WorkingWell: Developing a Mobile Employment Support Tool  for Individuals with Psychiatric Disabilities

Funding Source: National Institute on Disability and Rehabilitation Research (H133G140089)

Project Period: 2014 - 2017

Principal Investigator: Joanne Nicholson, Ph.D.

Other Project Staff: Sarah E. Lord, Ph.D. (Co-Investigator), Justin Tauscher, M.S., LADC, LCMHC

Project Summary: 

In this intervention development project we examine the feasibility and acceptability of WorkingWell, an innovative mobile employment support tool for individuals with severe psychiatric disabilities, who constitute a large and underserved population in need of vocational rehabilitation services. WorkingWell will be based on the Individual Placement and Support (IPS) model of supported employment. Despite strong evidence that IPS successfully connects individuals to competitive employment, studies suggest that individuals may benefit from additional follow-up support to sustain employment. Mobile communication devices and cloud computing may be the most effective, least expensive, and most non-stigmatizing way to provide follow-up support to the broadest group of individuals in the work place.

WorkingWell will target three key autonomy-supportive constructs derived from Self-Determination Theory and previous research to help people succeed in employment: engage (identifying personal motivation to work), manage (setting goals, assessing progress, and building self-efficacy), and connect (linking to social supports). The specific aims of the WorkingWell project include: (1) to develop the information architecture, functionality, technical specifications and general design for the WorkingWell prototype via iterative, user-centered design including focus groups of users and employment specialists, and expert review; (2) to develop the fully functional WorkingWell prototype using state-of-the-art processes informed by iterative, formative testing of the usability, accessibility and acceptability of prototype components; and (3) to test the acceptance and feasibility of WorkingWell through (a) a 6-month pretest-posttest demonstration field test with individuals receiving IPS, (b) usage metrics, and (b) post-implementation feedback interviews with a purposive sample of users and employment specialists. We hypothesize that use of the WorkingWell tool, by focusing on engaging, managing, and connecting in the workplace, will contribute to positive changes in motivation, self-efficacy, and social support, and will enhance job tenure.

WorkingWell will offer users an innovative, easy-to-access, self-directed and individualized employment support tool available where and when the user needs it, for as long as he or she needs it. Our goal is to create a validated application that can be easily installed onto a mobile phone, facilitating wide-scale and far-reaching dissemination of IPS and follow-up support for the target population of individuals with severe psychiatric disabilities.

Breathe Free: Smartphone Videogame-based Incentives for Smoking Cessation

Funding Source: National Institute on Drug Abuse (Small Business Innovation Research); R44DA036252

Project Period: 2014-2016

Principal Investigators: Bethany Raiff, PhD; Multi-PI Darion Rapoza, PhD

Other Project Staff: Nicholas Fortungno (Playmatics, Inc); Madeline Carrig (Duke University); Daniel Scherlis (Entertainment Science)

Project Summary:
Cigarette smoking remains the number one cause of preventable morbidity and mortality in the U.S. Each year, one third to one half of smokers attempt to quit at least once; however, approximately 94% of quit attempts fail. A number of interventions have been developed to help smokers initiate and maintain abstinence. Unfortunately, even though most smokers express a desire to quit, relapse is the most likely outcome. Thus, it is not only critically important that more effective interventions be developed to reduce relapse, but it isalso a primary public health goal to ensure that evidence-based smoking cessation interventions be made widely available, and at a low cost, to smokers. One of the most powerful, evidence-based behavioral interventions for smoking cessation is contingency management (CM). CM for smoking cessation consists of delivering incentives (typically money) contingent on objectiveevidence of smoking abstinence (e.g., carbon monoxide [CO] levels in the exhaled breath). However, the cost of providing incentives, the time it takes to administer the program, and the distance that must be traveled to participate in supervised monitoring procedures are often cited as barriers to CM. This SBIR Fast-Track project seeks to develop a mobile videogame-basedcontingency management intervention for smoking cessation. The goals of the present project are to markedly decrease costs, improve sustainability, and further increase accessibility of CM interventions for smoking cessation. To increase access, all aspects of the intervention will be available via Android or iOS smartphones used in conjunction with a matchbox-sized peripheral device for monitoring breath CO. To decrease costs and improve sustainability, themobile game we will develop will allow us to replace the monetary incentives typically used in CM interventions with in-game "virtual rewards" that can immediately be used to help players meet game objectives, as well as with social reinforcement, prompted and incentivized in the context of the game. In Phase I, an iterative design and formative evaluation process will be used to create a game design and storyboard for the mobile game to be developed in Phase II, the CO data collection software will be produced and integrated with the CO Monitor, and a demo of the videogame will be developed. The demo created will be presented to 20 treatment-seeking smokers owning the targetplatform devices, who will then complete a survey & prospective evaluation of the planned intervention. In Phase II the development of the videogame, capable of supporting 7 weeks of play, will be completed, and a 7 week randomized control trial outcome evaluation will be conducted with 114 subjects to assess the feasibility, acceptability, appeal, and efficacy of the smoking cessation intervention.

Public Health Relevance: 
We plan to develop and evaluate a mobile videogame-based smoking cessation intervention that will overcome barriers to treatment using such as cost, sustainability, participation time and travel burdens, and program appeal. This videogame will be the first of its kind, is based on an evidence-based intervention shown to promote smoking abstinence, and we anticipate it will be highly effective for helping smokers who wish to quitstop smoking. The findings from this research will be of great public health significance because of the unprecedented reach and relatively low cost, aswell as the potential for similar interventions to be developed for other health problems, such as alcohol or drug abuse and medication adherence forchronic illnesses.

Integrating Evidence-Based Behavioral Health Technologies into Primary Care

Funding Source: Dartmouth SYNERGY Translational Program (Community-Based Research Core)

Project Period: July 2014-June 2016

Principal Investigator(s): Lisa Marsch, PhD; Sarah Lord, PhD; Bob Drake, MD, PhD

Other Project Staff:  Erin Corriveau, MD; Elliott Fisher, MD; Mark McGovern, PhD; Haiyi Xie, PhD; Ardis Olson, MD; Ben Crosier, PhD

Project Summary:

This project engages community and academic partners in understanding needs and priorities among rural community health care systems around shifting health care systems (e.g., in light of ACA) – with a particular focus on integrating behavioral health and medical care in rural settings.

Behavioral health problems (addictions and mental health disorders, such as depression) are highly prevalent, especially in poor and disenfranchised populations. The great majority of these people (over 90%) receive no treatment. Behavioral health problems also complicate diagnosis, treatment, and outcomes for many chronic conditions, such as diabetes, obesity, heart failure, and cancer.  A sufficient workforce to address these problems does not exist - especially in rural communities.

Incorporating new health technologies could be a cost-effective solution.  New technology tools could be used in primary care to improve access, self-care, and outcomes, and to reduce costs and health disparities.  Yet, successful implementation and sustainability of any new intervention process, including a technology-based care approach, is strengthened by attention to pre-implementation readiness of the primary care community agencies and constituent stakeholders to adopt a technology treatment innovation in their system of care. 

This two-year, 2-phased project includes mixed-methods formative research in year 1 to assess community priorities and readiness for technology-based behavioral health tools in primary care settings, followed by a demonstration implementation project of a technology-based behavioral health intervention within rural primary care settings in year 2. 

Public Health Relevance:

This work will inform strategies for optimizing implementation outcomes when embedding technology-based behavioral health tools in rural primary care settings, supported by appropriate training/technical assistance.    

Jacob Borodovsky, BA

PhD Student, Dartmouth Psychiatric Research Center

Buprenorphine; Opioid, Behavioral Health Technology; Co-Occurring Disorders

borodovsky smallJacob Borodovsky is currently a Health Policy and Clinical Practice PhD student at The Dartmouth Institute in the Geisel School of Medicine. He graduated from Tufts University with a B.A. in Clinical Psychology. Before coming to the Center for Technology and Behavioral Health he worked as a research coordinator for WestBridge Community Services and Cambridge Health Alliance in Boston. Jacob’s research is focused primarily on exploring the role that technological interventions can play in enhancing behavioral health and the treatment of Co-Occurring disorders. Jacob is particularly interested in developing technologically based models of buprenorphine treatment that may help increase rates of medication adherence and reduce diversion. He is currently conducting this research under the supervision of Dr. Lisa Marsch and Dr. Alan Budney. In his spare time he enjoys rock climbing.

Selected Publications:

Schuman-Olivier, Z., Weiss, R. D., Hoeppner, B. B., Borodovsky, J., & Albanese, M. J. (2014). Emerging adult age status predicts poor buprenorphine treatment retention. Journal of Substance Abuse Treatment, 47(3), 202-212. doi: 10.1016/j.jsat.2014.04.006

Schuman-Olivier, Z., Hoeppner, B. B., Weiss, R. D., Borodovsky, J., Shaffer, H. J., & Albanese, M. J. (2013). Benzodiazepine use during buprenorphine treatment for opioid dependence: Clinical and safety outcomes. Drug Alcohol Depend, 132(3), 580-586.

Schuman-Olivier, Z., Connery, H., Griffin, M. L., Wyatt, S. A., Wartenberg, A. A., Borodovsky, J., . . . Weiss, R. D. (2013). Clinician beliefs and attitudes about buprenorphine/naloxone diversion. Am J Addict, 22(6), 574-580. 

May 9, 2014

Emerging Communications Technologies to Advance Prevention and Recovery

10th Annual Dartmouth Symposium on Substance Use 

Mary Brunette, MD – Associate Professor of Psychiatry, Geisel School of Medicine, Hanover, NH; Medical Director, Bureau of Behavioral Health, Department of Health and Human Services, Concord, NH

Andrew Campbell, PhD – Professor of Computer Science, Dartmouth College, Hanover, NH

Lynn Fiellin, MD – Associate Professor of Medicine, Yale University, New Haven, CT

Sarah Lord, PhD – Assistant Professor of Psychiatry and Pediatrics, Geisel School of Medicine, Hanover, NH; Director, Dissemination and Implementation Core, Center for Technology and Behavioral Health, Lebanon, NH

Lisa Marsch, PhD – Associate Professor of Psychiatry Geisel School of Medicine, Hanover, NH; Director, Center for Technology and Behavioral Health, Lebanon, NH; Director, Dartmouth Psychiatric Research Center, Lebanon, NH

Rachel Brian, MPH – Project Coordinator, Geisel School of Medicine, Hanover, NH

About the Conference:

Only a small percentage of persons with substance use disorders- or at risk for developing them- get the care they need. Communications technologies such as internet, smart phones, and interactive video games offer huge opportunities to expand prevention and treatment of substance use disorders and other mental health challenges. This symposium presents innovative initiatives that usetechnology to engage patients in addressing diverse substances challenges and phases of use - from tobacco to opioids to alcohol and across the spectrum of use from prevention to treatment to support of recovery. Speakers emphasize practical strategies for implementing use of technologies in clinical practice and attendees are given opportunities to try out many of the technology programs presented.