROC 0.61) and women (AUROC 0.62). Several psychiatric signs and symptoms were successfully inferred: blunted affect (AUROC 0.81), avolition (AUROC 0.72), lack of vocal inflection (AUROC 0.71), asociality (AUROC 0.63), and worthlessness (AUROC 0.61).ConclusionsThis study represents advancement in efforts to capitalize on digital data to improve diagnostic assessment and supports the development of a new generation of innovative clinical tools by employing acoustic and facial data analysis.

Assessing Knowledge and Experience of Integrated Behavioral Health among Patients with Limited English Proficiency at a Diverse, Urban Federally Qualified Health Center.

Integrated behavioral health (IBH) embeds behavioral health clinicians in primary care settings to improve access and quality of care. This study investigates whether co-located IBH impacts knowledge and experiences of behavioral healthcare, particularly for individuals with limited English proficiency (LEP). 330 patients were recruited from the waiting rooms of a federally qualified health center to answer multiple-choice and Likert scale questions about behavioral healthcare. English-speaking patients were more confident in their knowledge of IBH (X2(1) = 4.79, p = .03) and external behavioral healthcare (X2(1) = 28.75, p < .001). On average, the 77 patients who accessed IBH believed that IBH appointments had a positive impact (Likert scale mean = 3.90, SD = .10). Despite satisfaction with IBH across demographic groups and similar or higher interest in behavioral health services among patients with LEP, they were found to have less knowledge about IBH than English-speaking patients.

Effect of a Community-Based Medical Oncology Depression Screening Program on Behavioral Health Referrals Among Patients With Breast Cancer

Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. ClinicalTrials.gov Identifier: NCT02941614.

Connecting during COVID: The application of teleservices in two integrated perinatal settings.

Integrated perinatal behavioral healthcare provides opportunities to support women and their babies as part of their primary care medical home. The COVID‐19 pandemic required significant changes to be made to medical practices to enhance safety and reduce risk, particularly for vulnerable populations, including pregnant women. Previously established modes of mental health service delivery in the HEART program, an integrated behavioral health program embedded in a primary care clinic for adolescent mothers and their babies, and the PROMISE Clinic, an integrated obstetric behavioral health program that serves pregnant women, quickly pivoted to telehealth services because of the pandemic. HEART serves a racially and ethnically diverse patient population, with over 85% of patients publicly insured. The PROMISE Clinic serves a socioeconomically, racially, and ethnically diverse patient population. Behavioral health clinicians implemented a variety of technology‐based services including telephone interventions and support, virtual visits using iPads during medical visits, and video visits that patients accessed from their homes. In HEART, behavioral health visits continued at pre‐COVID rates during telehealth adaptations. In the PROMISE clinic, the number of perinatal women seen doubled, the total number of patient contacts tripled, and the missed appointment rate significantly decreased during COVID. In the PROMISE clinic, significantly more White and Hispanic perinatal women were seen during COVID and telehealth adaptations, while significantly fewer Black perinatal women were seen during this period. Further research is indicated to examine patient attitudes towards telehealth services, barriers to treatment for Black women, and outcome data.

Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design.

BackgroundTreating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined.ObjectiveThis study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns.MethodsAdolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality.ResultsParticipants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language.ConclusionsThe novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.