Health System Stakeholder Perspectives on a Text-Based Intervention for Caregivers of Suicidal Youth.

Abstract

Caregivers of adolescents at elevated suicide risk are tasked with significant responsibility following their child's Emergency Department (ED) visit, such as monitoring warning signs, restricting lethal means access, or encouraging coping. Caregiver uncertainties regarding post-discharge support, coupled with resource constraints limiting the health system's capacity to provide ongoing assistance, call for scalable strategies to address these challenges. Digital interventions, such as text messaging, offer a pathway for low‑burden and accessible post-discharge approaches to support families. Building on a pilot of a text-based intervention for parents (TESP), developed to increase caregiver follow-through with suicide prevention recommendations and improve caregiver well-being, this qualitative mixed‑methods study sought input from health system stakeholders (clinical providers, administrative leaders and decision makers) to investigate TESP's eventual implementation potential. Twenty-one providers and system-level staff from three EDs completed semi-structured interviews and surveys rating TESP's acceptability, perceived feasibility, and appropriateness. A thematic framework was applied to the interview transcripts to identify salient themes. TESP was seen favorably, and ratings across the domains were moderate‑to‑high. Additional themes highlighted the intervention's focus on validating caregivers' experiences and reinforcing safety recommendations in a scalable way. Key implementation facilitators centered on system-level organizational structure, workflow automation, and increasing perception of value from health system staff and parents alike. The findings show TESP's promise as a feasible, acceptable strategy to improve post-discharge safety for youth at risk for suicide, while highlighting the importance of provider and leader feedback to anticipate and address implementation barriers in resource-constrained care settings like the ED.