Optimizing a Personalized Health Approach for Virtually Treating High-Risk Caregivers of Children With Neurogenetic...

Even before the COVID-19 pandemic, caregivers of children with rare neurogenetic conditions (NGCs) experienced physical and mental health challenges. These challenges escalated during the COVID-19 pandemic due to crisis-level breakdowns in support services. Tele-mental health and parenting support services expanded rapidly in response to the COVID-19 pandemic and may be well suited to facilitate necessary support interventions for NGC caregivers. However, it remains unclear how to match these evidence-based interventions to individual NGC caregivers' needs.

Project WellCAST (Supporting Well-Being of Caregivers via Telehealth) is an early-phase clinical trial designed to prospectively test which evidence-based telehealth interventions best meet the needs of NGC caregivers.

Interested and eligible NGC caregivers are enrolled in a 24-week program with 5 phases, including baseline (2 weeks), support program (12 weeks), and follow-up (2 weeks) periods; a 4-week gap separates the phases. Caregivers participate in 2 randomizations, namely support program assignment via a precision health algorithm versus quasi-random assignment and motivational coaching by another NGC caregiver and project staff member ("peer coaching") versus standard check-ins by a staff member who is not an NGC caregiver ("staff coaching"). Virtual support programs include acceptance and commitment therapy, dialectical and behavioral therapy, culturally informed cognitive behavioral therapy, research units in behavioral intervention, naturalistic communication intervention, Durand sleep intervention, and self-guided resources. A subset of caregivers will participate as waitlist controls before engaging in support programs. We developed and optimized a personalized health decision tree algorithm that matches caregivers to telehealth support programs. We then proceeded to test the feasibility and efficacy of algorithm-assigned support programs across 4 waves of data collection, relative to quasi-random assignment and waitlist controls. During each wave, the personalized health algorithm relies on 2 weeks of baseline data collection using clinical tools and innovative smartphone-based ecological momentary assessments. Across waves, we also test the efficacy of a motivational peer-to-peer coaching protocol, deployed by trained NGC caregiver staff, in enhancing support program uptake and clinical outcomes.

Four waves of data collection are scheduled for August 2023 to September 2025. Preregistered analyses will contrast feasibility, efficacy, and acceptability across algorithms and coaching assignments. Multiple waves of data collection will allow us to continually optimize the algorithm and test incremental improvements across project phases. Secondary analyses will probe the feasibility and efficacy of individual evidence-based support programs and peer coaching.

Project WellCAST will test whether a digital personalized health decision tree algorithm and peer coaching protocol can prospectively enhance telehealth support program outcomes among NGC caregivers. This project is relevant to the specific population of NGC caregivers and may also inform how brief digital assessments, precision health tools, and community-academic partnerships can enhance the public health response to mental health crises across other high-need populations.

ClinicalTrials.gov NCT05999448; https://clinicaltrials.gov/study/NCT05999448 and OSF Registries 10.17605/OSF.IO/8WNDP; https://osf.io/8wndp.

DERR1-10.2196/64360.