Optimizing Suicide Prevention Strategies for Pediatric Primary Care

PROJECT SUMMARY/ABSTRACT This proposal responds to the youth suicide crisis by optimizing a suicide prevention intervention delivery strategy that is feasible, acceptable, and scalable in pediatric primary care (PPC). Although PPC providers routinely identify at-risk youth, no suicide prevention intervention is suited for the immediate, in-office delivery that this clinical situation demands. In our prior work, we developed and tested the effectiveness of an integrated adolescent suicide prevention intervention, iCHART (integrated Care to Help At-Risk Teens), in a controlled, academic PPC setting that relied on behavioral health (BH) providers. iCHART consists of: 1) Screening Wizard, a web-based enhanced screener to aid PPC providers in treatment decisions; 2) BRITE, an app-supported intervention that guides youth in developing a personalized, smartphone-based safety plan; and 3) Text2Connect, an automated texting intervention that motivates youth to follow providers’ recommendations. The original version of iCHART components showed feasibility, usability, and acceptability across youth, parents, and providers and preliminary effectiveness in enhancing BH referral, referral follow-through, and decreasing depression. However, a critical gap remains in equipping front line pediatricians, who generally lack access to onsite BH providers, with suicide prevention intervention strategies that are feasible, usable, and acceptable for their workflows and in their setting. This proposal aims to address this gap through the development of a computerized version of As Safe As Possible (cASAP) to deliver aspects of the iCHART intervention that required BH support (i.e., psychoeducation about safety planning, cognitive-behavioral skills to cope with distress, and facilitate collaboration with parents). In the proposed study, we will partner with the American Academy of Pediatrics (AAP) national PPC practice-based research network, Pediatric Research in Office Settings (PROS) to develop and test a version of iCHART that can be provided in the PPC setting without onsite BH providers, termed iCHART-cASAP. In this proposal, we will draw upon our extensive expertise in human-computer interaction (HCI) methods and user studies with youth, parents, and PPC providers, to inform the technology design of a computerized version of ASAP (cASAP) to provide youth and parents information about safety planning, cognitive behavioral skills to cope with distress, and parent communication with youth about their mental health. We will then conduct a stepped wedge pilot randomized trial with 60 youth aged 12-17 at risk for suicide (past month suicide ideation/attempt) identified in PPC. We will compare iCHART-cASAP to usual care and the impact on depression and suicide risk at 1-, 3-, and 6-month follow-up. Following the pilot trial, we will conduct a mixed methods study with PPC providers to develop an accompanying implementation strategy. Our findings will inform a future, fully powered R01 effectiveness-implementation trial in the PROS network and in partnership with the AAP to test iCHART-cASAP’s impact on identification, treatment engagement, safety planning, and ultimately, suicidal behavior.