Background The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents. Methods A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework and input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data were extracted on study methodology and measures, intervention design, and implementation characteristics, as well as policy, practice, and research implications. Results We screened 1142 abstracts. Of these, 31 articles published between 2013 and 2020 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (18/31), followed by changes in cognitions (16/31; eg, disease knowledge, self-awareness) and acceptability (16/31). Interventions were typically delivered in less than 12 weeks, and adolescents received 1-3 messages per week. Bidirectional messaging was involved in 65% (20/31) of the studies. Limited descriptions of implementation features (eg, cost, policy implications, technology performance) were reported. Conclusions The use of SMS text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bidirectionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone–based interventions for this population, a rigorous program of large-scale, well-designed trials is urgently required.

BACKGROUND Pathways to mental health services for youth are generally complex, and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text-messages offer a convenient, low-cost option for information-sharing, skill building and potentially activate youth and caregivers to positive behaviours prior to beginning formal therapy. To date, there is little evidence about the feasibility of initiating transdiagnostic text messages during the early stage of youth and caregiver contact with community outpatient mental health services. OBJECTIVE To develop and test the feasibility of implementing two novel text messaging campaigns aimed at youth clients and their caregivers during early stages of engaging with outpatient mental health services. METHODS A multidisciplinary panel of experts developed two sets of 12-message interventions with youth and caregivers prior to deployment. Each text included a link to an external interactive or multimedia resource to extend skill development. Enrolment of youth aged 13 to 18 years, and/or their caregivers,occurred in two early treatment timepoints. At both time points, text-messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in two phases between January and March 2020 and January and May 2021. Enrolment, willingness to persist in using, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. RESULTS A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% and 44% respectively. Over 1500 text messages were sent in total throughout the study. More than three quarters of youth reported that they learned something new and noticed a change in themselves due to receiving the texts. Eighty-eight percent of youth said they would recommend the texts to others. Youth ranked the most helpful text as the one related to coping with difficult emotions. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts and would recommend them to others. Caregivers perceived diverse levels of value in the text topics with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. CONCLUSIONS Results are preliminary but show brief, core skill-focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers showed promising knowledge and behaviour change with exposure to only 12 messages over 6 weeks. A larger study, with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention.

BACKGROUND More than half of adult mental disorders have their onset before the age of 18 and nearly one third of children and adolescents with a mental illness are estimated to have more than one diagnosable disorder. Improving broad dissemination of developmentally appropriate treatment and scaling up evidence-based interventions is vital to addressing issues before adulthood. Interventions delivered using text messaging have been effective in promoting behavioural change in various clinical contexts, but the reach and implementation of text messaging interventions within child and adolescent mental health and addictions are not well understood. OBJECTIVE The objective of this scoping review was to map and categorize the current state of peer-reviewed research around the use of text messaging based interventions for mental health and addictions services among children and adolescents. METHODS A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was co-created and adapted for five unique databases. Studies were screened using Covidence software. The PICO (patient, intervention, comparator, outcome) framework as well as input from multiple stakeholder groups were used to structure and pilot a data extraction codebook. Data was extracted on study methodology and measures, intervention design, implementation characteristics, as well as policy, practice and research implications. RESULTS Seven hundred and thirty six abstracts were screened. Twenty-five articles published between 2013 to 2018 were eligible for inclusion. Intervention engagement was the most common type of outcome measured (15/25) followed by changes in cognitions (14/25) (e.g., disease knowledge, self-awareness) and acceptability (13/25). Interventions were typically delivered in <12 weeks and adolescents received 1-3 messages per week. Sixty-eight percent (17/25) involved bi-directional messaging. Limited description of implementation features (e.g., cost, policy implications, technology performance) were reported. CONCLUSIONS The use of text messaging interventions is a rapidly expanding area of research. However, lack of large-scale controlled trials and theoretically driven intervention designs limits generalizability. Significant gaps in the literature were observed in relation to implementation considerations, cost, clinical workflow, bi-directionality of texting, and level of personalization and tailoring of the interventions. Given the growth of mobile phone based interventions for this population a rigorous program of large-scale, well-designed trials is urgently required.

Background Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. Objective To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. Methods A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. Results A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% (22/41) and 44%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73%) and would recommend them to others (16/22, 73%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. Conclusions Results are preliminary but show that brief, core skill–focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention.