Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study.

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.

Sleep-Related Issues in Children and Adolescents Presenting at Community Mental Health Clinics.

OBJECTIVE: To examine sleep-related issues in children and adolescents presenting at community clinics with diverse mental health concerns using a brief sleep questionnaire and to examine whether sleep issues would improve with mental health interventions. METHOD: Study 1: A questionnaire-based study that used a modified version of the Pittsburgh Sleep Quality Index to measure sleep-related issues in youth aged 4-18 years presenting at community mental health clinics. Study 2: A pre/post-treatment study that used the same questionnaire to measure changes in sleep-related issues in youth aged 4-19 years participating in a group mental health intervention. The main outcome measure for both studies was global sleep score. RESULTS: Using the recommended cut-off score of 5, 31% of children aged 4-11 years and 71% of adolescents aged 12-18 years had problematic sleep. Sleep-related issues did not differ by presenting mental health concern. The group intervention was associated with improved sleep for parent-reported child sleep and self-reported adolescent sleep, but not for parent-reported adolescent sleep. CONCLUSIONS: Problematic sleep is very common in youth with mental health concerns. More research is needed to understand best practices for assessment and treatment of sleep issues that are comorbid with mental health issues in children and adolescents.

OBJECTIF: Examiner les difficultés liées au sommeil chez des enfants et des adolescents se présentant à des cliniques communautaires avec divers problèmes de santé mentale, à l'aide d'un bref questionnaire sur le sommeil, et examiner si ces difficultés de sommeil s'amélioreraient par des interventions de santé mentale. MÉTHODE: Étude 1: Une étude basée sur un questionnaire qui utilisait une version modifiée de l'échelle de la qualité du sommeil de Pittsburgh pour mesurer les difficultés liées au sommeil chez des enfants et adolescents de 4 à 18 ans qui se présentent à des cliniques communautaires de santé mentale. Étude 2: Une étude pré/post traitement qui utilisait le même questionnaire pour mesurer les changements des difficultés liées au sommeil chez des enfants et adolescents de 4 à 19 ans qui participent à une intervention de groupe en santé mentale. La mesure principale du résultat pour les deux études était le score de sommeil total. RÉSULTATS: À l'aide du score d'inclusion recommandé de 5, 31 % des enfants de 4 à 11 ans et 71 % des adolescents de 12 à 18 ans avaient un sommeil problématique. Les difficultés liées au sommeil ne différaient pas par la présentation d'un problème de santé mentale. L'intervention de groupe était associée avec un sommeil amélioré pour le sommeil de l'enfant déclaré par le parent et celui auto-déclaré par l'adolescent, mais aucun parent n'a déclaré le sommeil de l'adolescent. CONCLUSIONS: Le sommeil problématique est très commun chez les jeunes ayant des problèmes de santé mentale. Il faut plus de pratique pour comprendre les pratiques exemplaires d'évaluation et de traitement des difficultés de sommeil qui sont comorbides avec des problèmes de santé mentale chez les enfants et les adolescents.