Bullying Prevention Intervention for Adolescent Primary Care Patients

Cyber-victimization predicts depressive symptoms and suicidality; it correlates with PTSD
symptoms, alcohol and other drug use, physical peer violence, and dating violence.

Almost 80% of adolescents have a well-child visit with their pediatrician each year.
Pediatricians recognize this visit as an important opportunity for behavioral screening,
interventions, and referrals, but they currently lack cyber-victimization interventions that
are feasible and effective in the clinical setting. Personalized text-message interventions
are accessible, feasible, and may be effective with these adolescents.

The purpose of this study is to test the feasibility and acceptability of a novel
text-message-augmented secondary prevention intervention, "iPACT." Drawing on effective
cognitive behavioral therapy (CBT) and motivational interviewing (MI) depression and violence
prevention interventions, a brief in-clinic session will introduce basic cognitive and
behavioral strategies. Following their clinic visit, eight weeks of tailored CBT-informed
daily text messages will be sent, to enhance skills and remind participants of
self-determined goals.

Participants will be identified in the course of usual clinical care. If eligible, parents
will be consented and participants assented. Participants will complete a baseline assessment
and will be randomized to experimental (iPACT, n=25) or enhanced usual care (EUC, n=25) care,
using stratified block randomization.

iPACT group participants will participate in a brief, structured in-clinic introduction on
CBT and the iPACT program, followed by 8 weeks of tailored, two-way, CBT-and MI-informed
automated text messages (short message service, SMS). EUC group participants will receive
standardized information on cyberbullying. The current standard of care for these patients is
no care: no cyber-victimization screening assessment protocols are currently used in our
clinic. Both iPACT and EUC conditions therefore exceed current levels of care.

At baseline, 8 week follow-up, and 16 week follow-up, participants will complete assessments
on cyberbullying, peer violence, and cognitive/behavioral skill-sets. At the 8-week
follow-up, standardized qualitative and quantitative process measures will be administered to
assess efficacy, acceptability, usability, and feasibility.

Inclusion Criteria:

- presenting to Hasbro Children's pediatric clinic

- being mentally and physically able to assent

- being English-speaking

- having a consentable parent present

- self-reporting cyber-victimization (defined as endorsing >1 past-year episode of
technology-mediated victimization)

Exclusion Criteria:

- being cognitively or emotionally unable to take part in the intervention as determined
by the pediatric attending clinician

- suspected by clinical staff of being a victim of child abuse

- currently incarcerated or under police custody