Using Active and Passive Smartphone Data to Enhance Adolescents' Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study.

Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents' limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges.

Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting.

Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment.

Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer.

Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee's clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings.