An Adaptive Intervention to Increase Engagement to Community-based Care After an ED Admission: For Youth Aged 10 to 14 at Risk for Suicide and Self-injurious Behavior

Prevalence rates for suicidal and non-suicidal self-injurious behavior (SSIB) in youth aged 10 to 14 years have increased in the past two years at alarming rates. As a result, the NIMH issued two Notice of Special Interest for the assessment and prevention of SSIB among children and preteens. Pediatric emergency departments (EDs) have become an essential and often routine mental health (MH) service for youth. While youth MH has recently been deemed a national public health crisis, overburdened EDs have continued to endure a two decade-long increase in youth presenting with MH emergencies. Increases in pediatric MH presentations have been observed throughout the U.S., with suicide rates for youth 10 to 18 years being the second leading cause of death. However, effective ED interventions to increase linkage to appropriate MH care are lacking. Adaptive interventions, which provide a tailored approach to the type, intensity, and timing of treatment, are well-matched for addressing this need and youth heterogeneity. The scientific premise of this application is supported by youth psychiatric emergency research and gaps in the literature. The purpose of this study is to refine and pilot a brief, adaptive ED intervention via Sequential Multiple Assignment Randomized Trial (SMART) design that targets individual and systemic barriers to care to increase linkage to subsequent community-based MH care for youth 10 to 14 years after an ED admission and referral. This study employs an ecological approach for the study of MH service disparities. This intervention is informed by the literature, ED interventions, a family-based approach, and directly targets three presumptive mechanisms: 1) MH literacy, 2) MH communication, and 3) MH engagement. Primary outcomes, measured at 2-weeks and 4-, and 6-month, include increased linkage to MH care (attendance), reduced SSIB symptoms and severity, and the engagement of the purported therapeutic mechanisms. This study is innovative because it offers a brief, family-based SMART to meet the needs of the population of youth and caregivers served in the ED. This proposal aligns well with the NIMH Strategic Plan Objectives 4.1 & 4.3, to “improve the efficiency, effectiveness, and reach of MH services through research” and “develop innovative service delivery models to dramatically improve the outcomes of MH services received in communities and populations,” respectively. This research has the potential to directly inform youth ED settings and has significant implications for dissemination.