2.2. Participants and Procedures
stroke, cognitive functioning, brain injury
STROKE
A total of 8 participants were recruited from the SHARE Military Initiative (SHARE) intensive outpatient program at Shepherd Center in Atlanta, Georgia. SHARE is a donor-funded program that provides comprehensive, intensive interdisciplinary outpatient rehabilitation care to military SM/Vs experiencing symptoms of brain injury and co-occurring psychological conditions in a civilian setting. Trained study staff approached each eligible SHARE client to inquire about participation in the current study. Prospective participants were assured that their decision to participate or not in the current study would have no bearing on their clinical care. Clients expressing interest were scheduled for a subsequent research visit, and informed consent was obtained. Participants were enrolled in the study and received care at different times based on when they were admitted to SHARE. Inclusion criteria:Diagnosis of mTBI at least 6 months post-onset;Identified by SHARE behavioral health (BH) provider or speech-language pathologist (SLP) as appropriate for Executive Plus/STEP interventions;18 years of age or older;Functional hearing and vision;Able to follow 2-step directions;English fluency;Functional reading;iOS or Android smartphone user; andSpeaks or types functionally for smartphone use.Exclusion criteria:Participation in SHARE for less than 6 weeks;Other conditions that may impact cognitive functioning (e.g., stroke, psychosis).Prior to study enrollment, all participants received instruction in use of the Executive Plus/STEP strategies from experienced SLP and BH providers in group therapy sessions as part of standard care. Continued training in the use of Executive Plus/STEP strategies was administered via weekly SLP group sessions and BH group sessions, each lasting 60 minutes. Homework assignments, individualized to the participant and determined through patient–provider collaboration, were given to support use outside of the clinical setting. Data on specifics and frequency of homework were not included in this study. Due to the COVID-19 pandemic, some participants received treatment via telehealth during portions of the program. Eligible participants who provided consent were block randomized to one of two groups. Conventional care group participants received ongoing Executive Plus/STEP strategy training using traditional paper manuals and protocols without the use of any mobile app, while experimental group participants received the same training and were provided version 1.0.4 of the SwapMyMood app, which was downloaded to their personal smartphone. In order to prevent cross-contamination between the conventional care group and the experimental group who were all receiving treatment in the same clinical setting, we block randomized such that 50% of all the participants were assigned to the conventional care group first. We then assigned the remaining 50% of participants to the experimental group.