Technology-based Treatment Research Articles

Recruitment of Hard-to-Reach Older Adults in Technology-Based Mental Health Services Studies: Lessons Learned

Homebound older adults are a hard-to-reach population with a high burden of depression and face substantial access barriers to mental health treatments. Internet-based psychotherapy is a promising strategy to address this persistent treatment gap, but older adults are severely underrepresented in internet-based psychotherapy trials. One challenge to advance this area of research and practice is the recruitment and retention of homebound older adults in clinical trials. Previous research has discussed the challenges of recruiting older adults in behavioral interventions and offered useful recommendations. However, recruiting homebound older adults, who face substantial mobility barriers, poses additional challenges not fully addressed in the literature. The expectation of using technology adds another layer of difficulty. In this presentation, we will discuss our group’s experiences working with community partners to recruit and retain homebound older adults for a study on technology-based mental health treatment. We partnered with home care agencies, senior apartment buildings, and Meals-on-Wheels and experimented with a few different ways to recruit study participants. Issues related to accessibility, trust, and stigma emerged as important considerations when designing recruitment strategies and materials. The discussion will be an integration of our experiences and a review of previous literature on the challenges and recommendations for recruiting older adults in mental health services research.

The Role of the Internet of Things in Healthcare: Future Trends and Challenges

Background and ObjectiveWith the recent advances in the Internet of Things (IoT), the field has become more and more developed in healthcare. The Internet of things will help physicians and hospital staff perform their duties comfortably and intelligently. With the latest advanced technologies, most of the challenges of using IoT have been resolved, and this technology can be a great revolution and has many benefits in the future of digital. Healthcare is one of the most useful areas for IoT use. The most important application of IoT is to monitor and make quick decisions in critical situations. Thanks to this technology-based treatment approach, there is an unprecedented opportunity to better the quality and productivity of treatments and better the patient's well-being and better government funding. MethodsIn this paper, we provide a comprehensive overview of the primary uses of IoT in healthcare. We used the Systematic Literature Review (SLR) method to analyze and comparison articles published in this field between 2015 and March 2020. ResultsA comprehensive taxonomy is presented based on the contents of the articles under study. In this article, a brief overview of selected articles based on research questions is given and highlights the most critical challenges and case studies for the future use of IoT in healthcare. ConclusionsAccording to a detailed study of the 89 articles and a glimpse into about 208 articles, challenges and future trends in healthcare have been identified.

A feasibility study providing substance use treatment in the Black church

BackgroundBlack adults with substance use disorders (SUDs) experience health care disparities, including access to and retention in treatment. The Black church is a trusted institution in the Black community and could be a novel setting for providing SUD treatment. MethodWe conducted a nonrandomized feasibility study evaluating (1) whether it was possible to conduct a clinical trial of SUD treatment in this setting, (2) whether an adequate number of individuals with SUDs would participate in technology-based treatment in this setting, and (3) whether an adequate number of individuals would be retained in this setting. We evaluated computer-based training for cognitive behavioral therapy (CBT4CBT), with modifications that the church-based health advisors (CHAs), who delivered the intervention within the church, made. ResultsParticipants were 40 Black adults, all of whom met DSM-5 criteria for a current SUD, (55% severe). The mean number of sessions completed was 6.8 and 31 completed all 7 sessions of CBT4CBT. Both self-reports and weekly urine toxicology screens indicated reduction in substance use over time. ConclusionWe demonstrated feasibility, as we were able to (1) collect weekly data and protect participant confidentiality, (2) recruit an adequate number of individuals with SUD, with (3) high uptake and retention of an adapted CBT4CBT in the Black church. If demonstrated to be effective in a future randomized clinical trial, delivery of technology-based treatments in the Black church may prove a promising, easily disseminable strategy to provide evidence-based interventions to an underserved and undertreated population.

Survey of psychiatrist use of digital technology in clinical practice

BackgroundPsychiatrists were surveyed to obtain an overview of how they currently use technology in clinical practice, with a focus on psychiatrists who treat patients with bipolar disorder.MethodsData were obtained using an online-only survey containing 46 questions, completed by a convenience sample of 209 psychiatrists in 19 countries. Descriptive statistics, and analyses of linear associations and to remove country heterogeneity were calculated.ResultsVirtually all psychiatrists seek information online with many benefits, but some experience information overload. 75.2% of psychiatrists use an EMR/EHR at work, and 64.6% communicate with patients using a new technology, primarily email (48.8%). 66.0% do not ask patients if they use the Internet in relation to bipolar disorder. 67.3% of psychiatrists feel it is too early to tell if patient online information seeking about bipolar disorder is improving the quality of care. 66.3% of psychiatrists think technology-based treatments will improve the quality of care for some or many patients. However, 60.0% of psychiatrists do not recommend technology-based treatments to patients, and those who recommend select a variety of treatments. Psychiatrists use technology more frequently when the patients live in urban rather than rural or suburban areas. Only 23.9% of psychiatrists have any formal training in technology.ConclusionsDigital technology is routinely used by psychiatrists in clinical practice. There is near unanimous agreement about the benefits of psychiatrist online information-seeking, but research on information overload is needed. There is less agreement about the appropriate use of other clinical technologies, especially those involving patients. It is too early to tell if technology-based treatments or patient Internet activities will improve the quality of care. The digital divide remains between use of technology for psychiatrists with patients living in urban and rural or suburban areas. Psychiatrists need more formal training in technology to understand risks, benefits and limitations of clinical products.

Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study.

BackgroundMany patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation.ObjectiveThe aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany.MethodsWe conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors.ResultsAgainst the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model.ConclusionsWhile mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement.Trial RegistrationGerman Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

Computerized Cognitive Behavioral Therapy for Substance Use Disorders in a Specialized Primary Care Practice: A Randomized Feasibility Trial to Address the RT Component of SBIRT

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has demonstrated efficacy for addressing unhealthy alcohol use in primary care, yet recent research indicates weaker efficacy for drug use as well as very limited success in referral to specialty care for patients with substance use disorder (SUD). Technology-based interventions for SUD delivered in primary care settings are a potential strategy of efficiently delivering treatment to those who need it. We conducted a randomized clinical trial evaluating feasibility, satisfaction, and substance use outcomes for 58 individuals with SUD. Participants being treated in a primary care practice which provides integrated addiction treatment were randomized to standard care or standard care plus access to a web-based SUD intervention (computer-based training in cognitive behavioral therapy, or CBT4CBT). Self-reported substance use and urine toxicology screens were assessed at 8 weeks after randomization. Uptake of CBT4CBT in this setting was high; 77% of those assigned to this condition accessed the program at least once; of those, 77% completed all 7 modules. Satisfaction with the program was very high. Participants reported >90% days abstinent for all classes of drugs; with no significant differences between conditions. This study demonstrates feasibility of implementing technology-based treatments in primary care settings to address weak follow-through with the referral component of SBIRT. The overall positive outcomes in this specialized, integrated treatment setting may have undercut the ability to demonstrate differential effects on substance use; results suggest evaluation in less specialized primary care settings is warranted. clinicaltrials.gov NCT03013478.

Promoting Emotional Well-being in Hospitalized Children and Adolescents With Virtual Reality: Usability and Acceptability of a Randomized Controlled Trial.

The aim of this study was to describe and compare small-sized preliminary data on the usability and acceptability of a randomized controlled trial. This study compares a one-to-one cognitive-behavioral treatment and a virtual reality treatment for children and adolescents hospitalized for long-term physical conditions. The final sample was composed of 19 children and adolescents with chronic illness who were hospitalized. The sample was randomly allocated to two intervention groups: cognitive-behavioral usual treatment and virtual reality-based treatment. Participants in the virtual reality group demonstrated higher perceived efficacy scores for every treatment component than for traditional treatment. Statistically significant differences were found for the total usability and acceptability scores. Participants in the virtual reality group show high acceptability of all the virtual environments. The components and environments of virtual reality were well accepted. The virtual reality program received high scores in immersion, feasibility of use, and sense of reality. Technology-based treatments, that is, virtual reality, can provide motivational benefits in relation to traditional treatments.

The Use of Digital Health Technologies to Manage Insomnia in Military Populations

Up to one-third of US Active Duty Service Members endorse insomnia symptoms. To support the overall readiness of service members at home and abroad, this rapid review analyzes findings from clinical trials and the results of an innovative market research protocol investigating digital health technologies to support treatment for insomnia. The authors searched the PubMed database for clinical trials incorporating internet and mobile technologies for treatment of insomnia. Market research used internet search engines to identify insomnia interventions available on the internet, and mobile app distribution platforms to identify insomnia-related mobile apps. A rapid review of the literature found that internet-based cognitive behavioral programs showed similar effectiveness when compared with in-person-delivered cognitive treatments. Similarly, mobile apps developed for smartphones were found to be an effective technology for treating insomnia and sleep disorders. Based on market research findings, this report identified four internet-based treatment programs and five mobile apps for the treatment of insomnia. While there is limited research on this topic, results show a potential for successfully delivering CBT-I treatments for insomnia using the internet and mobile apps. Future evidence-based studies are needed to determine the efficacy of technology-based treatments, and for determining best practices for the military population.

Remote Technology-Based Training Programs for Children with Acquired Brain Injury: A Systematic Review and a Meta-Analytic Exploration.

Introduction Multidisciplinary rehabilitation interventions are considered to be a need for children with acquired brain injury (ABI), in order to remediate the important sequelae and promote adjustment. Technology-based treatments represent a promising field inside the rehabilitation area, as they allow delivering interventions in ecological settings and creating amusing exercises that may favor engagement. In this work, we present an overview of remote technology-based training programs (TP) addressing cognitive and behavioral issues delivered to children with ABI and complement it with the results of a meta-analytic exploration. Evidence Acquisition We performed the review process between January and February 2019. 32 studies were included in the review, of which 14 were further selected to be included in the meta-analysis on TP efficacy. Evidence Synthesis Based on the review process, the majority of TP addressing cognitive issues and all TP focusing on behavioral issues were found to be effective. Two meta-analytic models examining the means of either cognitive TP outcomes or behavioral TP outcomes as input outcome yielded a nonsignificant effect size for cognitive TP and a low-moderate effect size for behavioral TP. Additional models on outcomes reflecting the greatest beneficial effects of TP yielded significant moderate effect sizes for both types of TP. Nevertheless, consistent methodological heterogeneity was observed, pointing to cautious interpretation of findings. A subgroup analysis on visuospatial skill outcomes showed a smaller yet significant effect size of cognitive TP, with low heterogeneity, providing a more reliable estimation of overall cognitive TP effects. Conclusions Promising results on remote cognitive and behavioral TP efficacy emerged both at the review process and at the meta-analytic investigation. Nevertheless, the high heterogeneity that emerged across studies prevents us from drawing definite conclusions. Further research is needed to identify whether specific training characteristics and population subgroups are more likely to be associated with greater training efficacy.

Technology-based parenting interventions for children's physical and psychological health: a systematic review and meta-analysis.

Parenting interventions have important consequences for the wellbeing and emotional competences of parents and their children. Technology provides an opportunity with advantages for psychological intervention. The aim of this systematic review and meta-analysis is to analyze the characteristics and effectiveness of technology-based interventions for parents to promote children's physical health or psychological issues. We conducted a systematic review and meta-analysis for articles about parenting skills for prevention or treatment of children's physical or psychological concerns using technology. We explore the aim of the intervention with parents, kind of problem with children, intervention model, instruments, methodological quality, and risk of bias. A random-effects meta-analysis was conducted. Twenty-four studies were included in the systematic review and a meta-analysis of 22 studies was performed to find out the effects of intervention depending on the kind of problem, intervention model, follow-up, type of intervention, type of control condition, and type of outcome data. Results show the usefulness of technology-based therapy for parenting interventions with moderate effect sizes for intervention groups with statistically significant differences from control groups. Technology-based parenting programs have positive effects on parenting and emotional wellbeing of parents and children. Attendance and participation level in technology-based treatment increase compared with traditional parenting intervention.

Essentials of precision medicine in practice of surgical oncology for hepatobiliary tumors

Precision, minimal invasiveness, digitalization, information technology and integrative medicine were considered as the future driving force of hepatobiliary surgery progress in the era of precision medicine, especially in the comprehensive management for patients with hepatobiliary (HB) tumors. Given the encouraging outcomes in the genomic technology-based precision treatment of cancers, we believe that a paradigm shift is emerging in the surgical management for HB tumors with cumulative practice in precision medicine. The current practice would be changed in: (1) the precision neoadjuvant therapy for unresectable HB tumors would come into practice to improve the long-term survival or increase the resec-tability; (2)precision management may become a first-line strategy to prevent the postoperative disease recurrence; (3)patients with recurrent intractable HB tumors could be conversed to the chronic status of surviving with tumor. Given the large population of HB tumors and current status of precision, the precision-based paradigm shift is inevitable in the surgical management for HB tumors. It’s therefore mandatory for the new generation of hepatobiliary surgeons to comprehend the concept and technology of precesion medicine into the current practice. We compose this article to emphasize the role of precision medicine in practice of surgical oncology for HB tumors Key words: Liver neoplasms; Cholangiocarcinoma; Surgical procedures, operative; Precision medicine

Removal Methods of Heavy Metals from Laboratory Wastewater

The removal of heavy metals from the environment is the special concern due to their persistence without degradation. Methods for treating laboratory and industrial wastewater containing heavy metals often involve technologies for reduction of toxicity in order to meet technology-based treatment standards. Physico-chemical removal processes such as; adsorption on new adsorbents, ion exchange, membrane filtration, electrodialysis, reverse osmosis, and ultrafiltration were discussed. Their advantages and drawbacks in application were evaluated. In the processes of biological treatments microorganisms play a role of settling solids in the solution. Activated sludge, trickling filters, stabilization ponds are widely used for treating industrial wastewater. Bioadsorption is a new biological method and various low cost bioadsorbents (agricultural waste, forest waste, industrial waste, algae etc.) are used for maximum removal of heavy metals from wastewater. Bioadsorption techniques are eco friendly best solutions for removing heavy metals from wastewater rather than physic-chemical methods. But chemical methods are most suitable treatments for toxic inorganic compounds produced from various industries which cannot removed from any biological and physical techniques. Keywords: Heavy metals; removal techniques; Bioadsorption; physico-chemical treatments DOI : 10.7176/JNSR/9-2-04

Technology to Facilitate Treatment for Childhood Anxiety Disorders and Obsessive-Compulsive Disorder: Proof of Concept

ABSTRACTWe report two studies examining family interest in, and the feasibility of, technology-based treatment of childhood anxiety disorders and obsessive compulsive disorder (OCD). In the first study, 33 parents of children (51.5% boys; age 5–18 years) seen for anxiety or OCD completed a survey regarding access to technology, experience with the mental health system, and interest in technology-based tools. The majority of parents (76%) expressed high interest in electronic treatment options and preferred to use technology to facilitate, rather than replace, face-to-face treatment. In the second study, 10 youth (40% boys; age 6–17 years) and a parent completed an interactive online prototype to deliver psychoeducation for childhood anxiety disorders and OCD. User data supported the ability of the application to cover the breadth of symptom presentations, with most families able to identify multiple feared stimuli as well as related beliefs, avoidance behaviors, and potential exposures exercises. Only two entries, one fear stimuli and one exposure item, were made via free text. In addition, user experience was positive, with 80% of respondents rating the prototype highly. Overall, the results of both studies support and inform further development of electronic treatment tools for children with anxiety and OCD.

Feasibility of an Internet-based positive psychological intervention for hemodialysis patients with symptoms of depression

ABSTRACTBackground: Depression is a pervasive psychological issue facing hemodialysis (HD) patients. Novel technology-based treatment strategies that deploy psychology-based interventions have not been the focus for therapy and few published studies exist. The aim of the current trial is to determine the feasibility and acceptability of an Internet-based positive psychological intervention in HD patients with comorbid depressive symptoms. Methods: HD patients (n = 14) with elevated symptoms of depression were enrolled in a single-arm pre-post trial with clinical assessments at baseline and immediately post intervention. Chairside during regularly scheduled HD treatment, patients utilized a web browser to complete online modules promoting skills for increasing positive emotion over a 5-week period using Apple IPads. Targeted skills included noting of daily positive events, gratitude, positive reappraisal, acts of kindness, and mindfulness/meditation. Results: Twelve of 14 patients completed the program for an 85.7% retention rate. Participants felt satisfied with each session and offered consistently positive feedback. On average, participants visited the website 3.5 times per week. Significant improvements were evident for depressive symptoms (15.3 vs. 10.9; p = 0.04), as per the Center for Epidemiological Studies Depression Scale. Conclusions: An innovative Internet-based positive psychological intervention represents a feasible and useful therapeutic option for HD patients with depressive symptoms.

Key Factors for the Success of Self-Administered Treatments of Poststroke Aphasia Using Technologies.

Background: Use of technology in language rehabilitation has grown significantly in recent years, and there is increasing evidence of its effectiveness in the treatment of poststroke aphasia. Technology has the potential to foster intensity and repetition by enabling people with aphasia to improve their skills without the constant presence of the clinician. The main objective of this article is to review and illustrate key factors for the success of self-administered treatments of poststroke aphasia using technologies. Methods: We briefly reviewed technology-based treatments of aphasia and described three determining factors for the success of self-administered treatments delivered by technology, namely, treatment-related, technology-related, and patient-related factors. Two clinical cases were also presented to illustrate issues and challenges related to the various factors to be considered before proposing such treatments. Conclusions: Self-administered treatments of poststroke aphasia using new technologies enable patients to be more independent in their rehabilitation and to benefit from more intensive and extended treatment. These benefits are important in the current economic context, where human and financial resources for clinical practice are limited. Speech-language therapists should consider these opportunities and propose new methods to deliver attractive and intensive treatments of poststroke aphasia.

Changing Trends from Traditional to Technology Based Approach

Aphasia is an acquired neurological disorder of communication with a range of language impairments. Aphasia rehabilitation is becoming an important concern in clinical aphasiology. Traditional approaches for rehabilitation are being practiced. In addition to this, computer-based strategies are also employed in aphasiology. In this study, a qualitative phenomenological research approach is used to gain an understanding on how the SLPs of Pakistan perceive the changing trends of clinical practice in aphasia towards technology-based treatment method. This study presents lived experiences and preferences of the SLPs regarding changing trends from the traditional approach to the technology-based method. Ten SLPs participated and were recruited through purposive sampling. The participants were included if they were qualified SLPs and had at least 2 years of experience. The data was collected through audiotapes of detailed group discussions with the participants. The data was analyzed by using thematic analysis. The findings were grouped into five themes: traditional rehab activities, auditory and visual input, cost-effective approach, access and prognosis note. A range of sub-themes were also identified. The findings suggest the SLPs’ preferences are showing limited trends towards adapting the technology-based method.

Pediatric Insomnia: Update and Future Directions

AbstractThroughout their childhood, pediatric insomnia impacts approximately 25% of all children in the general population. Although it can occur as an isolated condition, it commonly associates with other comorbidities, such as autism, developmental delay, and psychiatric disorders. Careful and detailed history is essential, and sleep logs and actigraphy are useful tools in the assessment and diagnosis of pediatric insomnia. However, polysomnography is usually not warranted in the assessment of pediatric insomnia unless underlying medically-based sleep symptoms are concurrently identified and justify such test. In the majority of cases, behavioral interventions are the recommended approach for treatment. Despite the fact that many pharmacological approaches are used for child insomnia off-label, there are currently no FDA (Food and Drug Administration) approved medications for the management of pediatric insomnia. The high prevalence of pediatric insomnia, coupled with the low number of providers, who are formally trained in behavioral treatment for this prevalent condition, highlights the urgent need for improving primary care practitioner awareness, while expanding alternative routes to access to care, such as interactive virtual technology-based treatments, parent education and manuals, along with ongoing efforts to increase professional training opportunities.

Technology-Based Rehabilitation to Improve Communication after Acquired Brain Injury.

The utilization of technology has allowed for several advances in aphasia rehabilitation for individuals with acquired brain injury. Thirty-one previous studies that provide technology-based language or language and cognitive rehabilitation are examined in terms of the domains addressed, the types of treatments that were provided, details about the methods and the results, including which types of outcomes are reported. From this, we address questions about how different aspects of the delivery of treatment can influence rehabilitation outcomes, such as whether the treatment was standardized or tailored, whether the participants were prescribed homework or not, and whether intensity was varied. Results differed by these aspects of treatment delivery but ultimately the studies demonstrated consistent improvement on various outcome measures. With these aspects of technology-based treatment in mind, the ultimate goal of personalized rehabilitation is discussed.

Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record

A Review of Technology-Based Youth and Family-Focused Interventions.

In the past 10years, mental and behavioral health has seen a proliferation of technology-based interventions in the form of online and other computer-delivered programs. This paper focuses on technology-based treatment and preventive interventions aimed at benefitting children and adolescents via either involving the parents and families, or only the youth. The review considered only technology-based interventions that had at least one published study with a randomized controlled trial design. Questions being addressed included: (1) What are the technology-based interventions in the mental/behavioral health area that have been systematically evaluated in published studies? (2) What are the common and unique characteristics of these interventions and their application with respect to sample characteristics, target problems, and technology characteristics (platforms, structures, elements, and communication formats)? and (3) Which intervention approaches and strategies have accrued the greatest evidence? The review identified 30 technology-based psychosocial interventions for children and families, 19 of which were parent or family-focused (32 studies) and 11 of which were youth-focused (in 13 studies). For the parent/family-focused interventions, greatest promise was found in those that addressed either youth behavioral problems or depressive/anxious symptoms, as well as more general bolstering of parenting efficacy. The youth-focused interventions showed some promise in reducing depressive/anxious symptoms. Advantages and disadvantages of the technology-based approaches were considered, and areas for future research and development were discussed.