JMIR Publications

ABSTRACT

Background:

Youth are at highest risk for re-attempting suicide in the period following hospital discharge. Furthermore, many adolescents do not attend scheduled appointments post-hospitalization and failure to link with a mental health provider is associated with increased suicide risk. Caring Contacts, a post-discharge follow-up program, has been shown to improve outcomes during this critical transition period.

Objective:

To determine the feasibility and acceptability of using an automated system to follow up with adolescent patients after discharge from hospital psychiatric services using a low-effort Caring Contacts process within a Quality Improvement (QI) framework.

Methods:

The Caring Contacts intervention was implemented at a large pediatric hospital in three phases. Phase 1 entailed developing text messages and corresponding images and determining eligibility criteria. Phase 2 included piloting Caring Contacts manually in the hospital’s Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services. Phase 3 included implementation within four participating hospital services, fully automating the text messages, and integrating Caring Contacts enrollment into the hospital’s electronic medical record. Process measures included staff compliance with approaching and enrolling eligible patients and results from an optional post-text satisfaction survey filled out by participants.

Results:

From March 2019 to September 2021, 4,062 adolescent patients were eligible for Caring Contacts. Of the 3,601 (89%) patients approached, 1,889 (53%) were enrolled, and 1,792 (95%) completed the program. Of the 1705 patients declining to participate, 754 (44%) preferred to “Discuss at a later time”, 686 (40%) indicated “No cell phone”, 145 (9%) reflected “Parent opt out”, and 120 (7%) were noted as “Inappropriate for the program”. Of the 1961 patients sent an optional post-text survey, 264 (13.4%) responded. Of those, 83% reported that the text made them feel moderately to very hopeful, 83% reported feeling moderately to very supported, 92% reported that peers would be helped by these texts, and 86% reported they would like to keep receiving texts in the future.

Conclusions:

The implementation of automated post-discharge Caring Contacts text messages appears to be feasible in a large pediatric healthcare setting and using a Quality Improvement approach led to improved enrollment processes across a busy service line. Optional survey results suggest that Caring Contacts text messages may contribute to increased feelings of support and hope for youth at risk of suicide. The low drop-out rate after enrollment and post-text survey results further reflect acceptability to adolescent patients.