Suicide and Self-harm
Conditions
Keywords
suicidal behavior, jail release, behavioral health providers, suicide training
Brief summary
The goal of this clinical trial is to test the effects of a suicide prevention intervention for individuals released from jail. The main question it aims to answer is: Does the use of Caring Contacts improve subscriber engagement with healthcare services while reducing suicide-related outcomes? Participants will include subscribers of a managed care organization (MCO). Intervention includes sending subscribers Caring Contacts letters for 6-months following jail release to target healthcare re-engagement and suicide prevention.
Interventions
BEHAVIORALCaring Contacts letters
Caring Contacts involves sending individuals at risk for suicide brief, non- demanding messages of care.
Sponsors
Michigan State University
Butler Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18+ years old * Released from an Ohio jail * enrolled in Medicaid through CareSource
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Suicide Attempt | 6-months | A suicide attempt is defined as engaging in a potentially self-injurious behavior, associated with at least some intent to die as a result of the act. We will assess total number of subsequent attempts using the already-developed Mental Health Research Network (MHRN) algorithm for extracting suicide attempt information from claims data |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All-cause Injury and Poisoning | 6-months | All-cause injury and poisoning data will be extracted from ICD-10 data. |
| Outpatient Behavioral Health Service Linkage | 18 months | We will extract number of outpatient behavioral health (i.e., mental health or substance use) visits during the 12 months prior to and 6 months following jail release from claims data. |
| CareSource Member Services (CMS) Line Use | 6-months | Caring Contact messages will list the CMS phone number (which is answered by the Care Management Team, who are trained to assess and connect callers to the appropriate services) as a way to reach out. Care Source will track calls to this line by subscribers in all study conditions. |
| Inpatient and Emergency Department Mental Health Care Visits | 6-months | Data on inpatient and emergency department mental health visits will be extracted from claims data using MHRN algorithms. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Arrests | 18 months | We will also extract past year and next 6 month number of arrests from the Jail-Medicaid database. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Caring Contact Letters Caring Contacts involves sending individuals at risk for suicide brief, non-demanding messages of care. | 22,380 |
| Caring Contact Control No contact control condition for the Caring Contact letters | 22,775 |
| Total | 45,155 |
Baseline characteristics
| Characteristic | Caring Contact Letters | Caring Contact Control | Total |
|---|---|---|---|
| Age, Continuous | 36.4 Year STANDARD_DEVIATION 10.9 | 36.4 Year STANDARD_DEVIATION 10.8 | 36.4 Year STANDARD_DEVIATION 10.8 |
| Race/Ethnicity, Customized American Indian Alaskan Native | 107 Participants | 110 Participants | 217 Participants |
| Race/Ethnicity, Customized Asian or Pacific Islander | 116 Participants | 100 Participants | 216 Participants |
| Race/Ethnicity, Customized Black (non-Hispanic) | 8528 Participants | 8432 Participants | 16960 Participants |
| Race/Ethnicity, Customized Hispanic | 25 Participants | 28 Participants | 53 Participants |
| Race/Ethnicity, Customized Native Hawaiian | 29 Participants | 25 Participants | 54 Participants |
| Race/Ethnicity, Customized Not Provided | 828 Participants | 830 Participants | 1658 Participants |
| Race/Ethnicity, Customized Other Race Ethnicity | 1 Participants | 2 Participants | 3 Participants |
| Race/Ethnicity, Customized White (non-Hispanic) | 12746 Participants | 13248 Participants | 25994 Participants |
| Sex: Female, Male Female | 8628 Participants | 8702 Participants | 17330 Participants |
| Sex: Female, Male Male | 13752 Participants | 14073 Participants | 27825 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 22,380 | 0 / 22,775 |
| other Total, other adverse events | 0 / 22,380 | 0 / 22,775 |
| serious Total, serious adverse events | 1,177 / 22,380 | 1,071 / 22,775 |
Outcome results
Primary
Suicide Attempt
A suicide attempt is defined as engaging in a potentially self-injurious behavior, associated with at least some intent to die as a result of the act. We will assess total number of subsequent attempts using the already-developed Mental Health Research Network (MHRN) algorithm for extracting suicide attempt information from claims data
Time frame: 6-months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Caring Contact Letters | Suicide Attempt | .0202 Number of suicide attempts | Standard Deviation 0.3871 |
| Caring Contact Control | Suicide Attempt | .0229 Number of suicide attempts | Standard Deviation 0.5836 |
Secondary
All-cause Injury and Poisoning
All-cause injury and poisoning data will be extracted from ICD-10 data.
Time frame: 6-months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Caring Contact Letters | All-cause Injury and Poisoning | 1.18 Number of all cause injury and poisoning | Standard Deviation 3.74 |
| Caring Contact Control | All-cause Injury and Poisoning | 1.17 Number of all cause injury and poisoning | Standard Deviation 3.6 |
Secondary
CareSource Member Services (CMS) Line Use
Caring Contact messages will list the CMS phone number (which is answered by the Care Management Team, who are trained to assess and connect callers to the appropriate services) as a way to reach out. Care Source will track calls to this line by subscribers in all study conditions.
Time frame: 6-months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Caring Contact Letters | CareSource Member Services (CMS) Line Use | 0.0088 Number of calls | Standard Deviation 0.2284 |
| Caring Contact Control | CareSource Member Services (CMS) Line Use | 0.0161 Number of calls | Standard Deviation 1.3033 |
Secondary
Inpatient and Emergency Department Mental Health Care Visits
Data on inpatient and emergency department mental health visits will be extracted from claims data using MHRN algorithms.
Time frame: 6-months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Caring Contact Letters | Inpatient and Emergency Department Mental Health Care Visits | 0.27 Number of visits | Standard Deviation 1.55 |
| Caring Contact Control | Inpatient and Emergency Department Mental Health Care Visits | 0.28 Number of visits | Standard Deviation 1.59 |
Secondary
Outpatient Behavioral Health Service Linkage
We will extract number of outpatient behavioral health (i.e., mental health or substance use) visits during the 12 months prior to and 6 months following jail release from claims data.
Time frame: 18 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Caring Contact Letters | Outpatient Behavioral Health Service Linkage | 0.32 Number of behavioral health visits | Standard Deviation 4.96 |
| Caring Contact Control | Outpatient Behavioral Health Service Linkage | 0.34 Number of behavioral health visits | Standard Deviation 4.99 |
Other Pre-specified
Number of Arrests
We will also extract past year and next 6 month number of arrests from the Jail-Medicaid database.
Time frame: 18 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Caring Contact Letters | Number of Arrests | 6355 Number of arrests |
| Caring Contact Control | Number of Arrests | 6312 Number of arrests |