Mental Health, Suicidal Ideation, Suicide Attempt
Conditions
Keywords
Suicide, Suicide Prevention, Safety Planning, Safety Net App
Brief summary
Safety planning is a brief, ED-feasible intervention which has been demonstrated to save lives and has been universally recommended by every recent expert consensus panel on suicide prevention strategies. In one popular version of the safety plan developed by Stanley et al, the patient is encouraged to write out the following items: identifying personal signs of a crisis; helpful internal coping strategies; social contacts or settings which may distract from a crisis; using family members or friends for help when in crisis; mental health professionals who can be contacted when in crisis; and restricting access to lethal means. This study aims to find out how valuable an electronic safety plan is compared to a traditional paper safety plan. People who are visiting the emergency department for thoughts of self-harm will be asked to participate.
Detailed description
This project has 3 aims: (1) Will ED patients with suicidal ideation/attempt accept coaching on safety planning from non-clinical personnel (i.e., medical students or peer supporters); (2) Are these safety plans of high-enough quality for clinical personnel; and finally, (3) Will ED patients with suicidal ideation/attempt complete safety plans electronically?
Interventions
OTHERSafety Net App
The Safety Net app is an electronic version of a safety plan and it is available for download in Apple's App Store. A preview of the app is available at: https://apps.apple.com/us/app/stanley-brown-safety-plan/id695122998. This app is owned by Two Penguins Studios, LLC. It was developed in partnership with the New York State Office of Mental Health. Unlike the paper version, the Safety Net app allows participants to email a copy of their safety plan to whomever they wish. It also allows patients to dial 911 or the National Suicide Prevention Lifeline from the app.
Sponsors
University of Arkansas
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 89 Years
Healthy volunteers
No
Inclusion criteria
* Patients presenting for suicidal ideation (SI) or after a suicide attempt to the UAMS ED * Willingness to engage in safety planning with trained non-clinical staff * Have not already filled out a safety plan at the current visit
Exclusion criteria
* \<18 or \>89 years of age * Incarcerated or in police custody * Non-English-speaking or Non-English-writing (as translators will not be available for this study) * Critically-ill (or appear to be critically-ill) * Intoxicated with alcohol or other substance(s) * ED staff objection to patient enrollment in study * Unwilling or unable to complete the safety plan electronically * Unwilling or unable to use a tablet device to complete the safety plan * Unwilling or unable to show/email the safety plan to clinical and research staff
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acceptability of Intervention | Up to 12 hours | The number of patients approached who agree to allow trained non-clinical staff to assist with safety planning. |
| Length of Stay | Up to 12 hours | The length of stay in the ED for patients approached who agree to allow trained non-clinical staff to assist with safety planning. |
| Satisfaction With Safety Planning | Up to 12 hours | Evaluate patient satisfaction with safety planning. This will be assessed by having the patient rate their experience with the safety planning process on a 7-point Likert scale (1 - strongly disagree; 2 - disagree; 3 - moderately disagree; 4 - neutral; 5 - moderately agree; 6 - agree; 7 - strongly agree). A Likert scale measures how much someone disagrees or agrees with a particular statement. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Written Safety Plan Participants will complete a traditional written suicide safety plan. | 14 |
| Electronic Safety Plan Participants will complete a suicide safety plan in the Safety Net app using a tablet.
Safety Net App: The Safety Net app is an electronic version of a safety plan and it is available for download in Apple's App Store. A preview of the app is available at: https://apps.apple.com/us/app/stanley-brown-safety-plan/id695122998. This app is owned by Two Penguins Studios, LLC. It was developed in partnership with the New York State Office of Mental Health. Unlike the paper version, the Safety Net app allows participants to email a copy of their safety plan to whomever they wish. It also allows patients to dial 911 or the National Suicide Prevention Lifeline from the app. | 16 |
| Total | 30 |
Baseline characteristics
| Characteristic | Written Safety Plan | Electronic Safety Plan | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 1 Participants | 0 Participants | 1 Participants |
| Age, Categorical Between 18 and 65 years | 13 Participants | 16 Participants | 29 Participants |
| Age, Continuous | 40 years | 39 years | 40 years |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Sex: Female, Male Female | 6 Participants | 5 Participants | 11 Participants |
| Sex: Female, Male Male | 8 Participants | 11 Participants | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 14 | 0 / 16 |
| other Total, other adverse events | 0 / 14 | 0 / 16 |
| serious Total, serious adverse events | 0 / 14 | 0 / 16 |
Outcome results
Primary
Acceptability of Intervention
The number of patients approached who agree to allow trained non-clinical staff to assist with safety planning.
Time frame: Up to 12 hours
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Written Safety Plan | Acceptability of Intervention | 14 Participants |
| Electronic Safety Plan | Acceptability of Intervention | 16 Participants |
Primary
Length of Stay
The length of stay in the ED for patients approached who agree to allow trained non-clinical staff to assist with safety planning.
Time frame: Up to 12 hours
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Written Safety Plan | Length of Stay | 250 minutes |
| Electronic Safety Plan | Length of Stay | 288 minutes |
Primary
Satisfaction With Safety Planning
Evaluate patient satisfaction with safety planning. This will be assessed by having the patient rate their experience with the safety planning process on a 7-point Likert scale (1 - strongly disagree; 2 - disagree; 3 - moderately disagree; 4 - neutral; 5 - moderately agree; 6 - agree; 7 - strongly agree). A Likert scale measures how much someone disagrees or agrees with a particular statement.
Time frame: Up to 12 hours
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Written Safety Plan | Satisfaction With Safety Planning | 5.29 units on a scale |
| Electronic Safety Plan | Satisfaction With Safety Planning | 5.31 units on a scale |