A targeted digital intervention for youth with suicidal thoughts and behaviours attending outpatient care

Participation in the trial involves a 12 week intervention period, with a follow up at week 26 and 52. Participants randomised to the intervention condition will receive access to the Moderated Online Social Therapy (MOST) platform with additional content specifically designed to target theoretical constructs of the interpersonal theory of suicide. Engagement in the MOST platform and novel content is at the user's discretion. Participants in the intervention condition will also receive a caring contact intervention via a digital postcard weekly during the 12-week intervention period. Additionally, they will have the opportunity to participate in a fortnightly psychosocial recovery group. As well they may allow their caregiver(s) to participate in a monthly psychoeducation session. Brief Summary of content on the MOST platform The MOST platform has content addressing a variety of mental health issues such as depression, anxiety, social skill development. It draws on a variety of psychological principles such as cognitive behavioural therapy, self-determination theory, behavioural activation. Users complete journeys. Journeys contain tracks with specific focuses. Tracks have activities that involve psychoeducation, behavioural activation, opportunities to communicate experiences with the broader platform, opportunities to reflect on experiences and journal thoughts. Brief summary of the novel additional content: - the novel additional content for the Affinity trial has been developed based on the interpersonal theory of suicide and targets experiences of perceived burdensomeness, thwarted belongingness and interpersonal hopelessness The mode of training used: - Content is delivered via psychoeducational material, behavioural activation tasks, visually and audio guided meditations. Strategies used to monitor adherence to the intervention: - certain content has the capacity for the participant to contribute a response / confirm completion. - all engagement with the MOST platform is captured as data and can be analysed to understand the way in which participants adhered to the intervention. - the caring contact intervention involves the clinical moderator sending a singular digital comic postcard to the participant each week with text content that will express care for the participant. The caring contact post card will be sent via the MOST platform. Details of the fortnightly psychosocial recovery group: - what it involves: Session 1: Introductions, guidelines for group sessions and group rules Psychoeducation about burdensomeness Discussion and sharing activity Vignette analysis and advice provision Session 2: Introductions, guidelines for group sessions and group rules Psychoeducation about belongingness Discussion and sharing activity Vignette analysis and advice provision Session 3: Introductions, guidelines for group sessions and group rules, Psychoeducation about interpersonal hopelessness Discussion, sharing and activity. Vignette analysis and advice provision Session 4: Introductions, guidelines for group sessions and group rules, Psychoeducation about mood monitoring Vignette analysis, and advice provision Session 5: Introductions, guidelines for group sessions and group rules, Psychoeducation about interpersonal skills problem solving Vignette analysis, roleplay, advice provision Session 6: Introductions, guidelines for group sessions and group rules, Psychoeducation about emotional regulation Vignette analysis, roleplay, and advice provision Duration of the sessions: 1 hour The group size: minimum group size is 2, maximum is 10 The mode of administration: over Zoom Who will be facilitating the sessions: psychologist or social worker. Brief description of any strategies used to monitor adherence to the intervention: session attendance checklist Details of the monthly psychoeducation session: What it involves, including a description of each of the procedures, activities, and/or processes used: Session 1 Reduce shame and stigma among caregivers Reframing and understanding suicidality in young people Psychoeducation regarding burdensomeness and belongingness Session 2 Psychoeducation and activities focussed on increasing emotional attunement to young person Session 3 Changing contingencies within the home environment Caregiver skills coaching Duration of the sessions: 1 hour Delivery format: minimum one attendee, no maximum attendees The mode of administration: Zoom Who will be facilitating the sessions, psychologist, social worker, or family therapy clinician Description of any strategies used to monitor adherence to the intervention: Session attendance checklists

Participation in the trial involves a 12-week intervention period, with a follow up at week 18, 26 and 52. Participants randomised to the intervention condition will receive access to the Moderated Online Social Therapy (MOST) platform with additional content specifically designed to target theoretical constructs of the interpersonal theory of suicide. Engagement in the MOST platform and novel content is at the user's discretion. Participants in the intervention condition will also receive a caring contact intervention via a digital postcard weekly during the 12-week intervention period. Additionally, they will have the opportunity to participate in a fortnightly psychosocial recovery group. As well they may allow their caregiver(s) to participate in a monthly psychoeducation session. Brief Summary of content on the MOST platform The MOST platform has content addressing a variety of mental health issues such as depression, anxiety, social skill development. It draws on a variety of psychological principles such as cognitive behavioural therapy, self-determination theory, behavioural activation. Users complete journeys. Journeys contain tracks with specific focuses. Tracks have activities that involve psychoeducation, behavioural activation, opportunities to communicate experiences with the broader platform, opportunities to reflect on experiences and journal thoughts. Brief summary of the novel additional content: - the novel additional content for the Affinity trial has been developed based on the interpersonal theory of suicide and targets experiences of perceived burdensomeness, thwarted belongingness and interpersonal hopelessness The mode of training used: - Content is delivered via psychoeducational material, behavioural activation tasks, visually and audio guided meditations. Strategies used to monitor adherence to the intervention: - certain content has the capacity for the participant to contribute a response / confirm completion. - all engagement with the MOST platform is captured as data and can be analysed to understand the way in which participants adhered to the intervention. - the caring contact intervention involves the clinical moderator sending a singular digital comic postcard to the participant each week with text content that will express care for the participant. The caring contact post card will be sent via the MOST platform. Details of the fortnightly psychosocial recovery group: - what it involves: Session 1: Introductions, guidelines for group sessions and group rules Psychoeducation about burdensomeness Discussion and sharing activity Vignette analysis and advice provision Session 2: Introductions, guidelines for group sessions and group rules Psychoeducation about belongingness Discussion and sharing activity Vignette analysis and advice provision Session 3: Introductions, guidelines for group sessions and group rules, Psychoeducation about interpersonal hopelessness Discussion, sharing and activity. Vignette analysis and advice provision Session 4: Introductions, guidelines for group sessions and group rules, Psychoeducation about mood monitoring Vignette analysis, and advice provision Session 5: Introductions, guidelines for group sessions and group rules, Psychoeducation about interpersonal skills problem solving Vignette analysis, roleplay, advice provision Session 6: Introductions, guidelines for group sessions and group rules, Psychoeducation about emotional regulation Vignette analysis, roleplay, and advice provision Duration of the sessions: 1 hour The group size: minimum group size is 2, maximum is 10 The mode of administration: over Zoom Who will be facilitating the sessions: psychologist or social worker. Brief description of any strategies used to monitor adherence to the intervention: session attendance checklist Details of the monthly psychoeducation session: What it involves, including a description of each of the procedures, activities, and/or processes used: Session 1 Reduce shame and stigma among caregivers Reframing and understanding suicidality in young people Psychoeducation regarding burdensomeness and belongingness Session 2 Psychoeducation and activities focussed on increasing emotional attunement to young person Session 3 Changing contingencies within the home environment Caregiver skills coaching Duration of the sessions: 1 hour Delivery format: minimum one attendee, no maximum attendees The mode of administration: Zoom Who will be facilitating the sessions, psychologist, social worker, or family therapy clinician Description of any strategies used to monitor adherence to the intervention: Session attendance checklists