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Implementing mHealth for Schizophrenia in Community Mental Health Settings: Hybrid Type 3
Dror Ben-Zeev1, Justin Tauscher1, Devon Sandel-Fernandez1
1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
Psychiatric Services (Washington, D.C.)
|October 24, 2025
Summary
External facilitation (EF) showed clinical advantages over internal facilitation (IF) for the smartphone intervention for schizophrenia (FOCUS), despite low uptake in both mobile health (mHealth) models. EF hubs may support community agencies implementing mHealth.
Area of Science:
- Digital health interventions
- Schizophrenia treatment
- Implementation science
Background:
- Mobile health (mHealth) interventions offer potential for schizophrenia care.
- Digital navigators can support mHealth deployment in community mental health settings.
Purpose of the Study:
- To evaluate two mHealth implementation strategies: external facilitation (EF) and internal facilitation (IF).
- To assess the effectiveness of the FOCUS smartphone intervention for schizophrenia using these strategies.
Main Methods:
- A hybrid type 3 effectiveness-implementation trial at 23 community mental health programs.
- Compared EF (hub-and-spoke model) with IF (local digital navigator).
- Assessed implementation outcomes (reach, penetration, etc.) for 3,816 patients and intervention outcomes (hospitalization, symptoms, recovery) for 274 patients.
Main Results:
- Both EF and IF yielded similar implementation outcomes.
- FOCUS reduced psychiatric emergency department admissions with EF, but not IF.
- EF demonstrated greater positive effects on psychiatric symptoms and recovery compared to IF.
Conclusions:
- Low uptake of the FOCUS intervention was observed in both mHealth implementation models.
- The EF model demonstrated a clinical advantage.
- Regional EF hubs show promise for supporting community agencies in mHealth implementation for schizophrenia.
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