Background: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. Objective: The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. Methods: We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. Results: Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. Conclusions: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis.

The bidirectional relationship between sleep and obsessive-compulsive spectrum disorders (OCSDs), chronic tic disorders (CTDs), and attention-deficit/hyperactivity disorder (ADHD) is not well understood. To better treat individuals with these co-occurring sleep and developmental neuropsychiatric conditions, it is necessary to determine the common neural underpinnings to then target with treatment. Research has implicated dysregulated cortico-striatal-thalamo-cortical (CSTC) neurocircuitry in the development of CTDs, OCSDs, and ADHD. We review current literature to assess the state of knowledge about the neurocircuitry of OCSDs, CTDs, and ADHD, and their related sleep disturbances. Our review consistently implicates CSTC-pathway disruptions in OCSDs, CTDs, and ADHD, as well as dopamine and GABA dysregulation, primary neurotransmitters in CSTC circuitry, in sleep disorders. In addition, we highlight reports of subjective poor sleep and insomnia in adults with OCSDs, CTDs, and ADHD, and sleep movement disorders in adults with CTDs. The limited sleep research on youth with these conditions has demonstrated some similar findings. Unfortunately, much of the current research to date has not employed polysomnographic methods for objective sleep-related assessments. Future research should further clarify the neural association between these neuropsychiatric conditions and sleep disturbances to better guide potential therapeutic targets. Determining the most effective treatments for subjective sleep-related complaints in patients with these conditions will be crucial, particularly for determining treatment course—whether to prioritize treatment of the underlying condition, the specific sleep symptoms, or both simultaneously.

School mental health (SMH) teams have been widely recommended to support multi-tiered mental health program implementation in schools. Available research suggests emerging best practices that promote effective SMH teaming and indicates the importance of having team members who are highly engaged (e.g., actively involved, retained on the team). Despite evidence that these factors improve team functioning, there is limited knowledge of SMH team prevalence, best practice use, and factors impacting member engagement among a diverse sample of elementary schools. This study surveyed a cross-sectional sample of elementary principals (n = 314) across the United States whose schools implement multi-tiered SMH programs. Most principals (89%, n = 280) reported using teams to organize these programs. Schools in urban/suburban communities, with 300 or more students, or with specific school funding for SMH activities were more likely to have SMH teams. Only one-third of principals reported that their team members participated in related training. Other SMH team best practices were commonly reported (by two-thirds or more teams). Results of a linear regression model indicate that larger teams (six or more members) and teams with access to resources had significantly higher member engagement scores. The study’s findings provide recommendations for practice and future research directions.

BACKGROUND Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. OBJECTIVE The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. METHODS We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. RESULTS Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. CONCLUSIONS Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis. CLINICALTRIAL

As youth behavioral health needs in the United States continue to grow, schools are increasingly important settings for prevention and service delivery. Yet evidence-based practices (EBPs) are not consistently implemented or sustained at scale. In this article, we present a critical narrative review of dissemination and implementation efforts in school behavioral health (SBH) through the lens of the Interactive Systems Framework for Dissemination and Implementation 2.0 (ISF 2.0). We reviewed and synthesized relevant SBH and implementation science literature to identify promising practices, persistent challenges, and gaps in the field, and then applied the ISF 2.0 as an analytic lens to examine how these issues operate across the systems involved in SBH implementation. Findings suggest that misalignment in goals, strategies, roles, and communication across systems can impede the delivery of EBPs to schools in ways that are feasible, responsive to local needs, and sustainable. Drawing on these findings, we developed ISF 2.0–guided questions and applied them to three prominent SBH implementation initiatives: the National Center for School Mental Health (NCSMH), the Center on Positive Behavioral Interventions and Supports (Center on PBIS), and the South Carolina School Behavioral Health Academy (SBHA). Selected based on their national or regional prominence, accessibility of information, and implementation activities, these illustrative cases demonstrate how the ISF 2.0 can be used to identify cross-system strengths, gaps, and opportunities for improvement. Although this review is narrative rather than systematic and the cases are illustrative rather than exhaustive, the analysis highlights the importance of stronger bidirectional communication and greater attention to how knowledge is generated, translated, adapted, and used in partnership with stakeholders. The ISF 2.0 provides a promising framework for understanding the complex systemic factors shaping SBH implementation and for strengthening alignment among the systems that generate knowledge, support implementation, and deliver services. Greater cross-system alignment should help schools implement and sustain effective behavioral health practices that are responsive to community needs and improve youth well-being.