Implementation of a text-messaging intervention for adolescents who self-harm (TeenTEXT): a feasibility study using normalisation process theory.

Christabel Owens,Nigel Charles

doi:10.1186/s13034-016-0101-z

Abstract

BackgroundThere 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.MethodsWe 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 6 months.ResultsDespite 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.ConclusionsUser-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.

Highlights

There are few interventions that directly address self-harming behaviour among adolescents
In Child and Adolescent Mental Health Services (CAMHS) Team C, three clinicians were recruited late in the study and were very keen, but further delays caused by sickness and annual leave meant that there was insufficient time for them to use it with their clients
The normalisation process theory (NPT)-informed themes that emerged from the data are presented below

Summary

Introduction

There are few interventions that directly address self-harming behaviour among adolescents. Self-harm is defined as any “act of self-injury or self-poisoning carried out by an individual, irrespective of motivation” [1]. It takes many forms, the most common being cutting or burning of the skin and overdosing on overthe-counter analgesics. Self-harming behaviour tends to become habitual and, once established, patterns can be hard to break. Self-harm is very common in children and adolescents, with prevalence peaking at 14–15 years [2]. UK school-based studies show that 13–14 % of 15–16 year olds report a lifetime history of self-harm [3, 4].

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Discussion

Conclusion