The Stay Strong App, Use of a Digital Wellbeing App with Indigenous People in Prison: A Randomized Controlled Trial

The Stay Strong App (SSA) is a culturally safe intervention tool, developed to enhance the wellbeing and mental health of Aboriginal and Torres Strait Islander peoples. It is an Android app delivered in conjunction with a therapist on tablet pcs, with administration of the SSA taking approximately 60 minutes. Therapeutic adherence is supported through practitioner supervision and training. The SSA is an 11-step intervention involving (1) the collection of demographics, (2) “people who keep me strong” or the identification of support people and the nature of their relationship, (3) strengths or factors that support client well-being, (4) worries or factors that reduce client well-being , (5) setting the client’s first goal for change, (6) setting the client’s second goal for change, (7) well-being tips, (8) tips to reduce substance use, (9) “my support” or a description of professional supports and contact details for use upon release from prison, (10) “client summary” or a review of client information provided across the previous 9 steps, and (11) the provision of a client card to the client. Items relating to the Stay Strong Tree (steps 3 and 4) provide descriptive data on the strengths and worries that were identified in the SSA sessions. The tree is divided into a 4-root system, representative of the four aspects of a client’s life: (1) spiritual and cultural; (2) physical; (3) family, social, and emotional; and (4) mental and emotional aspects. Each root system is then divided into individual strength or worry items (strengths: 16, including 4 open items idiosyncratic to clients; worries: 16 items, including 2 open items idiosyncratic to clients; steps 3 and 4). These items in the SSA represent the key determinants of SEWB for Aboriginal and Torres Strait Islander people. The primary aim of the project was to conduct a randomized controlled trial (RCT) within Queensland prisons to determine the feasibility and effectiveness of the SSA with Indigenous female and male prisoners. The project was conducted through the Indigenous Mental Health Intervention Program (IMHIP), a social and emotional wellbeing (SEWB) and mental health service for Aboriginal and Torres Strait Islander people in custody. The SSA was added to existing IMHIP services immediately after a baseline assessment or after a 3-month delay, and wellbeing, empowerment and psychological distress were assessed at Baseline, 3 and 6 months. Delivery of the SSA was facilitated in-person by Indigenous practitioners, requiring no prior computer literature of clients. Indigenous participants were recruited from three high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed wellbeing (Warwick-Edinburgh Mental Wellbeing Scale, WWS), empowerment (Growth and Empowerment Measure, GEM, giving Total, EE14 and 12S scores) and psychological distress (Kessler Psychological Distress Scale, K10). Intention-to-treat effects on these outcomes were analysed using Linear Mixed Models. Clients were provided with 2 copies of their client cards, one for use while in prison and one for their prison property, which would become available to them upon release from prison. Each client card had a summary of the SSA, including professional supports and contact details. The laminated cards were folded in a way that allowed clients to display their support network, or “people who help me are,” in their prison cells.