Short Message Assisted Responsive Treatment for Wraparound (SMARTWrap)

Background and Goals:

The Wraparound service model (WSM) is the most common care coordination strategy for youth with serious emotional disorders(SEO), with programs in nearly every U.S. state serving more than 100,000 youth. A recent meta-analysis of 17 controlled studies found significant positive effects of WSM on mental health (MH) symptoms, out of home placement rates, and health care expenditures, confirming its critical role in behavioral healthcare for children and adolescents. 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 the variance in outcomes for Wraparound. For example, collection and use of data assessing client satisfaction, therapeutic alliance, and progress substantially increase likelihood of achieving target outcomes as a function of treatment. However, research on WSM shows that measurement and use of data, such as via Routine Outcome Monitoring, is inconsistent at best.

The goal of this SBIR is to develop and test a mobile ROM (mROM) system tailored to WSM. The proposed SMART-Wrap (Short Message Assisted Responsive Treatment for Wraparound) product will provide a feasible and acceptable mROM approach for WSM-enrolled parents/caregivers and youth based on evidence-based principles and past research for effective mROM. SMS (“short message system”) is supported by every mobile device and network with no software download needed. More than 98% of SMS messages are opened, compared to just 20% of emails, and on average, 90% of SMS messages are opened within the first 3 seconds of receipt.l161 SMART-Wrap will periodically administer brief, straightforward (1-2 items) SMS-based assessments of intermediate outcomes that have been found to predict clinical outcomes of WSM (e.g., harm to self and others, hospitalization, out of home placement)). Data will be used to:

1. Populate tabular and graphical displays (based on user permissions) to inform decision-making by WSM care providers, supervisors, and program managers (i.e., the WSM care team);
2. Trigger alerts to WSM care team members, such as escalation in caregiver stress or youth symptoms; and
3. Generate automated SMS outreach messages for families.

This 18-month Phase I project will accomplish the following specific aims: 

Aim 1: Design SMS system. Leveraging our team’s unparalleled access to WSM-implementing organizations, we will work with 50 WSM expert advisors, including experienced youth and caregivers, to determine an initial set of SMS assessment items and define the algorithm for generating data-driven alerts and outreach messages for each end user type (youth, parents/caregivers, WSM care team members). The Phase I proof of concept prototype will focus on four intermediate outcomes associated with positive clinical outcomes for WSM, specifically: therapeutic alliance, treatment satisfaction, youth symptoms, and parent stress/optimism.

Aim 2: Test SMS system. We will evaluate item psychometrics and messaging system feasibility with 30 families with a youth with SEO currently enrolled in WSM. Parents/caregivers and youth will independently interact with the prototype messaging system over a two-week period and then participate in follow-up focus groups and complete a prototype evaluation survey. We expect target end users to report high feasibility, usability, and acceptability for the prototype messaging system. We also expect items to show acceptable psychometric properties for youth and caregivers. Findings will be used to inform iterative modifications to items and enhancements to the text messaging platform prior to Phase I pilot testing.

Aim 3: Develop care team report features. Building on recommendations from our WSM expert advisors in Aim 1 as well as input from our expert consultants, we will create an online dashboard for WSM teams including tabular and graphical data displays, message and alert tracking logs, and reports to support team­ based decision-making. The online dashboard will be fully functioning to support the Phase I pilot test.

Aim 4: Conduct pilot test. We will work with established WSM provider organizations (WPO) to recruit 10 WSM care teams (approx . 30 WSM providers, 10 program managers, and 10 supervisors across 10 WPOs). Teams will use the SMART-Wrap prototype with 1 family over a 2-month pilot period (n=30 families). Software usage metrics will be collected and participants will complete follow-up online surveys. We hypothesize high usability (e.g., expected completion times, few help requests) and positive views of the prototype’s feasibility, acceptability, and added value across participant types (youth, caregivers, care team members). Positive results will set the stage for a Phase II SBIR to fully examine efficacy for service and clinical outcomes.

Commercial Application. SMART-Wrap will offer a feasible, cost-efficient, and scalable software system to meet the documented public health need for mROM and MBC in care coordination for youth behavioral health. Our end product will provide a novel solution to over 1,000 WPOs and WSM initiatives, many of which already license other technologies from this team, with future expansion to programs that serve youth and adults via other coordinated care models. 3C’s expertise in iterative software development and UW’s extensive ongoing research and commercial channels into WSM will provide a solid foundation for these efforts.