Tech Connect: Results from a Pilot RCT Examining and Innovative Intervention to Improve Treatment Adherence for Adolescents with Mood Disorders

Background & Purpose: Over a third of adolescents dropout or terminate prematurely from mental health psychosocial treatment. A core underlying assumption of most, if not all, evidence-based psychosocial interventions is that clients will fully and actively engage in the treatment protocol. Poor adherence remains a fundamental challenge in the treatment of mood disorders in adolescents. Tech Connect is a proactive, technology-assisted intervention of manualized between-session contacts (e.g., SMS texting) and structural supports (e.g., transportation, scheduling) to increase adherence of adolescents with depression who are at high risk of dropout from community-based treatments. Informed by the Health Beliefs Model and the Ecological Perspective, Tech Connect utilizes adherence promoters that are readily tailored and personalized to the at-risk adolescent’s health decision making and structural support needs. This pilot RCT was designed to test the feasibility and acceptability of Tech Connect as a clinically relevant, practical, and user-friendly augmentative approach to promoting adolescents’ adherence and participation in their psychosocial treatment.

Methods: Tech Connect was pilot tested in a 2-arm RCT. Twenty depressed youths (13-17 years) that were at high risk for premature dropout at a New York area mental health clinic were randomized to Tech Connect (treatment condition) or standard community-based mental health care (control condition). Across their first 8 sessions, adherence promoters were delivered in 11 brief, personalized between-session contacts as 8 text messages, 3 phone calls, and provision of weekly structural supports. Standardized measures assessing mental health symptoms and outcomes, functioning, health beliefs, family involvement, adherence, and therapeutic alliance were conducted with youth and parents at baseline, after 4-sessions, after 8-sessions (post-test), and at 3-months post intervention.

Results: Pilot results found significant differences between the number of treatment sessions attended by the adolescents assigned to Tech Connect and those of the control group (t=1.8074; p<.05). Adolescents receiving Tech Connect attended 91.3% (mean 7.3 sessions; SD 1.64) of their initial eight sessions, while 66.3% (mean 5.3 sessions; SD 3.09) attended in the control condition. Satisfaction with the helpfulness of adherence promoters was high, with the majority of adolescents and parents reporting “very satisfied” or “satisfied.” Most adolescents reported being satisfied with the number of promoters received, whereas most parents reported that they would like to receive more adherence promoters. Overall satisfaction with Tech Connect was also high. Clinician feedback described the protocols as practical, user-friendly, and clinically relevant without being burdensome. Findings demonstrate that Tech Connect is feasible and acceptable to clinicians, youth and their families. 

Conclusion & Implications: Research has found that 35% of adolescents do not remain adherent to their treatment protocols, undermining treatment effectiveness. Tech Connect was designed to increase sessional adherence in the early phase of treatment. All adolescents in the treatment condition attended the first treatment session, with 80% attending the targeted first 8 sessions. In comparison, only 40% of adolescents in the control condition completed the first 8 sessions. Tech Connect is a novel, technologically-driven intervention designed to address this gap by improving engagement and adherence to treatment.