UC Irvine

The mental health workforce is insufficient to meet the current needs of service utilization, particularly with regards to geographic distribution and ethnoracial diversity. Technology-enabled services (TESs) have the potential to increase access by overcoming barriers related to clinician availability and geography. However, little research has focused on how TESs can be integrated into publicly funded service settings. As part of the state-wide Help@Hand project, Marin County conducted a single-site six-month pilot implementation of myStrength, a digital cognitive-behavioral therapy platform, to explore its potential to reduce loneliness amongst isolated older adults. We evaluated the pilot impact using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. English and Spanish-speaking isolated older adults (N = 30) received a digital literacy course followed by eight weeks of myStrength access and human support from a nurse intern, promotore, or in- house county staff (N = 20). We evaluated factors related to reach, effectiveness, adoption, and implementation using self-report measures of platform users and pilot staff. Descriptive statistics were used to examine reach, adoption, and implementation. Nonparametric tests, including Friedman and Wilcoxon Signed-Rank were used to examine pilot effectiveness. Results are as follows. Reach: Compared to overall county demographics, platform users were majority female (93.1% v. 50.5%), ethnoracialized (62.1% v. 24.2%) and of lower socioeconomic status (Md = $35,000 v. $131,008). Effectiveness: Users experienced a significant decrease in loneliness (z = −2.62, p < .001). Adoption: Users logged into myStrength an average of 10 times (SD = 11.7) and completed 33 activities (SD = 53.5) during the eight weeks of myStrength use. Implementation: Each pilot staff member spent an average of 19.8 hours (SD = 16.51), over the course of the six-month pilot, supporting several aspects of myStrength use, including accessing technology, onboarding, and gaining digital literacy skills. Furthermore, in presenting, discussing, and delivering myStrength, pilot staff made several adaptations to meet the needs of platform users. Our results revealed several challenges and opportunities. Successes included reaching the target population, reducing loneliness, and gaining adoption by platform users. However, pilot staff had to invest significant time in various activities to support those with lower digital literacy skills. Thus, although TESs hold the potential to address access needs, their use with underserved populations, may require upfront and ongoing support provided by the settings where they are implemented.