Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study

Abstract

Background Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. Objective This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth’s behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. Methods CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. Results Overall, 28 individuals participated in focus groups and interviews—8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. Conclusions Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but...

Use of Technology to Promote Child Behavioral Health in the Context of Pediatric Care: A Scoping Review and Applications to Low- and Middle-Income Countries

“…We did not include messaging/texting in the review because evidence suggests effective public health approaches to child mental health intervention require consideration of multicomponent interventions (e.g., including multiple domains of mental health knowledge, skill training, and practice support in parenting/child/health-worker interventions) (36–38). However, existing messaging/texting strategies tend to be used as support or enhancement strategies for interventions, and might be limited in serving as stand-alone mental health intervention strategies in multicomponent interventions (39–41). Finally, many adults and parents in LMICs have low literacy (primary or less than primary school education) and do not have smartphones, which make a messaging approach challenging.…”

Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care

“…This digital disparity is often not accounted for by stakeholders who expect the system-involved to function without additional assistance beyond their care team. Given that judicial requirements are high-stakes and that care delivery is fragmented, 41 digital technologies may mitigate barriers to fulfilling demands.…”

“…32,38,39 Further, such tools may offer specific advantages for youth in juvenile justice and/or child welfare systems. 41,42 One study found that text messaging between youth on probation and juvenile justice personnel is common, and that text messaging communication would be an accessible and feasible means of sending youth behavioral health appointment reminders. 42 Furthermore, the ability to provide services across geographic boundaries and reduce barriers associated with face-to-face help-seeking, 43,44 make mHealth an innovative and practical intervention that can also target barriers to care among young women with histories of CSE, a population with frequent systems involvement and similar risk profiles.…”

“…We build on previous findings that demonstrated acceptability and feasibility of mHealth among underserved youth populations in the judicial system. 41,42 Our intention was to elicit feedback from youth with histories of CSE, especially those with justice and child welfare involvement on their priorities, needs, and wants as it related to a mHealth application. We explored the perspectives of girls and young women currently or formerly involved in the child welfare and/or juvenile justice systems with identified histories of CSE to understand how a mHealth application could improve support for their identified needs and sustain engagement in treatment and service navigation across various service sectors, including housing, medical services, substance use, and court and probation requirements.…”

Lessons learned through piloting a community-based SMS referral system for common mental health disorders used by female community health volunteers in rural Nepal

“…Many mHealth tools developed for mental health are utilized by the patients with a focus on treatment retention or delivering treatment such as counseling through the telephone or motivational messages [12,13] [14] [15]. In contrast, mCIDT focused on care seeking behavior and was utilized by lay health workers.…”