Research suggests that people with schizophrenia or SAD have identifiable early warning signs that signal the
onset of a relapse. Accordingly, the Program for Relapse Prevention (PRP), which has been shown to prevent
relapse and hospitalization, calls for monitoring for signs of relapse with prompt clinical intervention, when
indicated, alongside maintenance pharmacotherapy. The Assertive Community Treatment (ACT) program
incorporates the PRP approach as a part of its management of people with serious mental illness (SMI).
Text messaging is a widely used technology that provides opportunities to implement a PRP-based program in
a cost-effective manner. Nationally, up to 81.4% of people with SMI report owning a cellphone, and text
messaging has been reported as the second most common use of their phones. We are therefore optimistic
about its feasibility to deliver a cost-effective program that empowers patients to manage their symptoms, while
also increasing the patient-provider communication flow if warning signs worsen, with improved mental health
services outcomes as a result.
In response to RFA MH-16-410, we propose to develop and test an innovative service delivery program,
Texting for Relapse Prevention (T4RP). We base T4RP components on key ACT components. Specifically, the
program will improve care outcomes by: (a) promoting ongoing monitoring of participants' early warning signs
to quickly identify possible relapse; (b) promoting medication adherence; (c) empowering patients to identify
and manage early warning signs of relapse; and (d) improving communication between patients and providers
to collaboratively develop a comprehensive plan to treat symptoms, if self-management techniques are
insufficient. Specifically, we aim to:
Specific Aim 1: Design T4RP, a comprehensive relapse prevention program delivered via text
messaging, with the ongoing feedback of people diagnosed with schizophrenia or SAD and their
providers. To ensure that the program is usable by patients and providers alike, we will conduct facilitated
interviews with patients (n = 20) and providers and administrators (n = 12). Text message content will then be
developed with the ongoing participation of people with schizophrenia/SAD and providers in our Content
Advisory Team (CAT; n = 15: 10 patients and 5 providers).
Specific Aim 2: Test program feasibility, safety, and acceptability over a 6-month period in a
pilot study with people who have schizophrenia or SAD (n = 40) and their mental health providers.
Participants will be randomly assigned to either the intervention or a treatment as usual (TAU) control group.
Subaim 1: Identify participant characteristics and experiences that affect program feasibility and acceptability.
Subaim 2: Identify provider characteristics and experiences that affect program feasibility and acceptability.
Specific Aim 3: Assess the program's impact on patient outcomes and target mechanisms.