Study shows text messages help youth at risk for suicide feel supported after discharge

As the nation’s youth mental health crisis continues, providers continue to find ways to help address gaps in care. Patients who receive care for suicidal thoughts and behaviors need extra support as they transition after they are discharged from inpatient care or the emergency department.

Caring Contacts are validating messages sent to patients via text messages, postcards or letters to offer patients ongoing care and support without placing any demands (such as reminders to attend their next appointment). At Nationwide Children’s, Caring Contacts has been implemented in a text-based format, as part of the hospital’s Zero Suicide quality improvement work.

Zero Suicide is a framework of best practices in suicide care that has been shown to reduce suicides in health care systems, and includes elements such as routine patient screening for suicide risk followed by an evidence-based assessment and safety plan when patients screen positive.

In a study published today in the JMIR Pediatrics and Parenting, faculty at the Center for Suicide Prevention and Research (CSPR) at Nationwide Children’s Hospital described the implementation of an automated Caring Contacts texting system and found the intervention helped youth at risk for suicide feel hopeful and supported during a period of heightened risk. According to the study, this intervention and similar efforts to improve care transitions are critical to improving youth suicide prevention outcomes.

“Prior research has shown that patients are around 300 times more at risk of suicide in the first week after hospital discharge, and 200 times more at risk over the first month compared to the general population,” said John Ackerman, Ph.D., child clinical psychologist and suicide prevention clinical manager for the CSPR at Nationwide Children’s.

“Reaching patients where they are in their day-to-day lives is crucial in supporting them before, during and after a crisis. That also means ensuring messages of hope and validation are accessible with the technology they use most—their phones.”

The study utilized Caring Contacts message content in the highest acuity behavioral health services at Nationwide Children’s, enrolling patients at the time of discharge from services sought during a suicidal crisis.

Sets of supportive text messages with accompanying images meant to promote hope, inclusivity and connection were automatically sent to enrolled patients during the four-month period starting the day after patients left the hospital. Each message also included crisis resources. There were three phases for this initiative, with message content development beginning in 2018, and full implementation and data collection concluding in 2021.

More than 1,700 patients completed the Caring Contacts program during the study period. As a result of post-text satisfaction surveys, 83% of respondents reported feeling moderately to very hopeful, and 88% reported feeling moderately to very supported.

Of note, 92% of respondents reported that peers would be helped by these text messages, and 86% reported wanting to keep receiving messages in the future if given the option. The lowest enrollment rate was seen in 13-year-olds, while the highest enrollment rate was seen in 18-year-olds, and females enrolled at a higher rate (54%) than males (48%).

“More work needs to be done in order to measure clinical effectiveness and improve rates of enrollment. However, as the first children’s hospital to study this approach and integrate it as part of an overall quality improvement framework, we are encouraged by what we’ve seen in terms of implementing this approach in our hospital,” said Glenn Thomas, Ph.D., lead author of the study, clinical psychologist and director in Behavioral Health Services at Nationwide Children’s. “Patients need to know that we are here for them even after they leave our walls.”