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Mobile health (mHealth)-that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care-is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeducation (i.e., information about mental health conditions), and delivering evidence-based practices. However, some groups may fail to benefit from mHealth despite a high need for mental health services, including people from racially and ethnically disadvantaged groups, rural residents, individuals who are socioeconomically disadvantaged, and people with disabilities. A well-designed mHealth ecosystem that considers multiple elements of design, development, and implementation can afford disadvantaged populations the opportunity to address inequities and facilitate access to and uptake of mHealth. This article proposes inclusion of the following principles and standards in the development of an mHealth ecosystem of equity: use a human-centered design, reduce bias in machine-learning analytical techniques, promote inclusivity via mHealth design features, facilitate informed decision making in technology selection, embrace adaptive technology, promote digital literacy through mHealth by teaching patients how to use the technology, and facilitate access to mHealth to improve health outcomes.

OBJECTIVE: To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention (“PeerTECH”) for adults with a serious mental illness. METHODS: Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or treatment-refractory major depressive disorder) and at least one medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 18 years and older received the PeerTECH intervention in the community. Nine peer support specialists were trained to deliver PeerTECH. Data were collected at baseline and 12-weeks. RESULTS: This pilot study demonstrated that a 12-week, digital peer support integrated medical and psychiatric self-management intervention for adults with serious mental illness was feasible and acceptable among peer support specialists and patients and was associated with statistically significant improvements in self-efficacy to manage chronic disease and personal empowerment. In addition, pre/ post non-statistically significant improvements were observed in psychiatric self-management, medical self-management skills, and feelings of loneliness. CONCLUSIONS: This single-arm pre/post pilot study demonstrated preliminary evidence peer support specialists could offer a fidelity-adherent digital peer support self-management intervention to adults with serious mental illness. These findings build on the evidence that a digital peer support self-management intervention for adults with serious mental illness designed to improve medical and psychiatric self-management is feasible, acceptable, and shows promising evidence of improvements in clinical outcomes. The use of technology among peer support specialists may be a promising tool to facilitate the delivery of peer support and guided evidence-based self-management support. CONCLUSIONS: People with serious mental illness (SMI; defined as individuals diagnosed with schizophrenia spectrum disorder, bipolar disorder, or treatment-refractory major depressive disorder) are increasingly utilizing peer support services to support their health and recovery. Peer support is defined as shared knowledge, experience, emotional, social, and/or practical assistance to support others with similar lived experiences (Solomon, 2004). Most recently the definition also includes the provision of evidence-based peer-supported self-management services (Fortuna et al., 2020). Mental health peer support can augment the traditional mental health treatment system through providing support services to maintain recovery between clinical encounters (Solomon, 2004) and is classified by the World Health Organization as an essential element of recovery (World, Health, and Organization, About social determinants of health, 2017).

Individuals with mental health challenges are at particularly high risk of experiencing negative outcomes (e.g., worsening of mental health, increased risk of mortality) due to the coronavirus disease (COVID-19) pandemic. Peer specialists may have the benefit of several protective factors, including higher levels of social support and better illness self-management skills that buffer against negative effects of the pandemic. In this study, we compared the differences in the impact of COVID-19 on those trained as peer specialists (e.g., certified peer specialists, recovery coaches) to those not trained in this role.Participants with self-reported mental health and/or substance use challenges completed an online survey to collect information on their experiences during COVID-19 (Epidemic-Pandemic Impacts Inventory [EPII]), loneliness (3-item Loneliness Scale), and access to and satisfaction with mental health support. Respondents self-identified as peer specialists or not.One hundred seventy-three U.S. resident participants from 23 states were included in the final analysis: 109 were peer specialists and 64 were nonpeer specialists. Those who were trained as peer specialists reported fewer negative outcomes during the pandemic, including less disruption in employment, less loneliness, and less worsening of mental health, while reporting more positive attitudes in the face of difficulties. Peer specialists were also likely to report more access to and satisfaction with mental health services.Possibly as a function of their role, peer specialists reported better mental health outcomes during COVID-19, providing key, empirical evidence to support the benefits of helping others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The purpose of this article is to delineate the current state-of-the-knowledge of peer support following the framework employed in the 2004 article (Solomon, Psychiatr Rehabil J. 2004;27(4):392-401 1). A scoping literature was conducted and included articles from 1980 to present. Since 2004, major growth and advancements in peer support have occurred from the development of new specializations to training, certification, reimbursement mechanisms, competency standards and fidelity assessment. Peer support is now a service offered across the world and considered an indispensable mental health service. As the field continues to evolve and develop, peer support is emerging as a standard of practice throughout various, diverse settings and shows potential to impact clinical outcomes for service users throughout the globe. While these efforts have enhanced the professionalism of the peer workforce, hopefully this has enhanced the positive elements of these services and not diluted them.

Adults with serious mental illness commonly experience comorbid chronic physical conditions and experience a reduced life expectancy of 10-25 years compared to the general population (Saha et al. in Arch Gen Psychiatry 64(10):1123–31. 2007; Hayes et al. in Acta Psychiatr Scand 131(6):417–25. 2015; Walker et al. in JAMA Psychiatry 72(4):334–41. 2015). Dimensions of personal recovery may have real-world implications that extend beyond functional and mental health outcomes to impact the self-directed health and wellness of adults with serious mental illness. This study examined the predictive utility of the Recovery Assessment Scale with respect to medical self-efficacy, self-management, psychiatric symptoms, and community functioning for adults with serious mental illness. Data were derived from a secondary analysis of baseline and 10-month data collected from a randomized control trial with adults aged 18 years and older with a diagnosis of bipolar disorder, schizoaffective disorder, schizophrenia, or major depressive disorder (N=56). A linear regression was conducted to examine the predictive value of total baseline RAS scores on self-efficacy at 10 months while controlling for study group. This model significantly predicted self-efficacy (F (2, 53) = 13.28, p < .001) and accounted for 36.1% of the variance. Total baseline RAS scores significantly predicted self-efficacy (β = 059, p < .001); specifically, higher baseline RAS scores were associated with greater self-efficacy. A greater degree of recovery may facilitate greater medical self-efficacy in managing chronic disease in people diagnosed with a serious mental illness. Future intervention approaches may consider recovery-focused therapeutic targets such as peer support to promote self-efficacy to manage chronic diseases in people with serious mental illness.

The prevalence of anxiety symptoms in children and adolescents aged 4 to 18 years has nearly doubled after the first year of the pandemic. However, only one in five adolescents diagnosed with anxiety is treated. We R H.O.P. E. is a school-based mental health program that includes evidence-based principles designed to engage children and adolescents in anxiety treatment, including wellness and emotional regulation, and the emotional CPR method. We R H.O.P. E. augments traditional services provided by school administrators, school social workers, school teachers, and school nurses. The purpose of this study was to examine the feasibility, acceptability, and preliminary effectiveness of We R H.O.P. E.

This Viewpoint describes how open innovation has been used by communities to support individual and community health and discusses how scientists and clinicians could apply this idea- and resource-sharing strategy to generate breakthrough advances that may extend the life span of people with serious mental illness (SMI).

This study aimed to test the validity and reliability of the Kessler Psychological Distress Scale-6 (K6) with a nationally representative clinical sample with various mental health disorders. The cross-sectional, nationally representative, and publicly available data were extracted from the 2014 Health Center Patient Survey (HCPS), which was sponsored by the Health Resources and Services Administration (HRSA). After excluding certain individuals for the purpose of this study, we had a total of 1,863 participants. The highest and lowest psychological distress weighted scores were reported by individuals with bipolar disorder ( M = 17.16) and individuals with schizophrenia ( M = 16.09), respectively, although psychological distress interference was highest in individuals with schizophrenia ( M = 2.44). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results yielded a unidimensional factor solution for K6 scale in all subgroups. The K6 is a brief, reliable, and valid measure of psychological distress in adults with panic disorder, generalized anxiety disorder, bipolar disorder, and schizophrenia.

The app evaluation framework of the American Psychiatric Association (APA) has emerged as an adaptable tool for those seeking to navigate the ever-growing space of mental health apps. The authors describe a meeting convened in December 2019 to refine the APA framework. The expert panel comprised 16 individuals across health care fields, with representation from psychiatry, psychology, social work, nursing, clinical informatics, peer support specialists, and individuals with lived mental health experience. This meeting resulted in an update to the APA framework with the addition of clearer question descriptions and the release of an eight-question screener that may be useful in clinical settings.

Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association of Peer Supporters. Study respondents completed a survey package including demographic questions and psychometrically sound self-report measures. Two hierarchical multivariable linear regression models were conducted to evaluate whether the recovery components of the process of recovery, social support for recovery, and work self-determination (i.e., work autonomy, work competence, and work relatedness) were associated with indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction). Results: Work autonomy was associated with the occupational performance indicator, while the process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health. Conclusions and Implications for Practice: Findings support the importance of work self-determination and social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE: Individuals with serious mental illness (SMI) experience a 10–25-year reduced life expectancy when compared to the general population that is due, in part, to poor health behaviors. Yet, in spite of the development of health promotion and self-management interventions designed for people with SMI to promote health behavior change, the mortality gap has increased, suggesting that relevant factors are not being addressed. The objective of the present study was to explore potential contributors to early mortality among individuals with SMI by drawing from the lived experience of certified peer support specialists and service users (SUs). METHOD: Face-to-face semistructured interviews were conducted with a convenience sample of SU participants (n = 17) and certified peer specialists (n = 15). Qualitative data were analyzed using a grounded-theory approach. RESULTS: We identified a final set of 27 codes relating to five overarching themes that relate to both risk factors and protective factors for early death: social connectedness (24.1% of coded items), treatment (21.3%), coping (21.3%), physical health and wellness (18.5%), and resilience and mental health (14.8%). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings add to the literature supporting the powerful role of social processes in shaping health in people with SMI beyond social determinants of health (SDOH; e.g., income, employment) and health behavior change. Interventions that reduce loneliness and isolation in combination with addressing more conventional SDOH may have the most potential to reduce early mortality in people with SMI.

Mounting scientific evidence over the past decades in the field of psychiatry has shown community engagement in research produces more relevant research, increased uptake of research findings, and better clinical outcomes. Despite the need for the integration of community engagement methodologies into the scientific method, doctoral and master's level competencies in the field of psychiatry commonly do not include dedicated training or coursework on community engagement methodologies. Without appropriate training or research experience, attempts to facilitate community engagement are often ineffective and burdensome and leave stakeholders feeling disenfranchised. The goal of this study was to co-produce an instrument designed to improve the quality of community engagement research practices by measuring the degree to which researchers have partnered with psychiatric patient stakeholders. The development of the Quality of Patient-Centered Outcomes Research Partnerships Instrument included an iterative co-production process with psychiatric patient stakeholders and scientists, including item formulation, followed by two phases of cognitive interviews with psychiatric patient stakeholders to assess and refine instrument items. A pilot study was conducted to assess acceptability and feasibility. The pilot study of the Patient-Centered Outcomes Research Partnerships Instrument suggested feasibility and acceptability among psychiatric patient stakeholders. The Quality of Patient-Centered Outcomes Research Partnerships Instrument may be a valuable tool to enhance the quality of community engagement research practices within the field of psychiatry. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

ImportancePeople with serious mental illness (SMI), defined as a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or disabling major depressive disorder) die approximately 10 to 25 years earlier than the general population.ObjectiveTo develop the first-ever lived experience–led research agenda to address early mortality in people with SMI.Evidence ReviewA virtual 2-day roundtable comprising 40 individuals convened on May 24 and May 26, 2022, and used a virtual Delphi method to arrive at expert group consensus. Participants responded to 6 rounds of virtual Delphi discussion via email that prioritized research topics and agreement on recommendations. The roundtable was composed of individuals with lived experience of mental health and/or substance misuse, peer support specialists, recovery coaches, parents and caregivers of people with SMI, researchers and clinician-scientists with and without lived experience, policy makers, and patient-led organizations. Twenty-two of 28 (78.6%) of the authors who provided data represented people with lived experiences. Roundtable members were selected by reviewing the peer-reviewed and gray literature on early mortality and SMI, direct email, and snowball sampling.FindingsThe following recommendations are presented in order of priority as identified by the roundtable participants: (1) improve the empirical understanding of the direct and indirect social and biological contributions of trauma on morbidity and early mortality; (2) advance the role of family, extended families, and informal supporters; (3) recognize the importance of co-occurring disorders and early mortality; (4) redefine clinical education to reduce stigma and support clinicians through technological advancements to improve diagnostic accuracy; (5) examine outcomes meaningful to people with an SMI diagnosis, such as loneliness and sense of belonging, and stigma and their complex relationship with early mortality; (6) advance the science of pharmaceuticals, drug discovery, and choice in medication use; (7) use precision medicine to inform treatment; and (8) redefine the terms system literacy and health literacy.Conclusions and RelevanceThe recommendations of this roundtable are a starting point for changing practice and highlighting lived experience–led research priorities as an option to move the field forward.

Adherence research commonly happens in a silo, focused on a particular disease state or type of therapy. Learning from outside disciplines can bring new insights and ideas. This article presents adherence research as related to people with a diagnosis of a serious mental illness (SMI) and medication adherence through smartphone applications (apps). Individuals with SMI have high rates of not taking medication, increasing risks of relapse and hospitalization. Advances in technology may be advantageous in promoting taking medication. Smartphones apps have been designed for people with SMI. Further research is needed to evaluate their efficacy on improving rates of taking medication.

BACKGROUND Digital peer support may show longevity past the COVID-19 era. In April 2020, a survey of 180 peer support specialists from 23 states found a 95% increase in peer support specialists offering digital peer support and a 90% increase in peer support specialists’ confidence in digital peer support. OBJECTIVE The purpose of this study is to inform the development of supervision standards for digital peer support and introduce guidelines that supervisors can utilize to support, guide, and develop competencies in digital peer support specialists. METHODS The analysis of digital peer support supervision standards was based on four, one hour focus groups with peer support specialists (n= 59). The focus group discussions were recorded digitally, transcribed, and anonymized. Researchers analyzed the data using Rapid and Rigorous Qualitative Data Analysis (RADar). RESULTS 51 codes and a set of eleven themes were identified relating to the development of supervision standards for digital peer support. The eleven themes in order of most frequent to least frequent included: 1) education on technology competency, 2) education on privacy, security, and confidentiality in digital devices and platforms, 3) education on peer support competencies and how they relate to digital peer support, 4) administrative guidelines, 5) education on the digital delivery of peer support, 6) education on technology access, 7) supervisor support of work-life balance, 8) emotional support (emerging), 9) administrative documentation (emerging), 10) education on suicide and crisis intervention (emerging), and 11) feedback (emerging). CONCLUSIONS Currently, supervision standards from SAMHSA for in-person peer support include the categories of administrative, educative, and supportive functions. However, the spread of digital peer support during the COVID-19 pandemic requires the expansion of supervision standards to include subthemes such as education on technology and privacy, support of work-life balance, and emotional support.

Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train peer support specialists for rapid uptake in providing digital peer support during the COVID-19 crisis. The purpose of this study was to examine the impact of the 4-h DPS course for peer support specialists. Surveys were administered to examine pre-post changes in DPS course for participants (N = 75) related to attitudes/ beliefs towards DPS, ability to use/ engage in DPS, and organizational readiness to implement DPS. Data were analyzed by conducting paired samples t-tests. Linear mixed models were used to explore significant results further. Statistically significant ( .05) changes were observed related to readiness to use DPS, attitudes/ beliefs towards DPS, and ability to use/ engage in DPS. The 4-h DPS course may be beneficial in providing diverse groups of peer support specialists with a standardized training framework. Widespread dissemination of the DPS short course may be beneficial in rapidly equipping peer support specialists with the skills and resources needed to expand the reach of peer support services during the COVID-19 crisis and beyond.

Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life.The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists.One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction.The SMMA model accounted for 49% of the variation in job satisfaction scores (RPerceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

Purpose The purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses. Methods This is a cross-sectional correlational design study. Our participants are 156 veterans with self-reported mental illness (Mage = 37.85; SDage = 10.74). Descriptive, correlation, and mediation analyses were conducted for the current study. Results Pain intensity was negatively correlated with physical health QOL, ability to participate in social roles and activities, and mental health QOL. Physical health QOL and ability to participate in social roles and activities were positively associated with mental health QOL, respectively. Physical health QOL was positively correlated with a ability to participate in social roles and activities. Study results indicate that the effect of pain intensity on mental health QOL can be explained by physical health QOL and ability to participate. Conclusions Specific recommendations for practitioners include implementing treatment goals that simultaneously focus on physical health and ability to participate in social roles and activities for clients who present with both physical pain and low mental health QOL.

The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50 years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with eight participants aged 55 to 62 years old with mental health conditions including schizophrenia spectrum disorder, bipolar disorder, major depressive disorder, personality disorder, and adjustment disorder. The quantitative data were assessed from observational methods, a pain rating scale and related measures. We used semi-structured interviews for qualitative feedback on experiences with the BA-PR intervention after participation. Overall, the participants had positive experiences following receipt of the BA-PR intervention. The recruitment and adherence rates for participants were 72.7% and 100%, respectively. Approximately 75% of the participants remained enrolled in the study. Findings from a paired t-test showed the BA-PR intervention was linked to significantly reduced prescription opioid misuse risk, t (7) = 2.42, p

Peer specialists, or individuals with lived experience of mental health conditions who support the mental health recovery of others, often work side-by-side with traditional providers (non-peers) in the delivery of treatment groups. The present study aimed to examine group participant and peer provider experiences with peer and non-peer group co-facilitation. Data from a randomized controlled trial of Living Well, a peer and non-peer co-facilitated intervention for medical illness management for adults with serious mental illness, were utilized. A subset of Living Well participants (n = 16) and all peer facilitators (n = 3) completed qualitative interviews. Transcripts were coded and analyzed using a general inductive approach and thematic analysis. The complementary perspectives of the facilitators, teamwork between them, skillful group pacing, and peer facilitator self-disclosure contributed to a warm, respectful, and interactive group atmosphere, which created an environment conducive to social learning. Guidelines for successful co-facilitation emerging from this work are described.

OBJECTIVE: This systematic review examined the impact of health homes on cardiometabolic risk in adults with serious mental illness. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures were used to conduct the systematic review. Databases were searched for peer-reviewed articles published between 1946 and August 2018 that compared health homes to a control condition (e.g., usual care, secondary data analyses using matched samples). Participants, interventions, comparisons, outcomes, and study design criteria were used to assess study eligibility. Studies were assessed for methodological quality using the Quality Assessment of Before and After Studies With No Control Group, and the Quality Assessment of Controlled Intervention Studies. RESULTS: Eighteen studies (i.e., eleven observational, four quasi-experimental, three randomized controlled trials) reported on 17 health homes. Most studies reported increases in receipt of screening for cardiometabolic risk factors and service use. There was a modest reduction in selected cardiometabolic risk factors among people with serious mental illness, but clinical outcomes varied widely among studies. DISCUSSION: Health homes are associated with increased rates of cardiometabolic screening and service use. However, improvement in cardiometabolic risk factors varied across the studies and the clinical significance of these reductions is not clear. Peer support and self-management training may represent strategies to improve cardiometabolic risk factors. CONCLUSIONS: Co-location of services may not be enough to significantly impact cardiometabolic risk factors. Health homes may have a greater impact on clinical outcomes if they include: standardized screening; peer support and self-management training; intervention components that target interdependent risk factors.

One in five older adults experience symptoms of depression and anxiety. Digital mental health interventions are promising in their ability to provide researchers, mental health professionals, clinicians, and patients with personalised tools for assessing their behaviour and seeking consultation, treatment, and peer support. This systematic review looks at existing randomised controlled trial studies on digital mental health interventions for older adults. Four factors have been found that contributed to the success of digital mental health interventions: (1) ease of use; (2) opportunities for social interactions; (3) having human support; and (4) having the digital mental health interventions tailored to the participants' needs. The findings also resulted in methodological considerations for future randomised controlled trials on digital mental health interventions: (1) having a healthy control group and an intervention group with clinical diagnoses of mental illness; (2) collecting data on the support given throughout the duration of the interventions; (3) obtaining qualitative and quantitative data to measure the success of the interventions; and (4) conducting follow-up interviews and surveys up to 1 year post-intervention to determine the long-term outcomes. The factors that were identified in this systematic review can provide future digital mental health interventions researchers, health professionals, clinicians, and patients with the tools to design, develop, and use successful interventions for older users.

Background As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Peer support specialists (i.e., lay interventionists representing one of the fastest-growing mental health workforce) are increasingly using technologies to support individuals with mental health challenges between clinical encounters. The use of technology by peers has been significantly increased During COVID-19. Despite the wide array of technologies available, there is no framework designed specifically for peer support specialists and service users to select technologies to support their personal recovery. The objective of the study was to develop a Decision-Support Tool for Peer Support Specialists and Service Users to facilitate shared decision-making when choosing technologies to support personal recovery. The study used an iterative co-production process, including item formulation and a series of group cognitive interviews with peer support specialists and service users (n=9; n=9, n=4). The total sample included 22 participants: peer support specialists (n=18, 81.8%) and service users (n=4, 18.2%). The final version of the Decision-Support Tool for Peer Support Specialists and Service Users (D-SPSS), includes 8 domains: (1) privacy and security; (2) cost; (3) usability; (4) accessibility; (5) inclusion and equity; (6) recovery principles; (7) personalized for service users’ needs; and (8) device set-up. Our study found that involving peer support specialists and service users in the design and co-production phase of a decision-support tool is feasible and has the potential to empower both peer support specialists and service users, and potentially increase engagement in the use of technologies that support individuals’ recovery from traditional clinical encounters. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Serious mental illness (SMI) is a leading disability worldwide. Partnering with people with SMI to co-produce smartphone apps to support mental health outcomes throughout the software development lifecycle may support patient engagement with smartphone health app interventions. Partnering with this community is often challenging and requires a highly specialized community engagement training and skillset. The purpose of this study was to identify stakeholders’ perspectives on partnering to inform the software development lifecycle of a smartphone health app intervention for people with SMI. We conducted thirty-five semi-structured qualitative interviews with 20 mental health patients and 15 peer support specialists. We identified six themes: (1) co-produce health app intervention content; (2) selection of app technology features; (3) integration of human factors in digital health apps; (4) consideration of personalized patient preferences in digital health apps; (5) identify unrecognized concerns early in the software development lifecycle; and (6) inclusion of real-world social, cognitive, and environmental contexts. Integration of these considerations may elucidate the partnering process to facilitate engagement among vulnerable populations that commonly disengage from mental health smartphone apps use such as people with SMI.

BACKGROUND Older adults who engage in physical activity can reduce their risk of mobility and disability. Short amounts of walking can improve their quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (e.g., Fitbit) are proprietary, often are not tailored to the movements of older adults and have been shown to be inaccurate in clinical settings. Few studies have developed step-counting algorithms for smartwatches – but only using data from younger adults and often validating them only in controlled laboratory settings. OBJECTIVE In this work, we sought to develop and validate a smartwatch step-counting app targeting older adults that has been evaluated in free-living settings over a long period of time (24 weeks) with a large sample (N=42). METHODS We developed and evaluated a step-counting app on the Amulet, an open-source wrist-worn device, to track the steps of older adults. The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm with a total of 42 older adults in the lab (counting from a video recording, N= 20) and in free-living conditions — one 2-day field study (N=6) and two 12-week field studies (using the Fitbit as ground truth, N=16). During system development, we evaluated four kinds of walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field study, we evaluated various values for algorithm parameters, and subsequently evaluated the method’s performance using correlations and error rates. RESULTS The results from the usability evaluation showed that our step-counting algorithm performs well, highly correlated with the ground truth and with low error rate. For the lab study, there was stronger correlation for normal walking R2=0.5; across all activities, the Amulet was on average 3.2 (2.1%) steps lower (SD = 25.9) than video-validated steps. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2 of 0.989) and 3.1% (SD=25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 of 0.669. CONCLUSIONS Our findings demonstrate the importance of an iterative process in algorithm development in advance of field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step-counter). Our app could potentially be used to improve the physical activity among older adults through accurate tracking of their step counts and in-app daily step-count goals. CLINICALTRIAL

Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings.We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time.We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions-one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics.The step-counting algorithm performed well. In the lab study, for normal walking (ROur findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults.

Adults with serious mental illness commonly experience comorbid chronic physical conditions and experience a reduced life expectancy of 10-25 years compared to the general population (Saha et al. in Arch Gen Psychiatry 64(10):1123-31. 2007; Hayes et al. in Acta Psychiatr Scand 131(6):417-25. 2015; Walker et al. in JAMA Psychiatry 72(4):334-41. 2015). Dimensions of personal recovery may have real-world implications that extend beyond functional and mental health outcomes to impact the self-directed health and wellness of adults with serious mental illness. This study examined the predictive utility of the Recovery Assessment Scale with respect to medical self-efficacy, self-management, psychiatric symptoms, and community functioning for adults with serious mental illness. Data were derived from a secondary analysis of baseline and 10-month data collected from a randomized control trial with adults aged 18 years and older with a diagnosis of bipolar disorder, schizoaffective disorder, schizophrenia, or major depressive disorder (N=56). A linear regression was conducted to examine the predictive value of total baseline RAS scores on self-efficacy at 10 months while controlling for study group. This model significantly predicted self-efficacy (F (2, 53) = 13.28, p.001) and accounted for 36.1% of the variance. Total baseline RAS scores significantly predicted self-efficacy (β = 059, p.001); specifically, higher baseline RAS scores were associated with greater self-efficacy. A greater degree of recovery may facilitate greater medical self-efficacy in managing chronic disease in people diagnosed with a serious mental illness. Future intervention approaches may consider recovery-focused therapeutic targets such as peer support to promote self-efficacy to manage chronic diseases in people with serious mental illness.