Remote "hovering" with individuals with psychotic disorders and substance use: feasibility, engagement, and therapeutic alliance with a text-messaging mobile interventionist

J Dual Diagn. 2014;10(4):197-203. doi: 10.1080/15504263.2014.962336.


Objective: People with serious mental illnesses and substance abuse problems (i.e., dual diagnosis) constitute a particularly challenging and costly clinical group. This study evaluated the feasibility and acceptability of a novel model of care in which a mobile interventionist used mobile phone text messaging to remotely monitor and provide daily support to individuals with psychotic disorders and substance use.

Methods: Seventeen participants with dual diagnosis were enrolled in a 12-week single-arm trial. A clinical social worker served as the mobile interventionist and sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The mobile interventionist provided text-message feedback and support and suggested various coping strategies flexibly, in response to participants' replies to prompts. At the end of the trial, participants completed a usability and satisfaction measure and two self-rated measures of therapeutic alliance with their clinicians. In one version, participants rated their relationship with their mobile interventionist; in the second version, they rated their relationship with their community-based treatment team.

Results: Participants received an average of 139 text messages (SD = 37.5) each from the mobile interventionist over the 12-week trial. On average, participants responded to 87% of the mobile interventionist's messages that required a reply. More than 90% of participants thought the intervention was useful and rewarding and that it helped them be more effective and productive in their lives. Participants' assessments of their relationship with the mobile interventionist were positive. Paired-sample t-test found that the therapeutic alliance ratings participants provided for their mobile interventionist were significantly higher than those provided for their community-based treatment team clinicians, who they met with regularly.

Conclusions: Our findings suggest that text-message "hovering" can be conducted successfully with individuals with psychotic disorders and substance abuse. Developing a cadre of mobile interventionists who are specifically trained on how to engage patients via mobile devices while adhering to ethical guidelines and regulatory standards may be an effective way to strengthen service delivery models, improve patient outcomes, and reduce costs.

Keywords: SMS; dual diagnosis; mobile health (mHealth); mobile phones; schizophrenia.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Antipsychotic Agents / therapeutic use
  • Comorbidity
  • Feasibility Studies
  • Feedback, Psychological
  • Female
  • Humans
  • Male
  • Medication Adherence
  • Monitoring, Ambulatory / methods*
  • Patient Satisfaction
  • Psychotic Disorders / complications*
  • Psychotic Disorders / therapy*
  • Schizophrenia / complications
  • Schizophrenia / therapy
  • Social Support
  • Social Work / methods
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / therapy*
  • Text Messaging*
  • Treatment Outcome


  • Antipsychotic Agents