*How do you Feelee?* Does an ordinary question a day supports youth in a forensic outpatient setting to become more emotional balanced?

Adolescents who frequently come in contact with the police and the judicial
system often exhibit mental problems that manifested itself in delinquent
behavior and internalizing problems (Frick & Marsee, 2005; Moffit, 1993, 2006,
2018; Ogloff et al., 2015). Treatment of these adolescents in the forensic
outpatient youth care is complex. Not only the demand for help: adolescents who
exhibit delinquent behavior often have, besides individual problems, also
problems within the family, at school or at work (van Duin et al., 2017). In
addition, in practice, treatment often does not get off ground, because
motivation for treatment among adolescents is very low and the treatment often
depends on the treatment alliance between the adolescent and therapist (Carl,
Schmucker & Lösel, 2020; Cullen et al., 2011).

Looking at existing treatments in forensic outpatient youth care, the common
thread in treatments appears to be aimed at regulating emotions and thereby
teaching adolescents skills to prevent future delinquent behavior (Day, 2009;
Modecki, Zimmer-Gembeck & Guerra, 2017). However, in treatment practice, it
appears that adolescents with delinquent behavior have great difficulty in
recognizing, understanding and reflecting on emotions which are important steps
in regulating emotions. The addition of the Feelee app to treatment as usual
(TAU) in forensic outpatient care can support adolescents in this. Indeed, the
Feelee app allows adolescents to keep track of emotions several times a day by
using emojis (active data). In addition, the Feelee app collects data on the
number of steps and hours of sleep per day (passive data). Separately and
combined, the active and passive data provide great insight into emotions and
underlying behaviors of the adolescent.

An initial exploration with the Feelee app in forensic outpatient treatment
practice shows positive results: Feelee supports (1) adolescents to make sense
of their emotions and underlying behaviors and (2) in treatment to have an
approachable conversation about emotions and underlying behaviors (e.g.,
movement and sleep/wake rhythms). This study serves as an initial impact study
to gain more insight into the workable factors of applying the Feelee app to
TAU in the forensic outpatient setting. The focus is on emotion regulation as a
common thread of treatments, specifically looking at the extent to which Feelee
for adolescents contributes positively to recognizing, differentiating,
reflecting on and on emotions. In addition, we will investigate whether Feelee
can also be a supporting factor in increasing treatment motivation and
strengthening the treatment relationship in treatment.

The aim of the study is to gain more insight into the working factors of the
Feelee app as a supportive tool to TAU in forensic outpatient settings. We
examine whether the daily tracking of emotions by means of emojis together with
the collected data on number of steps and hours of sleep per day in addition to
TAU contribute effectively to improving emotion regulation in adolescents. We
will also examine whether adolescents show progress on the underlying emotion
regulation factors. Specifically, differentiating, reflecting and emotional
awareness. Finally, we examine whether the use of the Feelee app to TAU also
has a positive influence on the treatment motivation and treatment alliance. By
studying both emotion and treatment factors, the study aims to contribute in an
innovative way to improving existing treatments for adolescents who exhibit
high levels of delinquent behavior.

This study involves a Single Case Experimental Design (SCED), which examines
the application of the Feelee app to TAU on emotion and treatment factors. In
the design participants will follow a 14-day baseline period in which various
measurements take place in the form of a pre-test and daily questionnaire, but
participants do not yet use the Feelee app. After the baseline phase, the
intervention phase follows in which participants use the Feelee app daily for 4
weeks and discuss the outcomes in the overview with their therapist in their
weekly treatment session. In addition, participants complete a short daily
questionnaire. After 4 weeks of the intervention phase, a follow-up phase of
14-days will follow in which the short daily questionnaire will be continued,
but participants will no longer use the Feelee app. Also, a post-measurement
will take place after completion of the intervention phase and a follow-up
measurement will take place after completion of the follow-up phase. The total
duration of the study for participants, will be 8 weeks. For all participants,
a one-time follow-up measurement will take place after 3 months after
completion of the baseline phase.

The intervention involves the application of the Feelee app to TAU.
Participants will use the Feelee app for 4 weeks during the intervention phase.
This includes (1) filling in daily an emoji that describes their emotion at
that moment and (2) discussing the active emoji data and passive data (number
of steps and hours of sleep per day) during the weekly treatment session.
Treatment providers will receive a handout for this purpose that includes
guidelines and examples about how the data can be discussed in treatment.

For participants the duration of this study is 8 weeks. Furthermore, a one-time
follow-up measurement after 3 months will be conducted. During the baseline
period (8 weeks), participants complete a short daily questionnaire. This takes
a maximum of 5 minutes. In addition to the short daily questionnaire,
participants will be asked to complete an extensive questionnaire as a pre-,
post, follow-up and follow-up measurement. The duration for completing the
extensive questionnaire will be around 45 minutes. In addition to the extensive
questionnaires, during the follow-up (Tf1) and follow-up measurement after 3
months (Tf2) an interview with the participant will be conducted to get
experiences of the adolescent regarding the use of the Feelee app for the
further development of the Feelee app and possible treatment protocols. The
entire interview is expected to take 30 minutes. Finally, during the
intervention phase, participants will be asked to use the Feelee app for 4
weeks on a daily basis. This requires participants to fill out an emoji at
least once a day. For the passive data (number of steps and hours of sleep per
day) the participant does not have to do anything. Participants receive
appropriate compensation for their efforts in the form of a voucher. Finally,
no risks are anticipated for participants that can be attributed to
participation in this study.