Testing and Implementing Technology-Based Interventions to Address Mental Health and Substance Use

Permanent URI for this collectionhttps://hdl.handle.net/10125/112483

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"Moving at the Speed of Trust": Implementing a Digital Tool to Improve Data-driven Response to the Opioid Crisis
(2026-01-06) Claborn, Kasey; Mccormick, Katie; Samora, Jake; Benzer, Justin
Efficient, equitable, and cost-effective responses to the opioid crisis require that communities have real-time, robust data. Traditional data sources are severely limited and better methods are needed to capture data among "hidden" and vulnerable populations and improve data infrastructure. This study pilot tested a digital tool to improve data capture and data-driven decision-making among harm reduction organizations (HROs). We enrolled 11 organizations over 17 weeks to assess feasibility, acceptability, and preliminary efficacy. We conducted surveys with N=71 staff and qualitative interviews with n=21 staff of participating sites. Thematic analysis of these interviews was conducted to understand the relative characteristics between sustaining and late-adopting organizations. Results demonstrated feasibility and acceptability of the digital tool in community-based outreach settings. Qualitative data revealed differences between sustaining and late-adopting organizations: sustainability was associated with organization-level priorities for data-driven overdose response, valuing improving overdose data accuracy, and leadership setting usage expectations.
What Are You Craving? Using Wearables to Distinguish Food and Drug Cravings During Treatment with Extended-Release Buprenorphine
(2026-01-06) Ramanand, Pravitha; Indic, Premananda; Kapadia, Nirzari; Graham, Powell; Carreiro, Stephanie
Craving, or the subjective, strong desire to use a substance, is a central factor in addiction, and part of the diagnostic criteria for substance use disorders (SUDs). Cravings can also occur for other triggers such as food, and cravings for food and drugs have been found to activate distinct neural pathways in the brain. Recently, physiologic signals from wearable devices have been applied to digitally detect cravings in patients with SUDs. But to date, no studies have explored digital detection of cravings by subtype. We collected continuous physiologic sensor data from N = 12 participants with opioid use disorder, treated with extended-release buprenorphine (BUP-XR). Data were analyzed to assess whether sensor signals carried differential information that could distinguish between food-, drug- and mixed-craving types. Accelerometer, heart rate and heart rate variability features significantly differed between drug, food and mixed trigger cravings. Cross validated models trained with these features distinguished each type of craving with area under ROC curve ranging from 75%-80%. These findings support the ability of wearable sensor-based digital biomarkers to distinguish craving subtypes in individuals with SUD.
Clinician Ratings of Acceptability, Appropriateness, Feasibility and Usability of a Suicide Risk Flag Implemented in Behavioral Health Clinics
(2026-01-06) Yarborough, Bobbi Jo; Ahmedani, Brian; Rossom, Rebecca; Stumbo, Scott; Janoff, Shannon; Westphal, Joslyn; Muegge, Jule
Risk models that leverage data collected in electronic health records and insurance claims to estimate risk of suicide attempt are an innovation in suicide prevention. Published studies of their effectiveness and implementation are rare and few report clinicians’ perceptions of this technology. This study measured clinician ratings of acceptance, appropriateness, feasibility, usefulness, usability, and organizational readiness—both prior to intervention start and 6 months following use—among 298 respondents practicing in behavioral health clinics in three large health systems. Clinician ratings were neutral at pre-implementation with mean scores of 3.5 for acceptability, 3.6 for appropriateness, 3.7 for feasibility (scale 1-5, higher scores more favorable), 4.1 for usefulness (scale 1-7), and 57.0 for usability (scale 0-100). Readiness for change was also moderate (40.7, scale 0-60). At post-implementation, usability increased slightly but perceived usefulness declined; there were no significant changes in other measures. While a suicide risk model was not considered unacceptable, inappropriate, or infeasible, it was also not considered especially useful. If an ongoing effectiveness trial does not show superiority of the model over usual care in terms of suicide risk reduction, clinicians may be unlikely to endorse its use.
Developing Technology-Based Messaging to Increase Engagement with Harm Reduction Services Among People Who Use Drugs in New York City
(2026-01-06) Aronson, Ian; Bennett, Alex S.; Marcus, Olivia; Cramer, Anthony; Quiles, Robert; Fong, Chunki
Overdose deaths in the US remain at epidemic levels. As part of a larger project to develop a technology-based intervention designed to encourage people who use drugs to protect themselves and others against overdose, our team conducted a series of qualitative interviews with PWUD in New York City (n=30) to better understand why people choose not to engage with overdose prevention and other community-based harm reduction services. We found that people often fear stigma if they disclose their drug use, but also, that many people who use drugs and may be at risk of overdose perceive harm reduction as better suited for someone else. We hypothesize that technology-delivered messages emphasizing the respectful, non-judgmental nature of community-based harm reduction programs, combined with outreach tailored to multiple populations by age, substance(s) used and frequency of use can facilitate greater engagement.
Suicide Prevention Among People Recently Released from Jail: Linking Data from Jail Release Reports to Electronic Health Records
(2026-01-06) Ahmedani, Brian; Wisnieski , Diane; Rossom, Rebecca; Weinstock, Lauren; Hu, Yong; Borgert-Spaniol, Caitlin; Johnson, Jennifer; Graves, Hannah; Strong, Sarah
Suicide risk among people recently released from jail is a critical problem of public health significance. Half (40-50%) of incarcerated individuals report lifetime suicidal ideation or behavior and 13-20% have attempted suicide. Incarcerated individuals are more likely to die by suicide than the general population. Jail release is a particularly high-risk period, as individuals often struggle with mental health concerns, including acute life stressors, and many fall through the cracks without community connection to mental health services. A new large trial is underway testing a novel informatics solution linking public jail release data with health system records via an automated computer program consisting of a set of common demographic and other data elements to stimulate immediate virtual care coordination, suicide risk screening, brief intervention, and an evidence-based telemedicine-based suicide prevention program called Coping Long Term with Active Suicide Program (CLASP) for those who screen positive. In this nested study, we provide data on the informatics matching approach to link jail records with health system records at one large health system in the US to initiate the telemedicine-based intervention. Data were examined from 1,363 individuals released from a county jail over a 2-month period. The informatics algorithm successfully matched 1,050 individuals to their health records. These data support initiation of the innovative intervention and provide promise that health systems can offer a solution to fill the gap in suicide risk after jail release.
Patient Impressions of Opioid-Related Printouts, Discussions and Care in a Primary Care Clinical Decision Support System Implementation Trial
(2026-01-06) Rossom, Rebecca; Happala, Jacob; Allen, Clayton; Mccormack, Jennifer; Bart, Gavin; Miley, Kathleen; Hooker, Stephanie; Olson, Anthony; Solberg, Leif; Romagnoli, Katrina; Wright, Eric; Crain, A. Lauren; Borgert-Spaniol, Caitlin; Gorodisher, Jule; Tusing, Lorraine
Primary care is a critical setting to provide care for the 75-79% of patients who have opioid use disorder (OUD) but do not receive medications for OUD. However, patient perceptions of primary care of OUD are not well understood. Patients completed surveys about their experience with opioid-related clinical decision support system (CDSS) printouts and OUD treatment in the first 7-9 months of implementation of an OUD-CDSS. Survey responses were presented overall and by reason for study eligibility. Of 277 patients completing surveys, 22% recalled seeing the printouts; of these, 85% said the printouts made them more comfortable discussing opioid risk. Of all respondents, half discussed opioids during their visit; of these, 84% felt conversations were conducted sensitively. Overall, 88% felt primary care was the right setting to discuss opioid risks. The opioid-related printouts and discussions were generally well-received, and patients felt primary care was a suitable setting for opioid-related care.
Factors Impacting Implementation of Electronic Screening and Brief Intervention (eSBI) for Alcohol in a Reproductive Healthcare Setting
(2026-01-06) Loree, Amy; Yeh, Hsueh-Han; Pappas, Celeste; Zelenak, Logan; Moore, Sarah; Kazan, Rowyda; Goyert, Gregory; Beatty, Jessica; Riba, Melissa; Ondersma, Steven
Excessive alcohol use is increasing among pregnant and non-pregnant women and is associated with multiple negative health outcomes. Even among those meeting criteria for alcohol use disorder, the majority is neither in treatment nor feel it is needed. Health systems play an important role in addressing alcohol use through their ability to proactively identify non-treatment-seeking women and promote change via Screening and Brief Intervention (SBI). However, traditional provider-delivered SBI often faces implementation challenges. We used a mixed methods approach to evaluate a program that implemented technology-based SBI (eSBI) within reproductive health clinics in a large health system to identify implementation barriers and facilitators. Key factors impacting eSBI implementation included the flexibility of the eSBI platform, electronic health record integration, low burden on clinic staff, COVID-19 impacts on clinical care, modest leadership support, and possible “assessment overload” among patients and providers. Implications for improving eSBI implementation are described.
Development of MindBodyU—An Innovative mHealth Intervention for Youth Living with HIV in South Carolina
(2026-01-06) Harrison, Sayward; Miller, Sarah; Weaver, Katherine; Joy, Eliza; Niederland, Amanda
Technology-based interventions may improve care engagement and quality of life for youth living with HIV (YLHIV). This paper describes the development of MindBodyU—a mobile Health (mHealth) intervention for YLHIV in South Carolina—a rural, southern state disproportionately burdened by the HIV epidemic. Semi-structured individual interviews were conducted with YLHIV (n=16) and HIV providers (n=15). Focus groups were held with staff from HIV community-based organizations (CBOs) (n=23). Guided by theories of resilience, data were integrated to inform the selection and development of MindBodyU—a multi-component mHealth intervention that includes health education, connection to social support, behavioral health monitoring/goal setting, and linkage to mental and behavioral health resources. mHealth interventions like MindBodyU may help YLHIV better cope with HIV-related stigma and connect to needed resources. Lessons learned from the development of MindBodyU can inform other efforts to improve HIV outcomes for young people in the southern United States (US) and beyond.
Incentives for Daily Surveys during the A-FRAME Mobile Personalized Feedback Intervention for Heavy Drinking: Feasibility, Acceptability, and Engagement
(2026-01-06) Merrill, Jennifer; Peterson, Roselyn; Maloney, Molly; Logan, Zoey; Loxley, Michelle; Lau-Barraco, Cathy; Barnett, Nancy; Carey, Kate
Monetary incentives are one way to increase engagement in digital interventions. Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME), a mobile personalized feedback intervention assesses alcohol use daily and delivers feedback proximal to drinking episodes and repeatedly over 28 days. The present study informs implementation of A-FRAME and other digital interventions by determining whether acceptability, feasibility, or engagement differs for participants who do and do not receive monetary incentives for daily surveys. Young adults were randomized to A-FRAME with monetary incentives, A-FRAME without incentives, and a control group. Incentive and no-incentive groups were compared (n=87). Both groups reported high acceptability, depth of processing, retention and attention. Participants receiving incentives demonstrated greater survey completion relative to those in the no-incentive group. Consistent with prior literature, monetary incentives for survey completion are important. Identification of ways to increase intrinsic motivation to engage with mobile interventions among young adults is crucial.
“Customize it to that population, my population, my people, my peeps.” Qualitative Evidence of Usability, Appropriateness, and Feasibility of an Anxiety-Facing Mobile Application for Co-Occurring Substance Use and Anxiety Disorders
(2026-01-06) Nardi, William; Guthrie, Kate; Freedman, Rohan; Dunsiger, Shira; Sun, Shufang; Brewer, Judson
Despite the rapid growth of app-based interventions (ABIs), effective and accessible tools for individuals with co-occurring anxiety and substance use (A-SUD) remain limited. Most usability studies of ABIs for substance use rely on quantitative methods and rarely focus on anxiety comorbidity. To address this gap, we conducted longitudinal qualitative interviews with 24 participants in SUD treatment (peer-led, n=11; pharmacotherapy, n=9; psychotherapy, n=4) over a two-month period. The study aimed (1) to assess the acceptability, appropriateness, and feasibility of the Unwinding Anxiety app as an adjunctive support for SUD treatment among patients with A-SUD ; (2) identify needed modifications to optimize it for A-SUD. Participants found the app's features and skills useful and relevant but emphasized the need for additional substance use-specific content. Findings underscore the value of evidence-based, step-by-step digital interventions for enhancing and complementing SUD care across treatment modalities. Future research should build on reinforcement learning and interoceptive awareness principles to better tailor ABIs for substance use.
Introduction to the Minitrack on Testing and Implementing Technology-Based Interventions to Address Mental Health and Substance Use
(2026-01-06) Braciszewski, Jordan; Bock, Beth

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