Homework, or between-session practice of skills learned during therapy, is one of the most integral, yetunderutilized components of high-quality, evidence-based mental health treatments (EBTs) such as CognitiveBehavioral Therapy (CBT). Many providers struggle to consistently develop, assign, and assess homeworkexercises with their patients, and many patients have difficulty remembering to practice skills in a correct andtimely way that fosters adequate learning. Innovative health IT solutions are needed to overcome thesebarriers to implementing this crucial component of high quality EBTs. To meet this need, our experienced teamat Adhere.ly, LLC, in partnership with the University of South Florida, the Medical University of South Carolina,and Doxy.me, LLC developed Adhere.ly, an innovative, state-of-the art, and user-friendly web-based solutionto improve provider implementation and patient engagement in homework during EBTs. Adhere.ly includesengaging therapeutic exercises for providers to introduce, practice, and assign as homework to patients, whoreceive SMS/email reminders with links to practice those exercises during the week. Adhere.ly was initiallydeveloped for providers treating children with PTSD and their caregivers. Broadening Adhere.ly's features andexercises will increase its clinical utility and ability to support NIMH priorities and PA-18-579 Specific Areas ofResearch Interest in "Tools and Platforms to Improve the Dissemination and Implementation of EBTs." Theobjectives of this Phase I STTR proposal-guided by the Accelerated Creation to Sustainment model andModified Consolidated Framework for Implementation Research-are threefold. First, we will seek tounderstand and prioritize key stakeholder goals, challenges, affordances, and constraints by conductingindividual, semi-structured qualitative interviews with adult mental health patients, providers, andadministrators (nâ¤20 each) and a quantitative survey of 100 providers. We will conduct a mixed methodsanalysis to inform the design of new Adhere.ly features and exercises and an implementation/sustainment (I/S)blueprint (Aim 1). Second, we will use participatory design methodologies (e.g., co-design workshops) withadult mental health patients and providers to iteratively design, refine, and develop new Adhere.ly features andtherapeutic exercises that support a range of adult EBTs, and an I/S blueprint (Aim 2). Third, we will conduct afeasibility Optimization, Effectiveness, and Implementation (OEI) Hybrid trial with 20 community mental healthproviders randomized to CBT+Adhere.ly (n=10) vs. CBT alone (n=10), and 40 treatment seeking,provider-referred adult patients with clinically elevated anxiety and/or depression (outcomes), which we willassess at baseline and 3-months post-baseline. We will assess homework use by providers and adherence ofpatients (targets) weekly via session audio recordings and patient-report. We will optimize new features,exercises, and our I/S plan during the trial and assess implementation outcomes post-implementation (Aim 3).
Public Health Relevance Statement: PROJECT NARRATIVE
Mental health disorders affect 1 in 5 adults in the U.S., yet there is a gap in the quality of mental health care
these patients should receive vs. what they do receive. Homework, or between-session practice of skills
learned during therapy, is an integral component of high quality, evidence-based mental health care, but its
implementation in "real world" clinical settings is generally lacking. This project aims to expand and
preliminarily evaluate an innovative, web-based solution to improve the implementation of this crucial
component of evidence-based mental health care.
Project Terms: <21+ years old><0-11 years old>
