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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to assist parents of children aged 11-17 who have experienced a mental health crisis and visited the emergency department. It tests a new text-messaging program designed to teach parents how to manage their child's mental health and navigate mental health services. The trial compares three groups: parents receiving regular text tips (iPEACE: Intervention for Parent Education about Care after the ED), those receiving appointment reminders, and those receiving standard care. Parents who live with their child most of the time and have a phone capable of receiving texts are well-suited for participation. As an unphased trial, this study provides parents with a unique opportunity to access innovative support strategies for managing their child's mental health.

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 prior data suggests that this text-messaging intervention is safe for parents?

A previous study used text message programs like iPEACE to assist parents after their child's psychiatric emergency. These programs are generally easy to use, offering education and support through simple text messages. Research has shown that digital programs like iPEACE are low-risk and can positively impact parents by enhancing their understanding of mental health and boosting their confidence in handling situations.

Similarly, text message reminders have helped people attend appointments without negative effects. One study found that these reminders helped families keep their follow-up appointments, indicating they are safe and effective.

Both iPEACE and text message reminders are automated and provide support through texts. Since they don't involve medication or physical procedures, they are considered safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to support parents after their child's psychiatric emergency. The iPEACE intervention is unique because it uses an automated text-messaging system to enhance parents' mental health literacy and self-efficacy over an 8-week period. This method is different from standard care, which typically involves in-person consultations and referrals. The text reminders arm offers a novel approach by providing weekly automated prompts to encourage parents to schedule therapy appointments for their child, aiming to improve follow-through on treatment plans. By leveraging technology, these interventions could provide more accessible, consistent support for families in a critical time.

What evidence suggests that this trial's treatments could be effective for parenting after a child's psychiatric emergency?

In this trial, participants will join different treatment arms to evaluate the effectiveness of text-based interventions for parents after a child's psychiatric emergency. Research has shown that the iPEACE program, one of the interventions in this trial, uses text messages to educate and support parents, potentially improving children's mental health. Previous studies found that similar programs for parents reduced stress and boosted their confidence in handling challenges, while also benefiting their children's mental health. Another arm of this trial involves text message reminders, which studies indicate can help parents keep appointments, ensuring they receive the necessary follow-up care. Both methods in this trial aim to assist parents after a child's mental health crisis, making access to mental health services easier and more effective. ^{1 2 3 4 6}

Who Is on the Research Team?

Margaret Benningfield, MD

Principal Investigator

Vanderbilt University Medical Center

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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15 A recent study found that automated text message appointment reminders improved follow-up attendance to primary or specialty care in adult ED patients.