Digital Tools for Mental Health Care: Integrating Technology for Young People’s Well-being

Digital technology has become deeply embedded in modern life, offering unprecedented opportunities to transform various sectors, including healthcare. In mental health, digital tools hold immense potential to revolutionize care delivery, particularly for young people. This article explores the perspectives of community behavioral health providers on incorporating digital tools into their clinical practice for children and adolescents, highlighting both the advantages and challenges of this integration. By understanding these viewpoints, we can pave the way for more effective and accessible mental health support systems tailored to the unique needs of young individuals.

The Promise of Digital Mental Health Tools for Young People

The increasing prevalence of digital devices in the lives of young people presents a unique opportunity to leverage technology for mental health care. Digital mental health (DMH) tools can seamlessly integrate into daily routines, potentially maximizing the reach and impact of interventions. These tools can extend mental health support to underserved populations, offer personalized treatment options, and facilitate continuous monitoring and engagement. However, translating the potential of DMH tools into real-world clinical settings requires a thorough understanding of the needs and perspectives of both providers and young users.

The “research-to-practice gap” is a well-documented challenge in the field of DMH. Despite the development of efficacious interventions, their effective and sustained implementation in routine care remains limited. Low engagement rates with mental health apps further underscore this gap, with studies indicating that only a small fraction of users actively engage with these tools daily. To bridge this divide, it is crucial to adopt user-centered design approaches that consider the specific needs, preferences, and contexts of stakeholders, including healthcare providers.

Frameworks like the Accelerated Creation-to-Sustainment (ACTS) model emphasize iterative stages of development, incorporating qualitative assessments and usability testing to ensure the successful implementation and sustainability of DMH tools. By involving stakeholders throughout the design process, we can create targeted, pragmatic, and sustainable tools that effectively address the needs of both providers and young people.

While research has explored factors influencing healthcare providers’ adoption of digital health tools in general, there is a relative scarcity of studies focusing specifically on mental health, particularly for child and adolescent populations. This is a critical gap, considering the potential of technology to resonate with tech-savvy young people and the fact that most mental health conditions emerge during adolescence and early adulthood. Understanding the perspectives of mental health professionals working with young people is essential to inform the development and implementation of DMH tools tailored to this specific demographic.

Previous studies have begun to explore the use of technology by child mental health professionals. Surveys have revealed uncertainty among clinicians regarding available technologies, leading to a reliance on older tools like helplines and websites. Focus groups have highlighted the perceived strengths of technology, such as symptom tracking and increased engagement, alongside concerns about accessibility, confidentiality, and crisis management. However, more in-depth research is needed to comprehensively understand the nuances of integrating digital tools into mental health care for young people.

Understanding Clinician Perspectives: Focus Group Insights

To gain deeper insights into the perspectives of community behavioral health providers, a study was conducted involving focus groups with clinicians working with children and adolescents. These clinicians, from a large community service organization, shared their experiences, current practices, and considerations regarding the use of digital tools in their clinical care. The focus groups aimed to understand:

• How mental health clinicians are currently using technology in their clinical care for young people.
• The challenges associated with technology use in treating this population.
• The types of digital tools clinicians find helpful.
• Considerations for integrating digital tools into everyday practice.

The study involved five focus groups with 37 clinicians from various service settings, including in-home, in-school, and outpatient services. Thematic analysis of the focus group transcripts revealed three key themes:

1. Digital Tools in Clinical Care with Young People: Exploring the current use of digital tools and their perceived strengths in skill-building, learning facilitation, and symptom monitoring.
2. Challenges of Using Digital Tools in Practice: Identifying barriers and limitations related to accessibility, outdated programs, and limited content.
3. Desired Digital Platform and Integration Considerations: Investigating clinicians’ vision for a centralized digital platform and their recommendations for successful integration into care.

Theme 1: Digital Tools in Clinical Care with Young People – Strengths and Applications

Clinicians participating in the focus groups recognized the inherent connection young people have with technology and viewed digital tools as a valuable means to engage this population in mental health treatment. They emphasized that young clients often express a preference for digital platforms over traditional methods, such as paper-based journaling. This preference highlights the potential of digital tools to enhance engagement and make therapy more appealing to young individuals.

Building Skills and Facilitating Learning

A primary application of digital tools identified by clinicians was skill-building and learning facilitation. They reported using a variety of tools, including apps and web-based videos, to guide young clients through practice sessions focused on meditation, relaxation, and mindfulness. Clinicians would model these techniques in sessions and encourage clients to practice them in their daily lives.

One innovative example involved clinicians having young clients record their own voice using relaxation prompts on their phones. This personalized approach not only reinforced skill practice but also empowered young people by giving them ownership of their self-care techniques. Gamification was also mentioned as a tool to enhance engagement, with apps like “Heads Up” being used to improve communication skills in a fun and interactive way.

Digital tools also served as effective aids in demonstrating therapeutic concepts. For instance, clinicians used wearable technology like Apple Watches to provide biofeedback, visually illustrating the mind-body connection. By showing real-time changes in heart rate during breathing exercises, clinicians could tangibly demonstrate the impact of relaxation techniques on physiological responses.

Beyond skill practice, digital tools were utilized to facilitate psychoeducation. Clinicians employed web-based videos, websites, and interactive story apps to educate young people about mental health conditions and coping strategies. These tools provided engaging and age-appropriate content that sparked discussions and enhanced understanding of complex topics. Clinicians highlighted the ability to tailor digital resources to the specific needs and developmental stage of each client as a significant advantage.

Monitoring Symptoms and Progress

Another key application of digital tools was symptom monitoring. Clinicians reported using mood-tracking apps, such as Daylio and Moodpath, to help young people chart their symptoms between sessions. These apps often utilize visual aids like smiley faces, making them user-friendly and relatable for young individuals.

The data generated by these apps, such as symptom charts depicting daily and weekly patterns, proved valuable in therapy sessions. Clinicians used this information to facilitate conversations about symptom fluctuations, triggers, and patterns, enabling more targeted and personalized interventions. The real-time engagement offered by tracking apps, combined with accessible language, helped young people understand and communicate their experiences more effectively.

Theme 2: Challenges of Using Digital Tools in Practice – Barriers to Overcome

Despite the recognized benefits, clinicians also voiced concerns and challenges associated with integrating digital tools into mental health care for young people. These challenges primarily revolved around accessibility and limitations of existing tools.

Accessibility Barriers: Beyond Device Availability

Accessibility emerged as a multifaceted challenge, extending beyond simple device availability. Clinicians highlighted issues related to:

• Broadband Access: Many young people, particularly from low socioeconomic backgrounds, lacked consistent access to broadband internet or had limited data plans, hindering their ability to utilize online DMH tools outside of sessions.
• Device Restrictions: Clinicians reported that caregivers and schools often imposed restrictions on device use, including screen time limits and prohibitions in certain contexts. Paradoxically, devices were often taken away as punishment, precisely when young people might need DMH tools most for coping with difficult emotions.
• Inconsistent Access: Shared devices within families and school restrictions further contributed to inconsistent access, limiting the ability of young people to engage with DMH tools when needed.

These accessibility barriers underscore the need for creative solutions, such as offline content availability and desktop versions of DMH tools, to ensure equitable access regardless of internet connectivity or device ownership. Furthermore, addressing caregiver and school policies regarding device use is crucial to facilitate the effective integration of DMH tools into young people’s lives.

Outdated Programs and Limited Content: Engagement Hurdles

Clinicians also expressed concerns about the design and content of existing DMH tools. Outdated interfaces and limited content were identified as significant barriers to engagement and sustained use. Young people, accustomed to visually appealing and dynamic digital platforms, were often deterred by clunky or outdated designs.

Similarly, limited content within some DMH tools led to boredom and disengagement. Clinicians emphasized the need for fresh, updated content and engaging designs to maintain young people’s interest and encourage continued use. This highlights the importance of ongoing development and iterative improvement of DMH tools to keep pace with evolving user expectations and technological advancements.

Theme 3: Desired Digital Platform and Integration Considerations – Shaping the Future of DMH

Building upon their experiences and identified challenges, clinicians articulated their vision for an ideal digital platform and offered key considerations for successful integration into mental health care.

Centralized Digital Platform: Connecting Stakeholders

A recurring theme was the desire for a centralized digital platform that securely connects clinicians, young people, and their families. Clinicians envisioned this platform as a hub for:

• Tool and Resource Sharing: Facilitating the sharing of recommended apps and digital resources for use outside of sessions.
• Activity Reminders: Sending reminders to young people to practice skills and complete assigned activities between sessions.
• Progress Tracking: Securely tracking mood patterns and progress in real-time, enabling data-driven therapy adjustments.
• Secure Communication: Providing a secure channel for communication between clinicians, young people, and parents, facilitating check-ins and resource sharing, especially during session cancellations or in specific situations.
• Parental Engagement: Enhancing parental involvement in their child’s mental health care by providing tools for communication, reminders, and progress updates.

Clinicians believed that such a platform could bridge the gap between therapy sessions and daily life, promoting skill generalization and continuous support. They also emphasized the potential for discreet use within school settings, allowing young people to access coping strategies on their smartphones or school tablets without drawing undue attention. However, they stressed the importance of parental buy-in and ensuring access to devices and internet connectivity for effective implementation.

Considerations for Integration into Care: Human-Centered Approach

Beyond platform features, clinicians highlighted crucial considerations for successful integration into clinical practice:

• Visual Engagement: Emphasizing visuals over text-heavy content to capture and maintain young people’s attention. Features like badges and avatars were suggested to enhance engagement through gamification.
• Privacy and Discretion: Prioritizing privacy features, such as discreet app branding and security measures like passwords and facial recognition, to protect sensitive mental health information and address young people’s concerns about stigma and confidentiality.
• Human Support: Underscoring the critical role of human support, whether from therapists, parents, or guidance counselors, in guiding and supporting young people’s use of digital tools. Clinicians unanimously agreed that digital tools should augment, not replace, human interaction and therapeutic relationships.
• Boundary Setting and Expectations: Emphasizing the need to establish clear boundaries and expectations regarding the capabilities and limitations of digital tools. This includes educating young people and families about the tool’s purpose, when immediate help is not available through the platform, and developing safety plans for crisis situations.
• Crisis Response Mechanisms: Suggesting the integration of automated crisis detection mechanisms within DMH tools, such as algorithms that identify crisis-related keywords and guide users to appropriate resources and contacts.

These considerations highlight the importance of a human-centered approach to DMH implementation, emphasizing the need to balance technological innovation with the essential elements of human connection, therapeutic relationships, and ethical considerations.

Discussion: Towards Effective and Equitable Digital Mental Health Care for Young People

The insights from these focus groups provide valuable guidance for the future development and implementation of digital tools for youth mental health care. Clinicians recognize the potential of DMH tools to engage young people, enhance skill-building, and monitor symptoms. However, they also highlight critical challenges related to accessibility and tool design that must be addressed to ensure equitable and effective implementation.

The complex nature of accessibility for young people, encompassing broadband access, device restrictions, and inconsistent availability, demands innovative solutions. Strategies such as offline content, desktop versions, and SMS-based interventions can help overcome these barriers and promote digital inclusivity. Addressing socioeconomic disparities in access to technology is crucial to prevent DMH tools from exacerbating existing health inequities.

The strong interest in a centralized digital platform underscores the need for integrated DMH solutions that connect stakeholders and facilitate seamless care coordination. Such platforms should prioritize user-friendly design, engaging content, robust privacy features, and mechanisms for human support. The emphasis on human support aligns with existing frameworks and research suggesting that blended care models, combining digital tools with human interaction, are often more effective than standalone interventions.

Moving forward, several key actions are needed to advance the field of DMH for young people:

• User-Centered Design: Incorporating feedback from young people, caregivers, and other stakeholders throughout the DMH tool development process is essential to create tools that are relevant, engaging, and effective.
• Addressing Accessibility Barriers: Developing strategies and technologies to overcome accessibility challenges and ensure equitable access to DMH tools for all young people, regardless of their socioeconomic background or device ownership.
• Focus on Engagement and Content: Prioritizing engaging design, updated content, and gamification features to maintain young people’s interest and encourage sustained use of DMH tools.
• Blended Care Models: Promoting the integration of DMH tools within blended care models that combine technology with human support and therapeutic relationships.
• Implementation Research: Conducting rigorous implementation research to identify effective strategies for embedding DMH tools into routine clinical practice and ensuring their sustainable use in real-world settings.
• Training and Education: Providing clinicians with adequate training and ongoing education to enhance their DMH literacy and equip them with the skills to effectively integrate digital tools into their practice.

By addressing these key areas, we can harness the transformative potential of digital tools to create a more accessible, engaging, and effective mental health care system for young people, ultimately promoting their well-being and fostering a healthier future generation.

Limitations and Future Research Directions

While this study provides valuable insights, it is important to acknowledge its limitations. The findings are based on the perspectives of clinicians from a single community behavioral health organization. Future research should expand upon these findings by:

• Gathering Feedback from Young People: Eliciting direct feedback from young people themselves regarding their experiences with and preferences for DMH tools is crucial to ensure user-centered development.
• Including Other Stakeholders: Incorporating the perspectives of caregivers, teachers, and other individuals who play significant roles in young people’s lives will provide a more comprehensive understanding of the ecosystem surrounding youth mental health care.
• Replicating in Diverse Settings: Conducting similar studies in diverse healthcare settings serving various populations of young people will help identify universal and context-specific needs and preferences.
• Establishing Standards for Qualitative DMH Research: Developing and adopting rigorous standards for qualitative data collection and analysis in the field of DMH to ensure the credibility and validity of research findings.

Further research is needed to build a robust body of literature that guides the design, implementation, and evaluation of sustainable DMH tools for children and adolescents. By continuing to explore the perspectives of all stakeholders and rigorously evaluating different approaches, we can realize the full potential of digital tools to transform youth mental health care and improve the lives of young people worldwide.

Acknowledgments

This research was supported by the National Institute of Mental Health (K01 MH121854, K08 MH112878, P50 MH119029, and T32 MH115882). ADC is a senior fellow at the Meadows Mental Health Policy Institute.

Abbreviations

ACTS Accelerated Creation-to-Sustainment

DMH digital mental health

Footnotes

Conflicts of Interest: DCM, PhD, has accepted honoraria and consulting fees from Apple Inc, Otsuka Pharmaceuticals, Pear Therapeutics, and the One Mind Foundation; has royalties from Oxford Press; and has an ownership interest in Adaptive Health Inc. JJS is employed by OhioGuidestone.