Implementation of a text-messaging intervention for adolescents who self-harm (TeenTEXT): A feasibility study using Normalisation Process Theory
Owens, CV; Charles, NT
Date: 28 June 2016
Article
Journal
Child and Adolescent Psychiatry and Mental Health
Publisher
BioMed Central
Publisher DOI
Abstract
Background
There are few interventions that directly address self-harming behaviour among
adolescents. At the request of clinicians in Child and Adolescent Mental Health
Services (CAMHS) in England and working with them, we redeveloped an adult SMS
text-messaging intervention to meet the needs of adolescents under the care of
CAMHS ...
Background
There are few interventions that directly address self-harming behaviour among
adolescents. At the request of clinicians in Child and Adolescent Mental Health
Services (CAMHS) in England and working with them, we redeveloped an adult SMS
text-messaging intervention to meet the needs of adolescents under the care of
CAMHS who self-harm.
Methods
We used Normalisation Process Theory (NPT) to assess the feasibility of delivering it through CAMHS. We planned to recruit 27 young people who self-harm and their
clinicians, working as dyads and using the intervention (TeenTEXT) for six months.
Results
Despite strong engagement in principle from CAMHS teams, in practice we were able to recruit only three clinician/client dyads. Of these, two dropped out because the clients were too unwell. We identified a number of barriers to implementation. These included: a context of CAMHS in crisis, with heavy workloads and high stress levels; organisational gatekeeping practices, which limited the extent to which clinicians could engage with the intervention; perceived burdensomeness and technophobia on the part of clinicians, and a belief by many clinicians that CAMHS may be the wrong delivery setting and that the intervention may have better fit with schools and universal youth services.
Conclusions
User-centred design principles and the use of participatory methods in intervention
development are no guarantee of implementability. Barriers to implementation cannot always be foreseen, and early clinical champions may overestimate the readiness of colleagues to embrace new ideas and technologies. NPT studies have an important role to play in identifying whether or not interventions are likely to receive widespread clinical support. This study of a text-messaging intervention to support adolescents who self-harm (TeenTEXT) showed that further work is needed to identify the right
delivery setting, before testing the efficacy of the intervention.
Institute of Health Research
Collections of Former Colleges
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