Virtual Avatar Coaches: Improving Mental Health Treatment for College Students with Accessible Peer Support (2018-2019)


Every year, approximately 25% of American adults are living with a diagnosable mental illness. College students are a particularly high-risk group; 75% of adult-onset mental illnesses are present by age 25.  Students face a multitude of stressors during college, and these stressors can serve to exacerbate underlying predispositions to mental illness.

There are significant barriers to the delivery and effectiveness of mental health services for college students. Barriers to seeking services include feelings of personal shame, feelings of ambiguity about the need for treatment and skepticism about treatment effectiveness. The traditional manner of delivery of mental health services may present another obstacle. We expect that talking to someone in an office on a weekly basis will lead to generalization of new skills. Yet, people often need coaching and support in the precise moment that something challenging is unfolding. If that were possible, the potency of therapeutic interventions could greatly improve. However, there are also significant barriers to implementation of in-the-moment services including cost, therapist availability, ethical or legal issues and potential for therapist burnout. The use of trained teams of virtual peer health coaches (“avatars”) has the potential to address these barriers.

Project Description

This Bass Connections project will develop and pilot an innovative way to improve the mental health of college students, through the use of peer health coaches who will deliver support via virtual avatars.

The project will build off an existing application, Sidekicks™, utilizing this technology to connect college students struggling with mental health disorders to peer health coaches. Trained by licensed professionals, the peer coaches will be able to provide one-to-one online help to students who are unwilling or unable to seek professional treatment and to students who could benefit from extra services. Students will be able to download an iPhone-compatible application that will connect them to a peer health coach. The coach, acting through a virtual avatar to remain anonymous, can provide real-time, moment-to-moment support via the phone app.

The team will start by addressing the needs of students with eating disorders, modeling services for daily disorder management on coaching someone through a meal. Team members will evaluate existing peer coaching programs on college campuses, and augment existing programs with tools to target eating disorders.

Team members will develop a curriculum to train the peer health coaches in providing mental health coaching services, with augmentation of services specifically for students with eating disorders. A website will connect students to peer coaches and other relevant mental health resources. The team will collect data on app usage, website traffic and peer coach and student satisfaction that will inform further research and grant applications.

Anticipated Outcomes

Training curriculum for peer health coaches; feasibility study regarding Sidekicks™ for college students; publications

Student Opportunities

Student research team members will participate in weekly meetings with team leaders in which they will learn about the design and conduct of clinical trials and the ethical and legal issues involved in the provision of non-traditional mental health support. Students will help design and implement a study examining the feasibility of this service delivery strategy. Student peer health coaches will participate in weekly practicum where they will get clinical supervision on their provision of support. This project will be conducted in partnership with Sidekicks™,

In addition to receiving course credit, students who participate as health coaches will receive training in general mental health coaching and specific strategies to support people with eating disorders, participate in group supervision led by a postdoc and learn about ethical considerations for delivering mental health treatment online. Undergraduates will learn skills in research design, recruitment and advertisement, creating and managing surveys, data analysis and poster and manuscript preparation. Graduate students will gain mentorship experiences, refine skills in poster preparation and presentation and contribute to publications.

The team be comprised of a graduate student in clinical psychology, a graduate student in electrical and computer engineering, a postdoc in clinical psychology and undergraduates in psychology, neuroscience, engineering or other fields.

There will be two weekly meetings: a project meeting and a supervision meeting (which will be a practicum section in which students who are volunteering as peer coaches for course credit will meet weekly for clinical supervision).

Credit will be granted based on participation in training, provision of support and attendance at group supervision meetings.


Summer 2018 – Spring 2019

Team meetings will take place on Fridays, 11:30 a.m. to 12:30 p.m.

  • Summer 2018: Review existing peer-health curricula; develop peer health training; conduct intensive peer health training in the final week of the summer prior to class initiation (for students already on campus this will occur live; if not it will recur by WebEx); design advertising campaign; identify legal and ethical issues and key stakeholders involved in decision-making; begin discussions and navigating legal and ethical barriers; submit IRB application
  • Fall 2018: Finalize peer health training; finalize legal and ethical barriers; mid-semester kickoff peer health coaching
  • Spring 2019: Collect data on program feasibility; revise and improve program based on satisfaction data; if possible, begin to analyze efficacy data


Independent study credit available for fall and spring semesters

Faculty/Staff Team Members

Franca Alphin, School of Medicine-Community and Family Medicine
Jonathan Bae, Duke Health Patient Safety and Clinical Quality
Richard Chung, School of Medicine-Pediatrics: Primary Care Pediatrics
Martha Foukal, School of Medicine-Psychiatry: Behavioral Medicine
Guillermo Sapiro, Pratt School of Engineering-Electrical & Computer Engineering*
Nancy Zucker, School of Medicine-Psychiatry*

Graduate Team Members

Savannah Erwin, Psychology-PHD

Community Team Members

Ron Suskind, Sidekicks

* denotes team leader


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