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

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.

Download Full-text

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

Psychotherapy and Psychosomatics ◽

10.1159/000516380 ◽

2021 ◽

pp. 1-14

Author(s):

Nina Reinholt ◽

Morten Hvenegaard ◽

Anne Bryde Christensen ◽

Anita Eskildsen ◽

Carsten Hjorthøj ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Behavioral Therapy ◽

Controlled Trial ◽

Well Being ◽

Major Depressive ◽

Outpatient Mental Health ◽

End Of Treatment

Introduction: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. Objective: This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. Methods: In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. Results: At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. Conclusions: This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

Download Full-text

The beneﬁts of outpatient mental health services for children in long-term foster care

Mental Health Services for Vulnerable Children and Young People ◽

10.4324/9780203095478-9 ◽

2013 ◽

pp. 35-50

Keyword(s):

Mental Health ◽

Foster Care ◽

Mental Health Services ◽

Health Services ◽

Outpatient Mental Health

Download Full-text

29 Symptoms of PTSD in a Burn Outpatient Clinic: Prevalence and Engagement Challenges for the Burn Team

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.033 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S21-S22

Author(s):

Andrew McAleavey ◽

Mariel Emrich ◽

Adina R Jick ◽

Collette L McGuire ◽

JoAnn Difede

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Mental Health Services ◽

Health Services ◽

Outpatient Clinic ◽

Stress Disorder ◽

Psychological Trauma ◽

Self Report ◽

Outpatient Mental Health ◽

Contact Information

Abstract Introduction Psychological distress, including posttraumatic stress disorder, acute stress disorder, and depressive disorders, are common after burn injury. These conditions are major determinants of long-term quality of life and productivity loss among burn patients, yet are generally under treated. Among the many reasons for limited treatment are lack of accessible quality care, limited clinical staff expertise in assessing these conditions, and patient avoidance of effective services. Methods During December 2018 to September, 2019, patients awaiting outpatient visits at an urban burn center were asked to complete brief standardized self-report questionnaires assessing symptoms of posttraumatic distress, anxiety, and depression. Using pre-defined criteria, we attempted to reach individuals with greater than moderate distress using contact information provided voluntarily and engage these patients in outpatient mental health services. Results 747 questionnaires were completed by 511 individuals in the assessment period, and of these 98 (19.2%) individuals had a likely PTSD diagnosis. Visual analog scale assessments for current anxiety, depression and stress all suggested high average distress in the overall group. Using pre-defined criteria to identify potential distress, we identified 195 people (38.2%) to whom we would proactively offer services. Only 159 provided contact information, and several more were not eligible for available clinical services so were not contacted. We called 128 individuals (81%). This led to direct communication with 48 patients (37.5% of those contacted), but only 22 individuals (17.2% of all those contacted) still endorsed distress at the time of the phone call (which was planned to occur within one week of the patients’ report) and 11 individuals were interested in seeking mental health services. Of these, 4 were referred to other services, 3 declined specific offers of service, 4 were scheduled for appointments and only 2 individuals attended appointments with the in-hospital psychological trauma group. Conclusions Psychological distress is highly prevalent in the burn outpatient clinic, with roughly one in five patients likely meeting criteria for PTSD. However, engaging patients in psychological and psychiatric treatment remains a major challenge for the effective care in this population. We discuss strategies tried here and systemic barriers to overcome in future research and care. Applicability of Research to Practice High prevalence of PTSD in outpatient burn clinics and difficulty engaging patients in separate outpatient mental health services suggest co-located and collaborative care models would be highly helpful in this population.

Download Full-text

Point prevalence of schizophrenia in immigrant groups in Rotterdam: data from outpatient facilities

European Psychiatry ◽

10.1016/s0924-9338(01)00558-2 ◽

2001 ◽

Vol 16 (3) ◽

pp. 162-166 ◽

Cited By ~ 35

Author(s):

A.C. Schrier ◽

B.J.M. van de Wetering ◽

P.G.H. Mulder ◽

J.P. Selten

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

The Netherlands ◽

Hospital Admission ◽

Mental Health Professionals ◽

Point Prevalence ◽

Outpatient Mental Health ◽

Netherlands Antilles ◽

Female Immigrants

SummaryObjectiveReports of an increased incidence of schizophrenia in some immigrant groups to The Netherlands are based exclusively on hospital data. The aims of our study were: 1) to determine the treated point prevalence of schizophrenia at outpatient mental health services in Rotterdam and to compare the results for immigrants to those for natives; and 2) to compare groups born in The Netherlands and immigrant groups in terms of the proportions of patients with a previous hospital admission.MethodWe included all patients aged between 20 and 64 who were treated for a non-affective psychosis at any of the outpatient mental health services in Rotterdam on October 1, 1994. The mental health professionals responsible reported on the socio-demographic and clinical characteristics of each patient.ResultsSeven hundred and thirteen patients with a diagnosis of schizophrenia (DSM-III-R) were identified (rate: 2.1 per 1000). The (treated) prevalence of schizophrenia in male immigrants from Surinam and Morocco and in female immigrants from Surinam, the Netherlands Antilles and Cape Verde was significantly higher than that in their native-born counterparts (odds ratios between 2 and 3). The (treated) prevalence was not significantly higher in immigrants from Turkey, female immigrants from Morocco or male immigrants from the Antilles. Proportions of patients with a previous hospital admission were similar in each ethnic group (81–93%).ConclusionThese findings are generally in line with earlier studies, based on the Dutch psychiatric registry, which has reported an increase in the (treated) incidence of schizophrenia in immigrants from Surinam and the Netherlands Antilles and in male immigrants from Morocco, and no increase in the (treated) incidence in immigrants from Turkey or female immigrants from Morocco.

Download Full-text