Session: Advancing Digital Behavioral Health In Social Work: Engagement, Implementation, and Ethical Innovation In Underserved Populations (Society for Social Work and Research 31st Annual Conference)

Digital behavioral health interventions can expand access to mental health and substance use prevention and treatment, particularly among underserved populations central to social work practice, including young adults, adolescents, and families served in safety-net systems. However, despite evidence of their effectiveness, the public health impact of mobile health (mHealth) interventions remains constrained by challenges related to engagement, usability, equitable reach, and real-world implementation. This symposium brings together four complementary studies that apply implementation science and user-centered design approaches to advance the development, optimization, and integration of digital interventions within community and healthcare settings. Collectively, these studies align with core social work priorities of equity, access, and person-centered care by addressing barriers to engagement and translation in underserved populations.

The first presentation examines patterns of user engagement with a large-scale, text message–delivered intervention for young adults with cannabis use disorder. Using mixture modeling, this study identifies distinct subgroups of engagement (e.g., disengaged, average, and high engagers), highlighting engagement as a mechanism critical to understanding intervention effectiveness and underscoring the need for tailored implementation strategies to support diverse users.

The second presentation focuses on integrating a mobile health substance use prevention intervention into a Federally Qualified Health Center (FQHC). Drawing on qualitative interviews with staff, adolescents, and parents, findings identify multi-level strategies to support implementation, including clinic workflow integration, provider endorsement, and technology-based recruitment approaches tailored to youth. This work highlights the importance of aligning digital interventions with organizational context and stakeholder preferences to improve reach and uptake in real-world social service settings.

The third presentation evaluates the use of user-centered design as an implementation strategy to refine a text message–delivered cognitive behavioral therapy intervention for depression (CBT-txt). Across two pilot randomized trials, iterative incorporation of end-user feedback led to reduced barriers related to personalization, usability, and engagement, demonstrating improvements in acceptability and appropriateness—key determinants of successful implementation.

The fourth presentation addresses methodological and ethical challenges in digital intervention research, focusing on data integrity and participant safety. This study presents a multi-layered system combining automated fraud detection, identity verification, and real-time safety monitoring, including crisis detection within text-based communication. Findings demonstrate high accuracy in identifying both fraudulent participation and participant risk, offering a model for ethical and rigorous digital research with vulnerable populations.

Across presentations, several themes emerge: (1) engagement as a central mechanism linking intervention design to outcomes; (2) the importance of tailoring strategies to user subgroups and stakeholder roles; (3) the necessity of multi-level implementation strategies that address both individual and organizational determinants; and (4) the importance of ensuring safety, trust, and data integrity in remote research contexts.

This symposium advances social work research by bridging intervention development, implementation science, and ethical practice in digital health. Findings provide actionable guidance for designing and scaling mHealth interventions that are responsive to the needs of underserved populations and aligned with real-world service systems. Implications for future research include testing these strategies in larger, more diverse populations and examining their impact on sustained engagement, service integration, and behavioral health outcomes.