ED to EPI: Using SMS to Improve the Transition from the Emergency Department to Early Psychosis Intervention

Center for Addiction and Mental Health (CAMH)

Status: Enrolling

Conditions: Schizophreniform Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia; Psychosis; Depressive Psychosis; Bipolar Disorder; Schizoaffective Disorder; Psychoses, Affective; Substance Induced Psychoses; Psychotic Episode; First Episode Psychosis

Treatments: Behavioral: Sham SMS; Behavioral: Active SMS Intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT04298450

088/2019

Details and patient eligibility

About

Psychosis is a disabling condition that typically has its onset in adolescence and early adulthood. Many young people with psychosis have difficulty navigating services or are reluctant to engage in treatment until their illness becomes an emergency. Consequently, nearly half of all new psychotic disorders are diagnosed in the emergency department (ED). Despite the rationale and evidence for early psychosis intervention (EPI), around half of youth do not access these services. The investigators will use short message service (SMS)/text messaging, a low-cost, low-complexity, youth-friendly approach, to improve transitions in care from the ED and related acute services to EPI services, investigating the intervention's effect on attendance at the first consultation appointment, longer term service engagement, and system-level outcomes. The investigators will also evaluate cost-effectiveness and user perspectives of the intervention.

Full description

At the Centre for Addiction and Mental Health (CAMH), the investigators will recruit a consecutive series of 186 participants aged 16 to 29 referred by the CAMH ED and related acute services to CAMH's EPI program for a pragmatic randomized controlled trial of a 2-way SMS intervention involving reminders, psychoeducation, and check-ins. The primary outcome will be rate of attendance at the first consultation appointment assessed through chart reviews. Secondary outcomes will include indicators of long-term service engagement as well as symptoms and functioning 6 months following study enrollment and health service utilization for up to 2 years using administrative data from the Institute for Clinical Evaluative Sciences (ICES). Administrative data will be used for an economic analysis. Participants who receive the active intervention will be asked to complete a web-based survey evaluating their experience and a subgroup will be asked to participate in in-depth in-person qualitative interviews. Patients and family members with lived experience will be engaged in all aspects of the project, including shaping the intervention and study design.

The investigators hypothesize that the intervention will result in increased rate of attendance at the first EPI consultation appointment, as well as improved longer-term engagement in outpatient EPI services compared to the sham comparator. Demonstrating evidence that this low-cost, low-complexity, youth-friendly intervention improves engagement in outpatient EPI services has the potential to improve long-term outcomes for young people with psychosis.

Enrollment: 186 estimated patients

Sex: All

Ages: 16 to 29 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Have been referred by the Centre for Addiction and Mental Health (CAMH) emergency department or related acute services to the CAMH early psychosis intervention (EPI) program for suspected psychosis

Exclusion criteria

• Inability to communicate in basic written English

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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186 participants in 2 patient groups

Active SMS Intervention

Experimental group

Description:

Participants assigned to the experimental arm will receive the active SMS intervention. Participants in the active intervention group who consent to participate will be asked to complete a web-based survey. Based on survey findings, purposive sampling will be used to select a subsample of 12 to 20 participants for qualitative interviews.

Treatment:

Behavioral: Active SMS Intervention

Sham SMS

Sham Comparator group

Description:

Participants assigned to the sham comparator will receive the sham SMS intervention. They will not be re-contacted.

Treatment:

Behavioral: Sham SMS