TIPS: Trans-Tasman Internet-delivered Prevention of (youth) Suicide

TIPS is a four-arm superiority RCT of mobile apps. 1 – Tune In (NZ); 2 – Bro (NZ); 3 – LifeBuoy (Australian); 4 – Mood tracking (attention-matched) control app (NZ). The RCT will be delivered by the Tirohia Platform, a configurable Web portal and suite of Web services that facilitates rapid and concurrent field trials. Young people will have uninterrupted access to their app for the duration of the trial until the final participant has completed the 90-day follow-up. At 30 and 90 days, the Tirohia Platform will send a URL for the assessment survey via SMS or email based on the information provided by the participant. The Web services provide an Application Programming Interface (API) that also allows apps to log event data (passive logging e.g., sessions of use, modules completed, as per relevant to each app), which is linked with assessments in the Tirohia Platform database for subsequent analysis. After downloading an app from the app store, on initial invocation the participant will be presented with a login to match to their identity in the Tirohia Platform (we expect young people will usually opt for this to be their phone number). This will cause the app to invoke the Tirohia Platform API and exchange a security token. The token will persist on the device and be renewable such that further logins are unnecessary (unless the participant chooses to logout, e.g. to secure their session if they share a device with others). 1. Tune In Tune in, is an app co-designed with young people in NZ that helps young people set and achieve personally relevant goals to reduce suicidal ideation and self-harm by incorporating health behaviour change theory and evidence to encourage behaviours to enhance wellness. Tune In uses goal setting - a key component of Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (DBT) and Acceptance and Commitment Therapy (ACT) to encourage behaviours that enhance wellbeing. It incorporates the ability to quickly connect with a nominated support person if needed. The nominated support person is someone that the user adds to their app (with the emergency contact number) to call if the user ever feels they need help. The call is made by using the phone button within the app but uses the phone(i.e. the call is not part of the app). A list of helplines is also provided in the user account, which again the user can call/text but not from within the app. In Tune In, users can choose their own goals, as well as the strategies to achieve their goals, which are specific behavioural strategies focused on improving coping capacities and promoting well-being and self-care from a strengths-based perspective to facilitating goal attainment. Further, Tune In provides feedback to reinforce goal attainment, scaffolds young people to access their existing support and provides rewards for adhering to and achieving goals. Once goals are set, the user is expected to engage with the app daily to indicate if the daily strategy has been completed and, if desired, to change that daily strategy (~2 minutes of engagement per day). On completion of each day, the young person is rewarded with a song selected by a New Zealand celebrity or peer, accompanied by an encouraging message explaining how the song may inspire them to feel, think and act positively. Co-design included rangatahi Maori, pilot testing included 20% Maori, and a further study examined how Tune In could be more culturally responsive for Maori (paper submitted), resulting in an update to Tune In to address the findings. 2. Bro Bro is a Chatbot that delivers safety planning via a customisable and personal experience, that engages a young person in a dialogue. Bro is fully scripted. Chatbot dialogue is used to connect and develop safety plan and wall of strength. As required use for instances where distress is increasing. Develop safety plan and wall of strength; review plan and wall of strength up to five times over four weeks. Bro was co-designed with rangatahi Maori, engaging them in the active participation as co-designers throughout the design process, to ensure that the app is accessible to Maori. Safety planning is an evidence based intervention that is very commonly used in face-to-face clinical settings and the co-designed Chatbot includes the core features of a plan with ideas about how a young person can notice they are becoming more upset and distressed, how they can make their environment safe, and pre-prepared coping strategies to them less upset and distressed, including social and crisis support as well as emotion regulation activities. A key feature is ‘the wall of strength’ that provides a reminder for the young person of those aspects of their lives that enhance their wellbeing, including a sense of meaning and purpose, people who support them. Chatbot dialogue to connect and develop safety plan and wall of strength. As required use for instances where distress is increasing. Develop safety plan and wall of strength; review plan and wall of strength up to five times over four weeks. The experience is customised based on user input. Bro is hybrid. The dialog is principally scripted with generative AI integrated principally to improve conversationally. 3. LifeBuoy LifeBuoy is an app co-designed in Australia for young people with suicidal ideation using dialectical behaviour therapy skills that aim to improve distress tolerance. LifeBuoy is a mix of CBT and third-wave (DBT and ACT) CBT (psychoeducation, calm breathing, cognitive reappraisal, problem-solving); DBT (grounding, distress tolerance, distraction, “PLEASE”, ); ACT (mindfulness, value direction) LifeBuoy includes text-based content, audio files (e.g., scripted mindfulness meditations), and interactive exercises. Examples include Technique (DBT): Distraction Popping bubbles: user plays against timer to pop as many bubbles as possible Technique (ACT): Mindfulness Mindful breath: interactive audio track to practice mindfulness technique - grounding, centering oneself away from unconscious autopilot mindfulness Technique (DBT): Distress tolerance TIPP: TIPP (temperature, intense exercise, paced breathing, paired muscle relaxation) user is guided by a timer to practice 'IPP'