Text Messaging for Parenting After Child's Psychiatric Emergency

(iPEACE Trial)

Overseen By Neil Chaturvedi

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Vanderbilt University Medical Center

Disqualifiers: No mobile phone, Non-English speakers

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

90 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment iPEACE: Intervention for Parent Education about Care after the ED, Text Messaging Reminders Only?

Research on similar text-messaging interventions for youths after emergency department visits shows that these messages can help reduce suicidal thoughts and behaviors, suggesting that text reminders may also support parents in managing their child's care after a psychiatric emergency. ^{1 2 3 4 5}

Is text messaging for parenting after a child's psychiatric emergency safe?

Research on a similar text-messaging intervention for youths after emergency department discharge found it to be safe and well-received, helping reduce suicidal thoughts and behaviors. ^{2 4 5 6 7}

How is the iPEACE treatment different from other treatments for parenting after a child's psychiatric emergency?

The iPEACE treatment is unique because it uses text messaging to provide education and support to parents after their child's psychiatric emergency, focusing on improving parental understanding and involvement in their child's care, which is not typically addressed by standard treatments. ^{4 8 9 10 11}

What is the purpose of this trial?

This grant aims to develop and test a text-messaging intervention for parents of children and teens evaluated in the emergency department for a psychiatric emergency and discharged home with outpatient referrals. The intervention for parents will teach parents skills to navigate the mental health services system and build their self-efficacy in managing their child's mental health. This research has the potential to improve services for families seeking emergency psychiatric support, with the goal of facilitating treatment engagement and reducing emergency services utilization using scalable, cost-effective, accessible tools.

Research Team

Margaret Benningfield, MD

Principal Investigator

Vanderbilt University Medical Center

Eligibility Criteria

This trial is for parents or legal guardians of children aged 11-17 who have been admitted to the pediatric emergency department due to a mental health crisis. The child must live with them at least 50% of the time and be discharged home with outpatient care referrals.

Inclusion Criteria

Parents or legal guardians must live with their child ≥50% of the time

I am the parent or guardian of a child aged 11-17.

My child was admitted to the ER for a mental health crisis.

Exclusion Criteria

Do not have daily access to a mobile phone that can receive SMS text messages

I am not fluent in English.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Intervention Development

Development and refinement of the iPEACE text-messaging intervention with stakeholder feedback

8 weeks

In-the-moment feedback via text-message surveys and in-depth feedback at the end of the period

Pilot Randomized Controlled Trial

Conduct a pilot randomized controlled trial with parents receiving different levels of intervention

8 weeks

Weekly text messages for intervention groups

Follow-up

Participants are monitored for key intervention targets and youth outcomes

24 weeks

Follow-up assessments at 4-, 8-, and 24-weeks

Treatment Details

Interventions

• iPEACE: Intervention for Parent Education about Care after the ED
• Text Messaging Reminders Only

Trial Overview The study is testing 'iPEACE,' a text-messaging intervention designed to educate parents on navigating mental health services and improving their confidence in managing their child's mental health after an emergency department visit.

Participant Groups

Group I: iPEACE: Intervention for Parent Education About Care after the ED Active Control 1 Intervention

Parents in the iPEACE condition will receive an 8-week text-messaging intervention to build skills in mental health literacy and self-efficacy. Texts will be delivered several days per week over an 8-week period. The intervention is fully automated.

Group II: Text Reminders Only Active Control 1 Intervention

Parents in the text-reminders only condition will receive weekly reminders to make an outpatient therapy appointment for their child. Texts will be fully automated, and will be delivered once a week for 8-weeks.

Group III: Treatment as Usual Active Control 1 Intervention

Parents in the TAU condition will receive typical treatment in the emergency department, including outpatient referrals and safety planning if needed prior to discharge.

Who Is Running the Clinical Trial?

Vanderbilt University Medical Center

Lead Sponsor

Trials

922

Recruited

939,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

A study involving 300 children aged 1 month to 6 years showed that parents who received therapeutic education on antibiotic use reported significantly higher satisfaction with the information provided compared to those who received standard fever control education (96.9% vs. 83.0%).

Parents in the therapeutic education group also demonstrated better attitudes towards judicious antibiotic use, indicating that pharmacist-led education in a pediatric emergency department can effectively enhance understanding and responsible use of antibiotics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department. Angoulvant, F., Rouault, A., Prot-Labarthe, S., et al.[2021]

Only 60.4% of guardians followed up with physician instructions after emergency department visits, highlighting a significant challenge in aftercare compliance among pediatric patients.

Children with private insurance showed better compliance rates for follow-up appointments and obtaining prescribed medications compared to those who were underinsured, indicating that health insurance status plays a crucial role in aftercare adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Characteristics of pediatric patients at risk of poor emergency department aftercare. Wang, NE., Kiernan, M., Golzari, M., et al.[2021]

In a study of 159 parents interviewed after their child's emergency department visit, 75% of parents correctly recalled a single diagnosis, but only 55% could recall all diagnoses when multiple were given, highlighting challenges in understanding complex medical information.

Parents were significantly less likely to remember medication names and follow-up appointment details when multiple medications or appointments were involved, indicating that clear communication is crucial for effective parental recall and understanding of their child's care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parental recall after a visit to the emergency department. Grover, G., Berkowitz, CD., Lewis, RJ.[2022]

A pilot study of a text-messaging intervention for youths discharged from the hospital after suicidal thoughts showed it was feasible and well-received, helping to reduce suicidal thoughts and behaviors.

The positive results of this intervention led to the Maryland Department of Health expanding the program to offer similar support to all Maryland residents, highlighting its potential effectiveness in suicide prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Brief Text-Messaging Intervention for Suicidal Youths After Emergency Department Discharge. Ryan, TC., Chambers, S., Gravey, M., et al.[2022]

A digital social needs intervention using personal phones or tablets in a pediatric emergency department was feasible and effective, with 67% of 266 participants identifying at least one health-related social need, such as housing or education.

At one month follow-up, 44% of participants reported that their most important need was 'completely' or 'somewhat' solved, and the intervention had minimal impact on clinical flow, with 95% of clinicians noting no increase in length of stay.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile Social Screening and Referral Intervention in a Pediatric Emergency Department. Kanak, MM., Fleegler, EW., Chang, L., et al.[2023]

In a study of 259 parent-child pairs in a pediatric emergency department, 32% of parents made errors in dosing acetaminophen for their children, highlighting a significant issue in medication safety during discharge.

Spanish-speaking parents were found to be 3.7 times more likely to make dosing errors compared to English-speaking parents, indicating that language barriers contribute to misunderstandings, but other factors also need to be addressed to improve overall comprehension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parental language and dosing errors after discharge from the pediatric emergency department. Samuels-Kalow, ME., Stack, AM., Porter, SC.[2022]

The SAFER Care framework, which includes standardized written and verbal discharge counseling, significantly improved caregiver comprehension of discharge instructions from 37% to 62% after implementation, based on surveys from 433 caregivers.

This study highlights the effectiveness of structured discharge counseling in a pediatric inpatient setting, suggesting that similar approaches could benefit other patient populations, especially those with limited English proficiency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SAFER Care: Improving Caregiver Comprehension of Discharge Instructions. Uong, A., Philips, K., Hametz, P., et al.[2022]

The Early Psychosis Education Program (EPEP) effectively addressed the knowledge gap among parents of children admitted to psychiatric care, revealing significant themes of surprise and feelings of helplessness regarding their child's mental health.

The evaluation suggests that a nurse-led EPEP could enhance community support for families, fostering better partnerships with mental health services and promoting a recovery-oriented approach to care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"It broke our hearts": understanding parents' lived experiences of their child's admission to an acute mental health care facility. Ward, L., Gwinner, K.[2014]

In an 18-month evaluation of telemental health services for 87 children in rural emergency departments, nearly half presented with depression or anxiety-related disorders, highlighting the urgent need for accessible mental health care.

The study found that children admitted for suicidal ideation had significantly longer lengths of stay in the emergency department compared to those discharged to outpatient care, indicating a need for improved mental health triage and resources in rural settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth Increases Access to Care for Children Dealing with Suicidality, Depression, and Anxiety in Rural Emergency Departments. Fairchild, RM., Ferng-Kuo, SF., Rahmouni, H., et al.[2022]

The Crisis Care smartphone application was developed to support suicidal adolescents and their parents during the critical post-discharge period from acute care facilities, addressing the heightened risk of suicide during this time.

A pilot test with 20 adolescent-parent pairs showed that the app was both acceptable and usable, indicating its potential as a helpful tool in suicide prevention and intervention for families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Study of the Acceptability and Usability of a Smartphone Application Intervention for Suicidal Adolescents and Their Parents. McManama O'Brien, KH., LeCloux, M., Ross, A., et al.[2022]

A qualitative study involving 72 parents of children aged 0-19 with anxiety or depression revealed significant barriers to accessing mental health services, including service shortages, lack of clinician expertise, and stigma.

Parents expressed a strong desire for improved access to mental health services, better support in schools, and enhanced mental health education to help them care for their children effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parent perspectives on children and young people's mental health services in Victoria - What's wrong and how to fix it: A multi-site qualitative study. Hiscock, H., Connolly, AS., Dunlop, K., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Characteristics of pediatric patients at risk of poor emergency department aftercare. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Parental recall after a visit to the emergency department. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

A Brief Text-Messaging Intervention for Suicidal Youths After Emergency Department Discharge. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Mobile Social Screening and Referral Intervention in a Pediatric Emergency Department. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Parental language and dosing errors after discharge from the pediatric emergency department. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

SAFER Care: Improving Caregiver Comprehension of Discharge Instructions. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

"It broke our hearts": understanding parents' lived experiences of their child's admission to an acute mental health care facility. [2014]

9. United States pubmed.ncbi.nlm.nih.gov

Telehealth Increases Access to Care for Children Dealing with Suicidality, Depression, and Anxiety in Rural Emergency Departments. [2022]

10. England pubmed.ncbi.nlm.nih.gov

A Pilot Study of the Acceptability and Usability of a Smartphone Application Intervention for Suicidal Adolescents and Their Parents. [2022]

11. Australia pubmed.ncbi.nlm.nih.gov

Parent perspectives on children and young people's mental health services in Victoria - What's wrong and how to fix it: A multi-site qualitative study. [2021]