Adapting a brief suicide intervention for pediatric primary care: Enhancing uptake and impact

Project Summary/Abstract Suicide is a leading cause of death among 10-to-24-year-olds in the United States1-2, and suicidal thoughts and behaviors (STB) in adolescents are prevalent and increase risk of death by suicide3-5. Nearly half of adolescents who die by suicide contact a primary care clinician within one month prior to suicide14, making routinely accessed pediatric primary care (PC) settings a clear target for reducing adolescent suicide. Unfortunately, many PC providers are reluctant to manage STB in PC, resulting in many PC providers triaging youth with any STB to the Emergency Department (ED)19-22. While EDs are an important resource, ED visits are often poorly equipped to handle mental health24 and most youth with STBs are discharged home with minimal mental health support. Consequently, there is a critical need to adapt evidence- based, responsive, just-in-time suicide prevention interventions for use in PC27-29. This would likely enhance clinician’s comfort with STB screening and would enhance access to higher level services through reducing unnecessary referrals for STB. The development, implementation, and adoption of comprehensive STB services (screening, brief intervention, care appropriate referral) in PC would fill an important service gap, reduce healthcare spending, and, critically, reduce suicides38-39. This K23 proposal aims to fill this gap by taking an innovative, user-centered design approach40 to adapt and optimize a brief, evidence-based suicide intervention, SAFETY-Acute33-34 (SAFETY-A; formerly known as Family Intervention for Suicide Prevention – aka FISP33-34), for use in PC to support PC management of adolescents with low to moderate STB. The candidate proposes training in development/adaptation of suicide prevention interventions for youth and families, inclusive of training in implementation science, user centered design, and advanced mixed-methods approaches and analyses with health-systems to carry out the following proposed study aims, partnering with diverse pediatric PC practices in Western Washington: (1) Conduct contextual inquiry to assess needs of PC staff, patients, and parents for suicide prevention services in PC, including context of use, barriers, and facilitators that impact STB screening, intervention, and referral within PC. (2) Based on data from Aim 1, design and build a SAFETY-A based STB model of care prototype for PC, via rapid prototyping and usability refinement with PC stakeholders (PC staff, patients, parents). (3) Pilot test the STB model of care, compared to treatment as usual, with 3 PC clinics, including 48 10–18-year-old patients with STB and their parents (16 dyads per clinic). Using self-report, interview, and clinic medical record and administrative data, assess acceptability and feasibility of (a) the STB model of care and (b) the research protocol, and (c) preliminary intervention impacts and need for further adaptation. The proposed project will yield pilot data to inform a larger R01 hybrid effectiveness-implementation trial of the intervention.