Developing and testing a text-messaging intervention to support parents after their child's psychiatric emergency

PROJECT SUMMARY/ABSTRACT
Rates of emergency department (ED) visits for psychiatric emergencies in adolescents have increased
substantially in the past decade, including for suicidality, self-harm, and aggression. A substantial number of
these adolescents will be discharged home from the ED with referrals to outpatient mental health treatment.
Yet, engagement in outpatient mental health treatment among adolescents is low, and rates of repeated
emergency services utilization are high, highlighting the need for better supports for these youth and families.
While effective, brief interventions have been developed to directly support adolescents at the time of their ED
visit, no evidence-based interventions have been developed to support parents of these youth. Further, the
period following an emergency visit is known to be high risk, yet no existing services support parents during the
transition home, while waiting for connection to outpatient services. In this intervention development study, we
seek to iteratively develop, refine, and test an automated, text-messaging intervention for parents of youth
discharged from the ED after a psychiatric emergency. The 8-week intervention (iPEACE; intervention for
parent education after care in the ED) will directly target (1) parent mental health literacy and (2) parent self-
efficacy, with the goal of reducing ED utilization and enhancing outpatient mental health service use and
engagement. In the first phase of the study, we aim to develop and refine the intervention with stakeholder
feedback. Parents (N=15) will receive the 8-week iPEACE starting immediately following ED discharge.
Parents will provide both in-the-moment feedback via text-message surveys and in-depth feedback at the end
of the 8-week period via semi-structured qualitative interviews and self-report measures. We will also conduct
qualitative interviews with enrolled parents’ children and key ED stakeholders. We will use this feedback to
refine the intervention materials. In the second phase of the study, we will conduct a pilot randomized
controlled trial (N=90), with n=30 parents randomized to enhanced usual care, n=30 randomized to enhanced
usual care with text-message reminders, and n=30 randomized to receive iPEACE. Parents will complete
follow-up assessments at 4-, 8- and 12-weeks to assess key intervention targets (self-efficacy and mental
health literacy) and outcomes (outpatient mental health service utilization and ED utilization). The goals for the
proposed project include: (1) developing and refining the iPEACE text-messaging intervention; and (2) piloting
the iPEACE intervention compared to enhanced usual care only and enhanced usual care with text-message
reminders to assess key study outcomes and mechanisms to inform a fully-power randomized trial. This R34
has important clinical implications, as findings from this study may support the testing and implementation of a
digital health intervention to improve outcomes for high-risk youth and families. The proposed study has the
potential to inform the provision of clinical services to support families during high-risk clinical transitions.

Grant Number: 5R34MH132711-03
NIH Institute/Center: NIH
Principal Investigator: Margaret Benningfield