PM2059: I-CARE: Feasibility, Acceptability and Appropriateness of a Digital Health Intervention to Support Youth Experiencing Mental Health Boarding

Background: Youth experiencing mental health crises are increasingly presenting to acute care hospitals. Given a national shortage of mental health beds, a substantial proportion of youth who require inpatient psychiatric care experience mental health boarding, defined by the Joint Commission as “the practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made”. Youth experiencing boarding rarely receive evidence-based mental health therapies. Therefore, a multidisciplinary team at our hospital developed I-CARE (Improving Care, Accelerating Recovery and Education), a modular, digital health intervention combining tablet-based videos with workbook exercises to teach youth evidence-based mental health skills (Table 1). I-CARE was delivered by licensed nursing assistants (LNAs) who provide safety supervision during boarding , following a six-hour training from a clinical psychologist. We evaluated the feasibility, acceptability, and appropriateness of the I-CARE program.

Methods: I-CARE was implemented beginning 11/2021 on our pediatric hospital medicine service using existing staff and resources. Program participants were youth aged 12-17 years who were boarding due to suicidality and/or self-harm; excluded were youth with psychosis, or cognitive or behavioral conditions that precluded participation. The program evaluation included youth who were offered at least two I-CARE modules and parents/caregivers who were present during the boarding period. Our mixed methods evaluation involved a triangulation design in which semi-structured interviews were conducted concurrently with validated acceptability, feasibility and appropriateness measures using a 5-point Likert scale. Quantitative measures were analyzed using descriptive statistics while interviews were analyzed using a general inductive approach.

Results: From 11/2021-04/2022, 20 eligible youth were offered the I-CARE program. The median age was 14(IQR:13-15) years; 10(50%) were female, 7(35%) were gender non-conforming, and 3(15%) were male. Median boarding duration was 6 days. Of youth offered the program, all completed the first module and 16(80%) participated in subsequent modules; reasons for discontinuation were refusal to engage with the program, baseline familiarity with module content (perceiving no learning benefit), and inter-facility transfer. 14 youth and 7 parents participated in the program evaluation (Table 2); the median appropriateness score was 3.5 (IQR:3-3.75), median acceptability score was 3.8 (IQR:3.3-4.0) and median feasibility score was 4 (IQR:4-4.5). In semi-structured interviews, youth and parents expressed positive attitudes towards the intervention and coaches, welcoming the delivery format and content. Some youth felt the intervention was better suited for a younger audience or those with less familiarity with mental health skills, but they acknowledged that the intervention would be helpful and appropriate for others.

Conclusion: The I-CARE program was feasible to implement by non-mental-health professionals and well received by youth and their caregivers. This program has the potential to teach evidence-based mental health skills to youth during boarding, providing a head-start on recovery prior to psychiatric hospitalization.