title: Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment.
abstract: BACKGROUND
  Children need access to high quality mental health care. Effective treatments now exist for a wide range of mental health conditions. However, these interventions are delivered with variable effectiveness in traditional mental health service settings. Innovative solutions are needed to improve treatment delivery quality and effectiveness.
  
  
  OBJECTIVE
  The aim of this study was to develop a scalable, sustainable technology-based approach to improve the quality of care in child mental health treatment.
  
  
  METHODS
  A tablet-based resource was developed with input from mental health training experts, mental health providers, and patients. A series of qualitative data collection phases (ie, expert interviews, patient and provider focus groups, usability testing) guided the initial concept and design of the resource, and then its refinement. The result was an iPad-based "e-workbook" designed to improve child engagement and provider fidelity in implementation of a best-practice treatment. We are currently conducting a small scale randomized controlled trial to evaluate the feasibility of e-workbook facilitated child mental health treatment with 10 providers and 20 families recruited from 4 local community-based mental health clinics.
  
  
  RESULTS
  Usability and focus group testing yielded a number of strong, favorable reactions from providers and families. Recommendations for refining the e-workbook also were provided, and these guided several improvements to the resource prior to initiating the feasibility trial, which is currently underway.
  
  
  CONCLUSIONS
  This study aimed to develop and preliminarily evaluate a tablet-based application to improve provider fidelity and child engagement in child mental health treatment. If successful, this approach may serve as a key step toward making best-practice treatment more accessible to children and families. As various technologies continue to increase in popularity worldwide and within the health care field more specifically, it is essential to rigorously test the usability, feasibility, acceptability, and effectiveness of novel health technology solutions. It is also essential to ensure that patients and providers drive decision making that supports the development of these resources to ensure that they can be seamlessly integrated into practice.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01915160; https://clinicaltrials.gov/ct2/show/NCT01915160 (Archived by WebCite at http://www.webcitation.org/6cPIiQDpu).
authors.affiliation: Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States. ruggierk@musc.edu.
authors.forename: Kenneth J
authors.identifier: http://orcid.org/0000-0001-8504-6988
authors.initials: KJ
authors.lastname: Ruggiero
authors.forename: Brian E
authors.identifier: http://orcid.org/0000-0002-4964-0688
authors.initials: BE
authors.lastname: Bunnell
authors.forename: Arthur R
authors.identifier: http://orcid.org/0000-0001-9071-0089
authors.initials: AR
authors.lastname: Andrews Iii
authors.forename: Tatiana M
authors.identifier: http://orcid.org/0000-0002-7987-4653
authors.initials: TM
authors.lastname: Davidson
authors.forename: Rochelle F
authors.identifier: http://orcid.org/0000-0002-6362-0720
authors.initials: RF
authors.lastname: Hanson
authors.forename: Carla Kmett
authors.identifier: http://orcid.org/0000-0001-5069-5072
authors.initials: CK
authors.lastname: Danielson
authors.forename: Benjamin E
authors.identifier: http://orcid.org/0000-0001-5357-4006
authors.initials: BE
authors.lastname: Saunders
authors.forename: Kathryn
authors.identifier: http://orcid.org/0000-0001-7458-6508
authors.initials: K
authors.lastname: Soltis
authors.forename: Caleb
authors.identifier: http://orcid.org/0000-0002-6493-8060
authors.initials: C
authors.lastname: Yarian
authors.forename: Brian
authors.identifier: http://orcid.org/0000-0003-0275-1599
authors.initials: B
authors.lastname: Chu
authors.forename: Zachary W
authors.identifier: http://orcid.org/0000-0001-8336-0797
authors.initials: ZW
authors.lastname: Adams
keywords: child mental health treatment; feasibility test; fidelity; mobile health; patient engagement; technology; traumatic stress