None listed
Conditions
Brief summary
Suicide remains a leading cause of death for Australian adolescents, and suicide and self-harm related Emergency Department presentations are rising. Brief contact interventions are an important component of comprehensive treatment approaches for adolescent suicide risk. Research has found that families feel excluded from their adolescent’s care in the ED and don’t receive sufficient information about how to support them, despite evidence suggesting involving families in adolescent suicide prevention interventions leads to better outcomes. Additionally, there is a need to provide continuity of care after discharge from the ED. The EDBridge Pilot Feasibility & Acceptability trial involves a multi-component brief-contact intervention for adolescents aged 12-18 who are discharged from an Emergency Department with suicidal thoughts or behaviours, and their parents/carers. It involves a suicide safety planning intervention for adolescents, a parent factsheet resource to support parents to manage adolescent suicide risk outside the ED, and an automated follow-up text message support program for both adolescents and their parents/carers. The aims of this trial are to determine whether EDBridge is feasible (that is, how easy or practical EDBridge is to provide), and acceptable to adolescents, parents, and clinicians. We also aim to collect early information about whether EDBridge can help improve the mental health and suicide-related symptoms of parents and adolescents, and increase their engagement with community mental health support. We hypothesise that EDBridge will be feasible and acceptable to clinicians, adolescents, and parents. We also hypothesise that the pilot trial will give early indication that EDBridge can support adolescents and parents to improve suicide-related and mental health outcomes and increase engagement with community mental health support.
Interventions
EDBridge involves three intervention components including safety planning (for teen participants), a psychoeducative factsheet (for parent participants), and an automated text message support program (for teen and parent participants). All teens who enrol in this study will be given access to the safety planning and text message intervention components. All parents who enrol in this study will be given access to the psychoeducative factsheet and text message intervention components. All interven
EDBridge involves three intervention components including safety planning (for teen participants), a psychoeducative factsheet (for parent participants), and an automated text message support program (for teen and parent participants). All teens who enrol in this study will be given access to the safety planning and text message intervention components. All parents who enrol in this study will be given access to the psychoeducative factsheet and text message intervention components. All intervention components will be delivered in the participating ED for seven months. 1. Safety planning (for adolescents) Adolescent participants will develop a collaborative safety plan with a trained paediatric emergency psychiatry clinician during their routine assessment in the Paediatric Emergency Department (ED). Adolescents will first be offered to develop a safety plan using the Beyond Now smartphone app, with a paper or verbal safety plan offered as alternatives. Beyond Now is a suicide safety planning smartphone application initially developed by Beyond Blue (now owned by Lifeline) that is freely available to the public on all major app stores. It has not been specifically designed for this study. The Beyond Now safety planning app contains seven steps for managing a suicidal crisis, including 1. identifying warning signs of a suicidal crisis, 2. making the environment safe (e.g., removing access to lethal means), 3. reasons for living, 4. internal coping strategies, 5. social contacts and places for distraction, 6. social support for help with a suicidal crisis, and 7. professional supports. The paper based safety plan will follow the same format as Beyond Now. If adolescents already have a safety plan developed, they will have the option to transition the plan to Beyond Now or an alternative. After developing a safety plan (with or without Beyond Now), adolescent participants will engage with their safety plan at their own discretion and will not be asked to use the app or their safety plan for any minimum duration once discharged from the ED (however some text messages as part of the text message intervention will encourage engagement with their safety plan). Clinicians will receive training on developing safety plans using Beyond Now two weeks prior to the anticipated first enrolment. Clinicians will record whether a participant safety plan was developed with Beyond Now, paper-based format, or verbally. Adherence to app usage will not be directly monitored (e.g., via app analytics). Adolescent participants will be surveyed on their engagement with their safety plan during follow up surveys at Week 2 and Week 12 post enrolment. Because participants are only eligible for the study if they are discharged out of the hospital system, and there is no follow up appointments with the ED clinician (due to the nature of cross-sectional ED assessments), participants will not have their safety plan reviewed by ED clinicians unless they return to the ED or discuss their safety plan with a community-based clinician (e.g., private psychologist). Reviewing of safety plans is not within the scope of the current research protocol. 2. Parent/caregiver psychoeducative factsheet (for parents/carers) Parents/caregivers of adolescents presenting to the ED will receive a paper-based psycho-educative factsheet resource from the trained paediatric emergency psychiatry clinician (or a researcher) upon discharge from the ED. The two-sided A4 factsheet includes strategies for managing adolescent suicide risk in the 24-48 hours post-discharge, options for seeking treatment and caregiver support, and psycho-education. The factsheet is tailored to the recruitment site and was co-designed by researchers, young people with lived experience and their parents, and clinicians. 3. Text message support (for adolescents and parents) Both adolescents and parents will receive a one-way, automated follow-up text message support program post-discharge from the ED. The trained paediatric emergency psychiatry clinician will activate the text message program using a web platform developed for the trial. Participants will be randomly allocated to one of two text-message intervention arms: a short-term (2-week) or long-term (3-month) arm. Parents in the short-term arm will receive 14 messages and adolescents in the short-term arm will receive 12 messages. For adolescents, text messages contain information and strategies about managing a suicidal crisis, safety planning, transitioning back to school/work, problem solving, places to get support (e.g., online support, crisis support, longer term mental health treatment), and psychoeducation about suicide and suicide risk factors (e.g., self-harm). Parents will receive information and strategies about safety planning for their teen, how to monitor for and respond to changes in suicide risk, connecting with their teen, places their teen can get mental health support (including crisis support), and options for parent/caregiver support. The long-term intervention arm does not contain additional or new information for parents or adolescents but rather involves reminders about previously delivering strategies and information. Text message delivery will be monitored via Twilio, a cloud-based communication service that is being used to deliver text messages.
Sponsors
Deakin University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Caregiver)
Eligibility
Sex/Gender
All
Age
12 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adolescent group Inclusion criteria 1. Aged 12-18 years 2. Presents to the trial site paediatric Emergency Department (ED) with suicidal ideation or behaviour and is discharged home/to community-based services. 3. Presents to the trial site with a parent/caregiver Parents/caregiver Inclusion criteria 1. Attends project site paediatric ED with an adolescent who meets eligibility criteria and for whom they have legal guardianship over Clinicians Inclusion criteria 1. Registered health practitioner e.g., psychologist, social worker, psychiatrist, psychiatry registrar, mental health nurse, occupational therapist 2. Assesses paediatric patients aged 12-18 with mental health concerns at the project site paediatric ED. 3. Trained in administering EDBridge.
Exclusion criteria
Adolescents Exclusion criteria 1. No suicidal ideation or behaviour at presentation to site ED. Justification: intervention designed for adolescents with suicidal ideation or behaviour. 2. Under 12 years old or over 18 years old. Justification: Intervention designed for adolescent patients aged 12-18. Patients over 18 are assessed by different services. 3. Adolescent presents without parent/caregiver. Justification: Parent/caregiver is needed to provide consent for adolescent to participate, and seeking parent consent via follow up is not feasible or appropriate as the intervention is designed to begin during ED mental health assessment. 4. Contraindication according to clinical judgement. Justification: Clinicians recruiting participants may obtain information via medical records (e.g., patient history) or assessment that suggests intervention is not suitable for some participants e.g., due to developmental difficulties, risk of harm to clinician, frequent ED presentations (requiring more tailored intervention that is outside the scope of this intervention), psychotic symptoms, manic symptoms or intoxication that impairs capacity to provide assent. 5. Transferred to another unit/ward. Justification: the intervention is designed to be received upon discharge outside of the hospital system where there is not continuous monitoring of patient available (e.g., if transferred to an inpatient unit). 6. No mobile phone. Rationale: Text message intervention requires a mobile phone to be received. 7. Out of home care status. Rationale: Seeking relevant approval to include young people living in out of home care is outside the scope of this feasibility study. 8. Unable to read English. Justification: all study materials are only available in English at this stage. Translation is out of the scope of the pilot trial but is being considered for future adaptations. Parents Exclusion criteria 1. Unable to provide informed consent for adolescent. Justification: Intervention must be offered to both parents and adolescents, and adolescents require parent consent to participate. 2. Unable to read or understand English. Justification: all study materials are only available in English at this stage. Translation is out of the scope of the pilot trial but is being considered for future adaptations. 3. No mobile phone. Rationale: Text message intervention requires a mobile phone. 4. Contraindication according to clinical judgement e.g., due to aggressive behaviours. Rationale: clinicians may discern during assessment or EMR that the parent it is not appropriate to offer the intervention or poses a risk to clinician safety. Clinicians 1. Not trained in administering EDBridge.
Outcome results
None listed