Social Services Innovations: Evaluating Health Apps
It’s no surprise, given our use of technology and smartphones, that people are turning to apps for self-help. Smartphone ownership in the United States has jumped from 35% to 75% in the past seven years, according to Pew Research. Americans check their phones nearly 80 times per day, equating to once every 12 minutes. According to a study by Hopelab Well Being Trust, 64% of teens and young adults say they use apps for health. In addition to offering on-demand services and support, reduced costs, and portability, smartphone apps feel familiar and may build on already developed habits and routines.
Apps help remove many practical barriers to accessing service, yet they are not without risk. Little is known about the efficacy of most health apps, which also lack regulation and oversight ascribed to most health aids. They claim to help with a variety of goals, ranging from self-management to assessment and treatment, but rarely help with connection to a licensed mental health provider. Whether your clients choose to use a health app on their own or with a recommendation, we must consider our duties to provide psychoeducation, operate within our scope of practice, and stay up to date on the latest tools.
Considerations for Use
Social workers should download and use the app before recommending it to others. Be mindful of the functions, successes, and frustrations of the use. User reviews may help in determining the strengths and weaknesses of the user experience, but shouldn’t be mistaken for clinical efficacy.
Apply your social work skills to analyze the claims of the app. What does the app claim to do? How will the services of the app support that claim? Become familiar with the methods the app will use to meet that claim. What informs the assessment or advice generated by the app? How does this align with evidence-based practice standards? How does it align with clinical standards and practice knowledge? Does it align with the values and ethics of the social work profession?
This line of assessment provides a high bar, but some apps have made the cut. For instance, the VA has apps that coach veterans through management of PTSD symptoms or help with sleep using evidence-based protocols. Their apps are typically meant for use in conjunction with a therapist, and are available free to download through app stores. In a 2018 research paper, “Veterans Affairs and the Department of Defense Mental Health Apps: A Systematic Literature Review,” authors collected the findings from about eight of 20 existing VA/Department of Defense apps, and found that they were widely acceptable to clients. Two had undergone research to demonstrate effectiveness: the Virtual Hope Chest, which offers tools for distraction, inspiration, relaxation, and coping, and the PTSD Coach, which provides tools for education, self-assessment, and symptom management.
Users can expect that government agencies such as the VA or Substance Abuse and Mental Health Services Administration develop apps in consultation with experts. However, a 2019 research review in Health Affairs by Savafi and colleagues titled “Top-Funded Digital Health Companies and Their Impact on High-Burden, High-Cost Conditions” found that the even the top-funded health apps usually pilot their tools with small samples of mostly healthy people, and have not demonstrated impact on cost-savings or health burden with the highest need populations.
Use Your Social Work Skills
You download the app yourself to explore it so you can better talk to Simone about her about her experiences and assess whether it may be helpful to your other clients. You notice some features such as spoken meditations may not be accessible to clients who are deaf or hearing impaired, and extensive written prompts and journaling may be a poor fit for those who have trouble with reading or writing, but you do think of some clients who might benefit from the app alongside case management and therapy.
Given Simone’s professional supports and your app assessment, you encourage her to try it out but warn about the possibility of future costs, the risk that someone may be able to log in to her phone and access her journals, and the critiques shared by other users. She says she does not plan to use social sharing because she wants to keep her mental health information private. You agree to check in weekly to talk about how it is going, get her evaluation of whether the app is helpful, and look at some app data with her during session if she is comfortable.
— Melanie Sage, PhD, MSW, is an assistant professor at University at Buffalo School of Social Work.
— Monaca Eaton, MSW, is the associate director for teaching and instruction at Michigan State University School of Social Work.
University at Buffalo School of Social Work Helping Apps for Practitioners and Educators blog: https://ubwp.buffalo.edu/happe