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Coaching & Care Management Models

Many meta-analyses of digital mental health intervention trials have shown that human coaching improves both patient engagement and outcomes. Yet relatively little literature has addressed what the essential elements of coaching are. We have proposed two broad models.

First, our Supportive Accountability model posits that a core function of a coach is to keep the user engaged. This is achieved through accountability, which is defined as the patient knowing that they will communicate with a coach about whether they have or have not completed the required activities with the digital tools. This process is wrapped in a supportive relationship, ensuring a warm, empathic bond in which the patient knows that the coach has the best interests of the patient at heart, and reassurance that coach is credible and competent. This model is simple to implement and is being used by a growing number of digital mental health programs worldwide.

This model has been extended to the Efficiency Model, which identifies additional potential failure points of digital mental health interventions and the coach’s role in overcoming those failure points. This expands the Supportive Accountability model to consider not just that a patient has used an intervention tool, but also how the patient is using it. For example, tools may fail because the patient does not know how to use them, in which case the coach can assist the patient. The tool may not match the needs or preferences of the patient, in which case the coach can direct the patient to more appropriate tools. Finally, the end goal of treatment is not that patients use digital tools, rather it is that they make changes in their lives, which may not be visible to the coach through tool use. This requires the coach to inquire about translation of skills into the patient’s daily life.

Coaching manuals are further described and provided on our Workbooks & Protocols page.


Mohr DC, Cuijpers P, Lehman K. Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions. J Med Internet Res. 2011;13(1):e30.

Schueller SM, Tomasino KN, Mohr DC. Integrating Human Support into Behavioral Intervention Technologies: The Efficiency Model of Support. Clinical Psychology: Science and Practice. 2016(24):27-45.

Lattie, E.G., Graham, A.K., Hadjistavropoulous, H.D., Dear, B.F., Titov, N., & Mohr, D.C. (2019). Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions. Digital Health, DOI: 10.1177/2055207619896145

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