The purpose of this randomized controlled study is to evaluate acceptability and
feasibility, and to gather preliminary data about efficacy, of "iDOVE," a brief emergency
department introductory session + longitudinal automated text-message depression prevention
program for high-risk teens.
Peer violence and depressive symptoms have mutual, reinforcing negative impacts on teens'
emotional and behavioral regulation strategies.
The emergency department (ED) is the primary source of care for many high-risk teens. It
provides an opportunity to initiate preventive interventions, to complement existing mental
health treatment or to stand alone for those who may lack access to formal care.
Personalized text-message interventions are accessible, feasible, and may be effective with
The purpose of this study is to test the feasibility and acceptability of a novel
text-message augmented depression prevention intervention, "iDOVE." Drawing on effective
cognitive behavioral therapy (CBT) and motivational interviewing (MI) depression and
violence prevention interventions, a brief in-ED session will introduce basic cognitive and
behavioral strategies. Following ED discharge, eight weeks of tailored CBT-informed daily
text messages will be sent, to enhance skills and remind participants of self-determined
Participants will be identified in the course of usual ED care. If eligible, parents will be
consented and participants assented. Participants will complete a baseline assessment and
will be randomized to experimental (ED+text, n=50) or enhanced usual care (EUC, n=50) care,
using stratified block randomization.
ED+text group participants will participate in a brief, structured in-ED introduction on CBT
and the iDOVE program, followed by 8 weeks of tailored, two-way, CBT-and MI-informed
automated text messages (short message service, SMS). EUC group participants will
participate in a brief, structured, in-ED introduction to home safety & nutrition, followed
by 8 weeks of automated SMS regarding home safety & nutrition. The current standard of care
for these patients is no care: no depression or violence screening assessment protocols are
currently used in our ED. Both ED+text and EUC conditions therefore exceed current levels of
At baseline, 8 week follow-up, and 16 week follow-up, participants will complete assessments
on depressive symptoms, violence, cognitive/behavioral skill-sets, and resource utilization.
At the 8-week follow-up, standardized qualitative and quantitative process measures will be
administered to assess efficacy, acceptability, usability, and feasibility.
- presenting to the emergency department for routine care
- reporting past-year physical violence (using a modified version of CTS) and current
mild-to-moderate depressive symptoms (using PHQ-9), as identified on a brief screen
administered in the ED
- accompanied by a consentable parent
- own or have access to a text-message-capable mobile phone
- medically/physically unable to assent
- chief complaint of suicidal ideation, psychosis, or child abuse
- in police custody
- severe depressive symptoms