Applying the EPIS Framework to Adapt and Implement a Meditation App for Justice-Involved Youth

ASHLEY KENDALL, PhD
University of Illinois at Chicago

Justice-involved youth on probation experience high rates of substance use and other risk behaviors driven by emotion dysregulation. Meditation can improve emotion regulation and be delivered by smartphone app, reaching youth in their daily lives. This study applied the Exploration and Preparation phases of the EPIS framework to guide the adaptation and implementation of Bodhi, an existing meditation app designed by meditation experts, to specifically address emotion regulation and risk behaviors among justice-involved youth on probation.

The study was conducted in collaboration with the Chicago Cook County Juvenile Justice System and Central States SER, a workforce development and education organization serving marginalized and disadvantaged Cook County residents including justice-involved youth. Justice-involved youth of all genders were eligible if they were 13-17 years old with smartphone access.

In the Exploration phase, we reviewed literature and consulted stakeholders to identify health need of probation youth and the Bodhi app as a relevant intervention. Bodhi teaches evidence-based mindfulness meditation techniques over a 30-day “path,” and includes a menu of “to go” meditations to prepare users for particular events. It includes elements that make it ideal for adaptation to new groups, including video capabilities that can showcase people relevant to the target population addressing barriers and facilitators to meditation. In the Preparation phase, we conducted formal qualitative interviews with justice-involved youth and collected informal input from a range of stakeholders to identify implementation determinants, adaptation targets, and an implementation plan. The stakeholders included a Youth Advisory Board, meditation experts, juvenile justice officers, community health workers, and professional app programmers.

Qualitative analyses conducted in MAXQDA identified substance use, sexual risk taking, and aggression as key health themes. Barriers and facilitators to use of the Bodhi app were identified in the areas of acceptability/usability, adoption, appropriateness, feasibility, and sustainability. Corresponding adaptations to the app included recording the meditations with a guide youth perceived as relatable and trustworthy; featuring relevant examples (e.g., staying mindful in court); and programming technical specifications to support ongoing use (e.g., limiting data demands). An implementation plan was developed in partnership with the Chicago Cook County Juvenile Justice System.

By applying a comprehensive implementation framework, EPIS, this study produced an adapted app for justice-involved youth, and considerations for adapting and implementing app-based interventions with high-risk youth more generally. These considerations, and next steps-including implementing and rigorously testing the adapted app with 200 youth on probation-will be discussed.