Caring Contacts via text message for suicidal adolescents after emergency department discharge

Project Summary (Abstract) The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Jennifer Hoffmann, MD, MS, a pediatric emergency medicine physician, for a career as an independent clinician- investigator focused on adapting and implementing evidence-based mental health interventions for youth in the emergency department (ED) setting, with a particular goal of reducing youth suicide attempts and deaths. This proposal includes intensive mentorship, training, and research activities that will enable Dr. Hoffmann to build on her existing strong foundation in health services and outcomes research to: (1) acquire experience with user-centered design, (2) become an expert in implementation science, including conducting hybrid effectiveness-implementation studies, and (3) develop expertise in ED-based digital mental health interventions. Suicide is the third leading cause of death in adolescents in the United States, and ED visits by youth for suicidal thoughts and behaviors have increased over the last decade. The ED represents a critical contact point to detect suicide risk and initiate preventive interventions. Youth who visit the ED for suicidal thoughts or behaviors remain at high risk after discharge, with as many as 22% attempting suicide within one year. Thus, effective interventions are needed for the high-risk period following ED discharge. Caring Contacts are brief, supportive messages that have been shown to prevent suicide attempts and suicides among adults after inpatient psychiatric hospitalizations or ED visits, but there has been limited evaluation of Caring Contacts for adolescents. The objective of this proposal is to adapt and implement Caring Contacts delivered via text message to adolescents with suicidal thoughts or behaviors following discharge from the ED. To do so, Dr. Hoffmann will pursue the following specific aims: (1) adapt Caring Contacts delivered via text message to align with adolescent preferences, (2) develop a multicomponent implementation strategy for delivery of Caring Contacts via text message for adolescents following an ED visit for suicidal thoughts or behaviors, and (3) pilot Caring Contacts via text message to assess feasibility, acceptability, and preliminary intervention effectiveness and implementation outcomes. Results will provide the data necessary for a planned R01 that is a full-scale hybrid effectiveness-implementation type II study of Caring Contacts for adolescents. The proposal is closely aligned with the National Institute of Mental Health Strategic Priority 3.2.A, “establishing the safety and efficacy of efficacious therapeutic interventions developed for adult populations in children” and addresses an urgent need to prevent youth suicide during the high-risk post-discharge period. This intervention is scalable for widespread use and has potential for high impact to prevent youth suicide.