Avail: Mobile Health App for Self-Management Intervention by People with I/DD and Mental Illness

Program Description

Avail (Assisted Visuals Achieving Independent Living) is a Mobile Health Application created to teach people with intellectual/developmental disabilities (I/DD) to be more independent. The Avail “app” allows facilitators, including staff, case managers, or caregivers, to produce customized behavioral interventions for clients. The facilitator can record each step of the intervention process with pictures or video. The app collects data on how often a client employs the intervention, and how long it takes to complete each step. Data is automatically forwarded to the facilitator, progress is measured, and reports are generated by Avail. In 2017, KenCrest provided Avail to 42 clients with I/DD. Most had difficulty regulating emotions, and needed constant staff guidance to stop inappropriate behaviors or redirect attention. Facilitators created Avail interventions which taught the clients skills and strategies, such as self-calming. After three months, clients displayed 40-66% fewer problem behaviors requiring staff intervention. They learned new ways to self-manage their behaviors with Avail. In 2018, KenCrest will examine the effectiveness of Avail for people with I/DD and mental illness. We will partner with Jewish Education and Vocational Services (JEVS) to test Avail with 50 individuals who have a dual diagnosis, and report results.

Creativity

The Avail app puts personalized, outcome-based mental health care in an individual’s pocket. It is a revolutionary approach to disability services, combining two technological advances: smart phones and data they collect. The app has a simple, visual layout that requires no reading ability. Its video-based format allows facilitators to record a task or behavioral strategy in whatever way makes sense to the client. Clients can be filmed while performing their own mental health or behavioral interventions. They can then watch the video at any time, or be prompted by Avail to do so at certain times. Unlike other Mobile Health apps, Avail interventions are customized to the user. Its automatic data collection provides evidence in real time about whether an intervention is working, and also generates progress reports. This combination of flexibility and feedback allows caregivers to optimize interventions for clients.

Leadership

Since 1905, KenCrest has pioneered new services, including the first transitional homes for medically-fragile infants in the nation, the first inclusive preschools for children with and without disabilities in the region, and the first community homes for adults with I/DD in Philadelphia. We are the first provider agency in the U.S. to use Avail with clients. If the 2018 project is successful, it will show that Avail has significant benefits for the mental health field, particularly for clients with a diagnosis of mental illness and I/DD. Project leaders Angela Marshal, our Personal Support Network Program Director, and Joseph McGuire, Program Specialist and trained Avail facilitator, will disseminate information at provider agency meetings and at the 2018 National Council for Behavioral Health Conference. Widener University Assistant Professor Dr. Claudia Guerrazzi, a specialist in Statistical Analysis and Health Policy, will provide data analysis and assist with publication of the KenCrest Avail study.

Sustainability

The Avail app has potential to save agencies substantial amounts in the care of individuals with I/DD and mental illness. Their Cost Saving Model shows a 60% overhead reduction for clients using Avail instead of continuous Direct Service support. Demands of documentation and reporting consume ever more staff time, as funding to pay for that time decreases. The Avail app automatically collects data and generates progress reports, saving valuable staff time. A tool that cuts costs, increases productivity, and benefits clients, is likely to be adopted by the disability services field. Since Avail is software, it can be provided to a large number of clients at relatively low cost. KenCrest would like to distribute Avail to all clients who could benefit from it. Our staff informs us that most clients have a smart phone or mobile device, and take them everywhere. This allows caseworkers to serve clients at any time.

Replicability

We will collaborate on our 2018 Avail study with JEVS Human Services, a leading local provider and 2007 Scattergood award recipient for the Happy Healthy Life program, or HHL (Illness Management and Recovery model serving individuals diagnosed with mental illness and I/DD). This study is an expansion of HHL, as the client uses the customized Avail app to self-manage behaviors, rather than a trainer’s assistance. A total of 50 clients with this dual diagnosis (25 from KenCrest and 25 from JEVS) will participate in the project. Their staff will be trained as Avail facilitators. The clients will receive the app and learn to use it on their iPhones or iPads. Analysis of data from two agencies will help to demonstrate that Avail can be used by different providers serving people diagnosed with mental illness and I/DD.

Results/Outcomes

We will measure client progress on behavioral and mental health interventions using the Avail app. We anticipate 40-60% fewer problem behaviors (through use of self-calming interventions on Avail); increased independence and confidence in daily routines through use of Avail; increased flexibility when facing transitions or challenging experiences; and learning of new or alternate outlets for aggression (meditation prompts, preferred music). We anticipate a 15-45% cost savings for each agency due to client use of Avail and need for less Direct Service support. KenCrest and JEVS Human Services will present project information at local and state provider agency meetings and at the 2018 National Council for Behavioral Health Conference. We anticipate that positive results from the study will lead to wider adoption of the Avail platform for people with I/DD and mental illness. More details on the study can be found in the “Avail 2018 Study” document attached to this application.