The agency worked with Johns Hopkins University Evidence-based Practice Center in Baltimore, Maryland, to develop the brief due to “a lack of guidance on how to choose wisely from the thousands of mental health mobile applications without clear evidence of safety, efficacy and consumer protections,” according to AHRQ.
The brief proposes a framework to assess the apps called The Framework to Assist Stakeholders in Technology Evaluation for Recovery (FASTER) to Mental Health and Wellness, which assesses the risk/safety, technical functionality and mental health features of apps. FASTER can be used by advocacy organizations, payers, healthcare systems and others to inform selection of mental health mobile apps.
John Hopkins researchers performed systematic reviews of mental health apps as well as published and gray literature on mental health app frameworks, and conducted four key informant group discussions to identify gaps in existing mental health frameworks and key framework criteria.
Iterative testing and refinement of the framework was done in seven successive rounds through double application of the framework to a total of 45 apps. Items in the framework with an interrater reliability under 90 percent were discussed among the evaluation team for revisions of the framework or guidance.
Through this process, they identified gaps in the assessment of risks that users may face from apps, such as privacy and security disclosures and regulatory safeguards to protect the users. Key informant discussions identified priority criteria to include in the framework, including safety and efficacy of mental health apps.
The FASTER to Mental Health and Wellness brief comprises three sections:
Section 1. Risks and Mitigation Strategies, used to assess the integrity and risk profile of the app.
Section 2. Function, which focuses on descriptive aspects related to accessibility, costs, organizational credibility, evidence and clinical foundation, privacy/security, usability, functions for remote monitoring of the user, access to crisis services and artificial intelligence (AI).
Section 3. Mental Health App Features. This section focuses on specific mental health app features, such as journaling and mood tracking.