The below evaluation is an example of the types of information you may find when using our Model to assess specific apps. This sample evaluation is not intended to enable you to make a decision about choosing these specific apps for actual use, as such a decision is a personal one that you will make based on your own unique preferences, needs, and evaluation. We strongly encourage you to download these apps for yourself and use our Model to conduct your own assessment.
This evaluation was completed December 6th and 7th, 2019, and is based on publicly available information found by our Panel at that time. In June 2020, APA's contacted the app developers and offered to them an opportunity to provide feedback on these assessments. Comments from developers who responded are included here. These comments do not necessarily reflect publicly available information at the time of the original assessment or presently.
Access & Background
On which platforms/operating systems does the app work? Does it also work on desktop?
iOS and Android, and a website version available for desktop.
Has the app been updated in the last 180 days?
Yes
Does the app identify ownership?
BetterHelp
Does the app identify funding sources and conflicts of interest?
Yes, the app is funded by users and/or 3rd party payers (i.e. insurance plans)
Does the app come from a trusted source?
BetterHelp is a well-known app, but this reviewer was unable to determine its trustworthiness given information available.
From BetterHelp: Yes
Does the app claim to be medical?
No, it claims to be a "Health and Fitness" app.
Are there additional or hidden costs?
Yes. App is free to download, but services cost $40-70 per week. Insurance options are available.
Does the app work offline?
The journaling functions works offline, but connectivity is required to transmit data to a counselor.
Does the app work with accessibility features of the iPhone/Android? Is it accessible for those with impaired vision or other disabilities?
No app accessibility settings are apparent within the app to this reviewer.
From BetterHelp: This feature will be available by end of Q3 2020.
Privacy & Safety
Is there a transparent privacy policy that is clear and accessible before use?
Yes, though some information was on the FAQ page instead of the Privacy Policy page.
Does the app collect, use, and/or transmit sensitive data? If yes, does it claim to do so securely?
Yes, the app collects sensitive information (conversations between therapist and user). There is a Privacy Policy posted, but it is vague in the opinion of this reviewer. The policy refers to encryption and keeping up with best industry practices. There is no information about being able to delete data or ownership of data.
From BetterHelp: Yes, they collect sensitive information (conversations between therapist and user).
Does the app declare data use and purpose?
Yes, see the FAQ page.
Does the app describe use of PHI?
Yes, see the FAQ page.
Can you opt out of data collection or delete data?
It does not appear to be so according to this reviewer.
From BetterHelp: Yes. Users can anonymize their data, "Shred" text conversations, and request data deletion under applicable law.
Is data maintained in the device or on the web?
On a web database/company servers
Does the app explain security systems used?
Yes, the app uses a "Grade A" facility host and "banking-grade 256-bit encryption" SSL encryption.
What third parties does the app share data with?
The reviewer was unable to answer this question at the time of this review.
From BetterHelp: Mix panel, Facebook, PII and PHI is not sharing, only IP address.
If appropriate, is the app equipped to respond to potential harms or safety concerns?
Yes, app asks for an emergency contact and screens for suicidal ideation.
Clinical Foundation
Does the app appear to do what it claims to do?
Yes, the app appears to connect users to licensed counselors via web/app based platform.
Is there evidence of specific benefit from academic institutions, publications, end user feedback or research studies?
Betterhelp cites an effectiveness study on their About page: "extensive study by the Berkeley Well-Being Institute found BetterHelp to be as effective as face-to-face counseling." The study has no control group.
Does the app have a clinical/recovery foundation relevant to your intended use?
"BetterHelp offers access to licensed, trained, experienced, and accredited psychologists (PhD / PsyD), marriage and family therapists (LMFT), clinical social workers (LCSW / LMSW), and board licensed professional counselors (LPC)."
Is the app content correct, well-written, and relevant?
Difficult to assess because it is variable. This information will be dependent upon quality of the counselors the user connects to.
What are the relevant sources or references supporting the app use cases?
An effectiveness study on their About page.
Was there an attempt to validate app usability and feasibility?
Yes
Is there evidence of effectiveness/efficacy?
Evidence looked at depressed patients only and showed that they had an improved PHQ-9 over time.
Usability
Does the app seem easy to use?
Yes.
What are the main engagement styles of the app?
Connecting to a counselor, journaling, video counseling, video content (streamed group therapy)
Do the app and its features align with your needs and priorities?
This app would be appropriate for someone looking to be virtually connected to a counselor.
Is it customizable?
Yes. It is flexible and allows for different modalities (ie. text, phone call, video session)
Does the app clearly define its functional scope?
Yes, in the opinion of this reviewer. The app clearly outlines its use cases and target audience (e.g., those seeking virtual counseling services).
Therapeutic Goal
Can data be easily shared and interpreted in a way that's consistent with the stated purpose of the app?
It appears that users can copy and paste text out of the app; It allows for screenshots. If you are quitting use, can copy all text data.
Do you own your data?
Unclear
Can the app share data with EMR and other data tools (Apple HealthKit, FitBit)?
No
Is the app for individual use or to be used in collaboration with a provider? If intended to be used with a provider, does the app have the ability to export or transfer data?
The app is intended to be used in collaboration with a provider. The app allows individual users to export their data. It also allows for data to be transferred to the provider within the app.
Does the app lead to any positive behavior change or skill acquisition?
The app can potentially lead to positive behavior change, depending upon the quality of the counseling provided.
Does the app improve therapeutic alliance between patient and provider?
The app creates a therapeutic alliance that is isolated to the app in that the relationship is between a user and an e-therapist. This app facilitates a therapeutic alliance between only providers who enroll on the platform as a user. This app cannot be used in conjunction with an outside provider who does not have an account on Betterhelp.