Suicide Attempt, Suicide Ideation
Conditions
Keywords
Suicide, Safety Planning, Adolescent, Mental Health Services, Emergency Services
Brief summary
The goal of this observational study is to determine whether implementing a culturally sensitive, tablet-based safety planning program called Plan & Protect (P&P) within rural emergency departments can improve home safety and reduce suicide risk in adolescents presenting with suicidality. The main questions it aims to answer are: * Will implementing P&P increase caregiver-reported home safety (reduce access to firearms and unsafe medication storage) for adolescents 12-17 years old presenting to rural EDs with suicidal ideation, self-harm, or mental health crisis? * Will implementing P&P decrease adolescent-reported perceived suicide risk and related outcomes (e.g., suicide events, and attendance at follow-up mental healthcare)? Researchers will compare outcomes for adolescents and caregivers receiving P&P (implemented as the new standard of care at sites during the intervention periods) to those receiving usual care (prior to P&P implementation at those hospitals) to see if P&P increases home safety and decreases suicide risk and related healthcare utilization. Participants will, if clinically appropriate: * Complete the tablet-based P&P modules during their ED visit * Complete self-report measures at baseline, \ 30 days, and \ 3 months post-discharge * A subset will also participate in semi-structured interviews
Detailed description
One-in-five children and adolescents in the United States (US) live in rural areas where they are more likely to live in poverty, have neurodevelopmental, behavioral and mental health conditions, and die during childhood than their urban-residing peers. Suicide is a leading cause of childhood mortality, and rural-residing youth are two times more likely to die from suicide than urban-residing youth. Nearly half of children and adolescents with mental health conditions do not receive treatment, and those in rural areas face unique barriers to care due to geographic isolation, stigma, and shortages of pediatric services and clinicians. Given barriers to community-based mental healthcare, youth with suicidal ideation and/or suicide attempt (hereafter "suicidality") increasingly present to emergency departments (EDs) for care. However, most clinicians practicing in rural EDs are under-prepared and under-resourced to care for this population. In order to fill this gap, this project aims to improve home safety and decrease suicide risk in youth 12-17 years of age who present to rural EDs with suicidal ideation or attempt, leveraging community-based participatory research approaches and technology to implement, with high fidelity, culturally-sensitive and nationally recommended safety planning procedures. To achieve this goal, we will integrate P&P, a culturally sensitive, tablet-based safety planning program as a quality improvement intervention at 4 hospitals in the Dartmouth Health network using a hospital-randomized stepped wedge design and will evaluate the program using a type 1 hybrid implementation-effectiveness design. Aim: To determine the effectiveness of P&P compared to usual care for youth with suicidality and their caregivers to increase home safety and decrease suicide risk; evaluate the extent to which these outcomes are mediated by caregiver and youth self-efficacy and expectations of suicide risk; and assess the reach, effectiveness, adoption, implementation and maintenance of P&P using a mixed methods approach.
Interventions
BEHAVIORALPlan & Protect safety planning intervention
Plan and Protect (P\&P) is a tablet-based, family-centered quality improvement program targeted to rural Northern New England that combines a youth-facing safety-planning module with a caregiver-facing home safety decision aid and youth safety information. The goal is to help adolescents and their caregivers develop concrete, culturally-sensitive safety plans during emergency department visits.
BEHAVIORALCare as usual
Adolescents and caregivers will receive treatment as usual at the Emergency Department.
Sponsors
Dartmouth-Hitchcock Medical Center
National Institute of Nursing Research (NINR)
Trustees of Dartmouth College
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Stepped wedge randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
12 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
for children: * 12-17 years of age (and their parent/caregiver(s)) * Ability to speak and complete surveys in English * History of emergency department visit for suicidality, self-harm or mental health crisis * Medically stable
Exclusion criteria
for children: * Cognitive or developmental delays that preclude program participation based on clinical team assessment * Diagnosis of psychosis * Primary diagnosis of an eating disorder * Parent/guardian not able to provide consent in English * Clinical team concern for patient or staff safety based upon active behavioral concerns * Parent/guardian not available to provide consent (e.g youth is in child protective custody/ward of the state) Inclusion criteria for parents/caregivers: * Parent or caregiver of an eligible child * 18 years old or older * Ability to speak and complete surveys in English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improved home safety (parent and youth) | 30 and 90 days after ED visit | Reduced access to firearms and medications at home. This will be collected with five questions about presence of medications and firearms at home, if they are stored unlocked, and if firearms are loaded. We will measure improvement in safety across the time frame. |
| Concise Health Risk Tracking 9-item measure (youth) | 30 and 90 days after ED visit | The Concise Health Risk Tracking (CHRT) is a 9-item survey that assesses suicidal thoughts and behaviors in the past week, with response options ranging 0-4. Total scores range 0-36, with higher scores indicating more severe suicidality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Suicide Events (youth) | 30 and 90 days after ED visit | Four self-reported questions from the Youth Risk Behavior Survey focus on suicidal ideation, attempts, and attempt severity, augmented by electronic health record review for emergency room and hospital visits for suicide ideation and/or attempt and/or death. |
| Youth Mental Health Care Utilization (parent and youth) | 30 and 90 days following ED visit | Any mental or emotional health care received after their emergency department visit using a checklist adapted from nationally administered healthcare utilization surveys. Response categories (primary care, mental health provider, outpatient/urgent care, emergency department, school based care) were derived from health service use domains captured in the Medical Expenditure Panel Survey. |
| Reduced Access to Firearms at Home (parent and youth) | 30 and 90 days after ED visit | Improved home safety with respect to firearm access. This will be collected with three questions about presence of firearms at home, if they are stored unlocked, and if they are loaded. We will measure improvement in safety across the time frame. |
| Reduced Access to Medications at Home (parent and youth) | 30 and 90 days after ED visit | Improved home safety with safer storage of medications. This will be collected with two questions about presence of medications at home and if they are stored unlocked. We will measure improvement in safety across the time frame. |
Countries
United States
Contacts
CONTACTJacqueline Pogue, MPH
PRINCIPAL_INVESTIGATORJoAnna K Leyenaar, MD, PhD, MPH
Dartmouth College
Outcome results
None listed