Can Text Messages Enhance Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment? A multimethod formative evaluation (Preprint)

Abstract

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.