Prevention and Assessment of Risk in Teens (PART) Longitudinal Study

Suicide rates among adolescents have increased dramatically, particularly for youth. The majority of suicide decedents have their last clinical contact in primary care. Thus, pediatric primary care (PPC) settings are critical for identifying and treating suicidal youth, but there are challenges with respect to identification, intervention, and implementation. Annual screening for depression using self-report may miss identifying many high-risk youth, as many suicide attempters, do not report ideation prior to their suicidal behavior. A second challenge is that once high-risk youth are identified, PPC providers lack a reliable service delivery strategy to effectively treat these youth. A third challenge is that are many barriers for identifying or intervening with youth at risk for suicide. Our Signature R01 addresses these challenges as follows: we will test and refine a predictive analytic platform for PPC based on electronic health records (EHR) at the University of Pittsburgh Medical Center (UPMC) and Children’s Hospital of Philadelphia (CHOP) to examine whether it improves prediction above and beyond self-report and to optimize its performance across all demographic groups. We will also test our algorithm on EHR in other health care systems and examine the performance of other existing algorithms. The Signature R01 will also test the effectiveness of an intervention, iCHART (integrated Care to Help At-Risk Teens) and facilitate recruitment for the R34s, which are focused on treatment development for target risk factors for suicidal behavior, specifically, sleep, anhedonia, and stress related to cybervictimization. We will recruit 1200 adolescents, 12-18 years of age, from PPC and the sample will be representative of the pediatric practices from which we recruit. These youth and their caregivers will be followed with interviews and self-reports at 1, 3, 6, and 12 months following baseline. Of the 1200 youth, 900 at high suicidal risk will be randomized to iCHART or treatment as usual (TAU). iCHART is a suite of tools developed in the current project period to guide the pediatric provider in assessing suicidal risk, making a treatment recommendation, launching an automated texting intervention to increase treatment engagement, and generating a safety plan that is loaded on the patient’s smartphone, developed in collaboration with caregivers. Based on our previous work, we hypothesize that iCHART, compared to TAU, will decrease suicidal-related events by 50%, and the effects will be mediated by increases in referrals, treatment engagement, and safety planning. We will use implementation science methods to assess contextual factors (i.e., barriers and facilitators) and implementation outcomes specifically, acceptability, feasibility, appropriateness, and cost for our predictive algorithm and iCHART to inform future implementation efforts and promote interventions that are effective and acceptable to all youth and their families. This study can improve identification and monitoring of youth at risk in PPC and reduce suicidal events.