Progressing Bend Health’s Digital Rapid Crisis Support for Adolescents and Caregivers

1 PROJECT ABSTRACT 2 Self-injurious thoughts or behaviors (SITBs) have sharply increased among adolescents in the past 3 decade. In the U.S., 3.7 million adolescents have seriously considered suicide and 2.9-9.6 million have self- 4 harmed. Adolescent SITBs not only pose serious short- and long-term health risks for adolescents, but also 5 impose significant economic and emotional burdens on their caregivers. While digital mental health interventions 6 (DMHIs) have proven successful for various pediatric mental health issues, most commercial DMHIs do not 7 address adolescent SITBs, and none provide concurrent care for caregivers. Despite evidence that peer support 8 groups and caregiver involvement can improve treatment outcomes, no DMHI currently offers a comprehensive, 9 age-appropriate approach to adolescent SITBs that addresses the social and economic costs across all 10 populations. 11 Bend Health is a pediatric digital mental health care provider for over 5,500 children, adolescents, and 12 their caregivers and is the one of the very few commercially-available DMHIs that includes adolescents who 13 exhibit SITBs. Bend Health’s current SITB treatment is a remote rapid crisis support team (RCST) paired with 14 therapy and behavioral health coaching. Despite its positive impact on outcomes, it lacks comprehensive 15 caregiver and peer support, which are critical components shown to improve treatment retention and overall 16 effectiveness. Additionally, it has not been rigorously tested in a randomized controlled trial (RCT), limiting the 17 evidence base necessary for broader adoption and standardization in clinical practice. 18 In Phase I, with input from caregivers and adolescents with lived SITB experience, we will develop peer 19 and caregiver content to maximize Bend’s existing RCST. We will assess the more comprehensive RCST-Max 20 by conducting an 8-week feasibility study with 30 adolescents and their caregivers, assessing key metrics such 21 as recruitment, retention, engagement, and user satisfaction. Phase II will involve a RCT comparing the 22 enhanced RCST-Max to the existing RCST in 344 adolescents, with the goal to demonstrate that RCST-Max 23 can increase engagement and retention, reduce SITB risk, decrease emergency service utilization, improve 24 comorbid anxiety and depressive symptoms, and enhance parent-adolescent communication and caregiver well- 25 being. This study aims to establish the clinical and commercial value of a comprehensive DMHI for SITBs, 26 promoting its adoption by healthcare providers and addressing the significant social and economic costs 27 associated with adolescent SITBs.