The Acceptability and Feasibility of an ED-based, Peer-delivered, Suicide Safety Planning Intervention
Phase: NA
Conditions: Suicidal Ideation, Suicide, Attempted, Mental Health Issue
Sponsor: University of Arkansas

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Date: 05/07/21 
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Study Title: 
The acceptability and feasibility of an ED-based, peer-delivered, 
suicide safety planning intervention  
 
 
 
Principal Investigator:  
Michael Wilson 
 
University of Arkansas for Medical Sciences 
  
4301 W. Markham Street, Slot # 584 
Little Rock, AR 72205 
Telephone: 501-686-7000 
Email: MPWilson@uams.edu 
 
 
Sub-Investigator (s): 
Ronald Thompson, Jr, PhD 
 
Psychiatric Research Institute 
 
University of Arkansas for Medical Sciences 
 
4301 West Markham Street, #554 
 
Little Rock, Arkansas 72205 
 
Telephone: 501-686-7000 
 
Email: RGThompson@uams.edu 
 
 
Angie Waliski, PhD 
 
Psychiatric Research Institute 
 
University of Arkansas for Medical Sciences 
 
4301 West Markham Street, #554 
 
Little Rock, Arkansas 72205 
 
Telephone: 501-686-7000 
 
Email: ADWaliski@uams.edu 
 
 
Manuel Alvarez Romero 
 
Department of Emergency Medicine 
 
University of Arkansas for Medical Sciences 
  
4301 W. Markham Street, Slot # 584 
Little Rock, AR 72205 
Telephone: 501-686-7000 
Email: MAlvarezromero@uams.edu 
 
 
Study location: 
UAMS 
 
 
 
 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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Background and Rationale 
Scientific rationale: Suicide deaths are increasing 
     Suicide is a leading– and growing– cause of death in the United States.1 From 2008-2017, suicide was 
ranked the 10th leading cause of death for all ages combined, and from 1999-2017, the age-adjusted 
suicide rate rose by 33%.2 Thus, suicide is a large problem nationwide.3  
     Safety planning is a brief, ED-feasible intervention which has been demonstrated to save lives,4,5 and 
has been universally recommended by every recent expert consensus panel on suicide prevention 
strategies.3,6-8 In one popular version of the safety plan developed by Stanley et al,4 the patient is 
encouraged to write out the following items: identifying personal signs of a crisis; helpful internal coping 
strategies; social contacts or settings which may distract from a crisis; using family members or friends 
for help when in crisis; mental health professionals who can be contacted when in crisis; and restricting 
access to lethal means.4 In most emergency departments, safety-planning is done by clinical personnel 
such as psychologists or social workers, but these providers are often too busy to perform safety-
planning well or have multiple other patient care responsibilities. 
     This project aims to answer the following three research questions: (1) In general, do ED patients with 
suicidal ideation/attempt prefer to interact with/receive support from peers with life experiences of 
suicide or clinical professionals who might have such life experiences or not? (2) Will patients with 
suicidal ideation/attempt accept a peer-delivered safety planning intervention as opposed to one 
delivered by clinical personnel? (3) Are peer-delivered safety plans of equal quality as those delivered by 
clinical personnel?  
     Please note that the study will not otherwise alter usual or customary care in the emergency 
department. 
 
Rationale for testing peer-delivered interventions in the ED 
     The rationale for testing a peer-delivered intervention in the ED relies on the following evidence: a) a 
peer is an individual with lived experience who is now supporting other mental health patients in crisis; 
b) the experience of a mental health patient in the ED often shapes the perception of the health system, 
and may influence willingness to seek future care;9 c) peers may provide more empathetic care than 
providers without lived experience, which may positively impact patients; d) peer-based programs for 
patients with serious mental illness that do not involve safety planning are at least as good as non-peer 
based programs at preventing hospitalizations and promoting engagement in care, with the most 
promising interventions involving self-management or peer-navigator roles;10 and e) existing evidence 
from high-quality studies is scarce, but in moderate-low quality studies has indicated that peers are no 
less effective than mental health workers.11 However, even if peers are also no more effective than 
mental health workers in the same role, it is likely more economically feasible to employ peers 
compared to more costly mental health staff. Please note that as economic costs of a peer-delivered 
safety plan have never been studied formally, the investigators will conduct a time analysis of peers in 
the ED in order to calculate potential costs. 
     As noted in a previous systematic review by Lloyd-Evans et al12 and a 2013 Cochrane review by Pitt et 
al,11 there is little high-quality evidence regarding the benefits of peers in mental health settings. Where 
high-quality evidence exists, available studies have generally demonstrated that, outside of a reduction 
in emergency department usage, peer support is not worse than trained mental health workers in the 
same role.11 However, this conclusion primarily relies on evidence from outpatient studies,11,13 not the 
ED. In addition, existing studies have included peers in a variety of roles interacting with patients who 
had a variety of mental health conditions.  

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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Concerns about peer vulnerability to relapse 
     Anecdotally, there have been concerns that peer-delivered 
interventions may not be effective in the ED, since peers may 
be vulnerable to relapse in the stress of the acute-care 
environment. As some authors have noted, working in acute 
care is stressful for many individuals, not just peers.14 However, 
it is not true that peers are too “fragile” for a study of this type. 
Findings from peers in non-ED environments have generally 
indicated that peers receive positive benefit from the 
experience,15 including increased confidence and self-esteem.16 
Nonetheless, peers will be given the opportunity to experience 
the ED environment before committing to this project (please 
see “Recruitment of peers for this project” and “Training of 
peers” below). In addition, peers will be closely monitored and 
debriefed by the sub-investigator of this project (Waliski), who 
is a licensed clinical counselor (please also see “Supervision and 
debriefing of peers” below). While adverse events are not 
expected as a result of this intervention, the PI will carefully 
monitor for any such event and report any adverse event to the IRB. In addition, if a peer has a relapse 
or any psychiatric emergency during the course of the intervention, they may contact Dr. Waliski using 
the contact information provided during peer training. After this initial contact, Dr. Waliski will debrief 
the peer by meeting with them and further discussing the situation. 
     Please note that although peers will receive mandatory confidentiality training required at the study 
institution, there is little concern that peers will “say the wrong thing” or break a patient’s 
confidentiality. Given that these peers have personal experience of hospitalization, it is more likely that 
they will be willing to guard the patient’s confidentiality and less likely than clinical staff to make 
insensitive remarks to a patient. However, all peers will be CITI-certified, with periodic reminders about 
patient confidentiality from the investigators. 
 
Recruitment of peers for this project 
     Peers will be recruited through existing relationships with community suicide prevention 
organizations (i.e. Arkansas Foundation for Suicide Prevention, Arkansas Governor’s Suicide Prevention 
Council, Veterans Service Organizations, etc.). Eligible recruits will complete an interview with Dr. 
Waliski where they will be informed about the responsibilities and expectations becoming a peer. 
Recruits will be asked to briefly give an overview of their suicide history and treatment history. Training 
and supervision of peers (please see “Training of peers” and “Supervision and debriefing of peers” 
below) will be used to further monitor the appropriateness of the individual to assist patients in 
providing the intervention. 
 
Training of peers 
     As this project utilizes individuals that have lived through serious suicidal ideation or attempts, 
training, debriefing, and supervision of research staff are paramount (please see “Supervision and 
debriefing of peers” below). Training will follow constructivism learning theory,17 which posits that 
individuals learn best when they actively construct their own meaning of new information by relating it 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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to their experiences, attitudes, and beliefs.18,19 In this mode of instruction, instructors facilitate learning 
by asking guiding questions and providing individualized feedback, utilizing role play and role modeling, 
and providing a safe learning environment that promotes self-exploration and self-evaluation.18-20  
As shown in the Suicide Safety Planning Training Cycle (please see figure), training conducted by 
sub-investigator Waliski, sub-investigator Thompson, and PI Wilson will extend over approximately 12 
hours (please see “Training agenda” uploaded to the IRB as a separate document). Training will involve a 
four-step cycle that starts with exploring personal experiences about suicide and suicide prevention. 
Using videos, presentation slides, and active learning techniques, students will be provided education 
about suicide and the safety planning intervention using training materials originally developed by Drs. 
Stanley and Brown.21 The information presented to the student may be new or previously known by the 
student, but will be presented in a way that encourages deeper examination of the topic and how it 
relates to the student’s experiences. The instructor will then facilitate the revision of beliefs and skills 
using guiding questions and individualized feedback based on student comments. Examination and 
exploration will promote the revision of the student’s knowledge and beliefs about suicide and the 
safety planning intervention. Finally, role modeling and role play will be used to allow the student the 
opportunity to test their now-revised beliefs and skills related to suicide and safety planning 
intervention. This is an iterative process and will be performed as many times as needed for each 
student. 
     Specific training will be conducted about how to conduct the safety plan intervention, using materials 
developed by Brown & Stanley. Five learning objectives will guide the development of the training 
structure (please see Table I). The instructor (Drs. Thompson & Waliski) will present information using 
various didactic and technological methods, and will take place over approximately 12 hours. During 
initial topics, the focus will be on building a safe learning environment that utilizes the student’s 
personal life experiences to understand empirical evidence of suicide and suicide prevention. Later 
topics will provide more specific training on the safety plan using materials from Brown and Stanley.21 
This portion of the training will also use videos, presentations, and role-playing. While lists of examples 
of warning signs, strategies for internal and external distractions, methods for restricting lethal means, 
and mental health treatment providers will be provided, students will be encouraged to provide input 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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based on their own experiences. Finally, training will also involve a general orientation to the emergency 
department. This part of the orientation will be provided by Dr. Wilson, and will involve already-
developed training materials for orienting new research staff to the UAMS ED. Follow-up trainings will 
be provided depending on identified needed. 
     Special training about COVID-19: patients presenting to the UAMS ED are universally screened for 
COVID-19 signs or symptoms (fever, cough, recent travel) and are placed into specially-marked isolation 
rooms. As part of training, peers must demonstrate awareness of ED policies regarding the marking of 
these isolation rooms for suspected COVID-19 patients; must understand the importance of not entering 
these rooms; must understand and agree to use hand sanitizer when entering and leaving a patient’s 
room (“foam in/foam out”); must demonstrate awareness of UAMS policies regarding screening of 
employees when they arrive for work; and must agree to stay home if they are feeling sick. 
     Please note that safety planning is a process that requires in-person interaction with participants due 
to the setting involved and confidentiality concerns. Having the special training detailed above in place 
reduces the health risk to potential participants and research staff. In addition to using the special 
training about COVID-19 detailed above, research staff will further minimize health risk by maintaining a 
safe social distance from participants during all study procedures and properly sanitizing all study 
equipment (pens, tablets, etc.) by using sanitizing wipes after use by each participant. 
 
Supervision and debriefing of peers 
     Although anecdotally peers may be vulnerable to stress-induced relapse in the ED clinical 
environment, scant support for this idea is noted in the literature (please see above). Nonetheless, all 
peers will receive close supervision and debriefing during the study. Supervision will be provided using 
the discrimination model.22  
As a licensed clinical counselor, Dr. Waliski will assess the provider’s skill level and will become the 
role of a teacher, counselor, or consultant based on need. In other words, peers and mental health staffs 
will be provided with either instruction and direct feedback (i.e., the teacher role), support for reflection 
and processing of personal experiences (i.e., the counselor role), or encouraging confidence in required 
skills (i.e., the counselor role) depending on need. 
In terms of direct supervision, Dr. Waliski will be on site during the first week of the intervention to 
observe performance and operation. She will ensure that the safety plan is being administered, 
documented, and managed appropriately by each provider (see also “Fidelity of the intervention” 
below). If deficits are identified, she will work with individuals to make needed improvements. During 
the first week of intervention implementation, Dr. Waliski will also conduct an individual face-to-face 
interview with each peer. Interview questions will be guided by the Consolidated Framework for 
Implementation Research (CFIR)23 and focus on identifying and overcoming perceived barriers to 
implementation of the intervention.  
Peers will also be provided with clear instructions on how to obtain help during any difficult or 
uncomfortable situations during the intervention. After the first week of the intervention, peers may 
inform ED clinical staff (social worker or psychiatric nurse) on site of such situations so that the staff may 
continue working on the safety plan with the participant. ED clinical staff are available 24/7 so peers 
would not have much trouble in finding and asking someone for help with a participant during these 
situations. Participants who do not complete the safety planning with a peer will be withdrawn from the 
study, but peers will be informed that their safety and well-being remains a priority when completing 
the intervention and so they should not hesitate to ask clinical staff for help. Peers may also contact Dr. 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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Waliski using the contact information provided during peer training in order to schedule an in-person 
meeting. Dr. Waliski will debrief the peer at these meetings by further discussing the difficult or 
uncomfortable situations. 
Once the pilot project is underway, periodic debriefing of peers will be provided by Dr. Waliski. This 
debriefing will provide an opportunity to identify areas of needed improvement in the study protocol or 
in training (please also see “Fidelity of the intervention” below). Given this study utilizes individuals that 
have lived through serious suicide ideations and/or attempts, peers will likely have their own 
preconceived opinions about suicide and how to encourage survival. Debriefing will allow an 
opportunity to monitor how past experiences could be impacting the delivery of the intervention or how 
participating in the study could be impacting the peer. Dr. Waliski will also use this time to review 
personal safety plans and encourage peers to participate in appropriate self-care. 
 
Description of interventions 
     Written safety plan: Please see separate upload for the Stanley et al version of the safety plan. The 
safety plan contains 6 components, and is completed by the patient. This intervention takes 
approximately 20-40 minutes to complete. As a former site for the ED-SAFE study,24 the UAMS ED 
typically has patients complete safety plans if being discharged and if trained staff is available. Trained 
staff are typically available weekdays, and usually consist of a psychiatric nurse or social worker. These 
clinical providers typically place a progress note containing the patient’s safety plan in the electronic 
medical record (EMR), and must approve all safety plans in this study, as peer supporters/research staff 
do not have the ability to place notes in the EMR. 
 
Study Design and Procedures 
     This is an effectiveness-implementation randomized controlled trial which will be conducted at the 
emergency department (ED) at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, 
Arkansas. The UAMS ED is an urban emergency department which sees approximately 60,000 patients 
per year, including more than 1,200 suicidal patients. 
     This clinical trial will compare the intervention of ED patients completing a written safety plan with a 
peer to completing a written safety plan with clinical personnel. Patients triaged and flagged with the 
chief complaint of “SI” or “suicidal ideation” on the ED trackboard when a peer is available will be 
approached to participate. Patients will be approached after evaluation by an emergency physician. 
     Please note that clinical staff will be notified when a peer is on site by posting of a flyer that is visible 
only to clinical staff, not patients. This flyer is not meant for the purpose of recruiting patients, but will 
be utilized solely to inform clinical staff of the ongoing study. 
     Study flow: Utilizing a peer with lived experience of suicide (e.g., history of suicidal ideation/attempt 
prior to last year; loss of immediate family member to suicide), ED staff will approach patients identified 
from the ED trackboard as being at risk for suicide until as many as 32 patients have completed the 
study. Patients are typically triaged by UAMS nursing staff as being “at-risk” after questions about self-
harm. If so triaged, patients are then flagged with the chief complaint “SI,” “suicidal ideation,” “suicide 
attempt,” or “Psychiatric BEE” on the ED trackboard. A partial waiver of HIPAA for recruitment purposes 
is requested to allow research staff to visualize the ED trackboard, and is appropriate for the following 
reasons: 
 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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•The PHI use or disclosure involves no more than minimal risk to the privacy of individuals based 
on the fact that no PHI will be recorded, reused, or disclosed to any other person or entity 
except as required by law or for authorized oversight of the research study. 
•The research could not practicably be conducted without the requested waiver or alteration, as 
it would be difficult or impossible to identify ED patients at risk of self-harm in any other 
manner. 
•The research could not practicably be conducted without access to and use of the PHI. 
 
     Please note that that the safety plan intervention will be delivered by individuals with lived 
experiences of suicide. These peers will receive training in both ED operations (by Dr. Wilson) and safety 
planning (Dr. Waliski), data collection techniques, how to operate REDCap data collection software, and 
how to obtain informed consent. All research staff will be CITI certified and will receive periodic 
reminders about confidentiality. 
     Upon approach by research staff, patients will be asked if they would like to participate in the study 
and if they would allow peers to help them with safety planning. If the answer to both questions is yes, 
patients will be offered a brief screening procedure: 
 
Inclusion criteria: patients presenting for suicidal ideation (SI) or after suicide attempt to the UAMS ED; 
willingness to engage in safety planning with trained peers (non-clinical staff); have not already filled out 
a safety plan at the current visit. 
Exclusion criteria: <18 or >89 years of age; incarcerated or in police custody; non-English speaking; 
critically-ill; unwilling or unable to complete the safety plan; unwilling or unable to show safety plan to 
clinical staff. Please note that patients may be unable to complete the safety plan for any of a number of 
reasons, including being actively psychotic, acutely manic, or intoxicated with alcohol/drugs. Patients 
will be evaluated for these inclusion/exclusion criteria by research staff. 
 
     If participants indicate interest in the study and meet all inclusion/exclusion criteria, informed 
consent will be obtained using IRB-approved consent forms & processes. If they provide consent, 
participants will then be asked to answer a short questionnaire concerning their demographics (e.g., 
age, gender) and any history of previous suicide ideation, attempts, or related behaviors.  
     After completing this short demographic questionnaire, participants (n=37) will be randomized in a 
1:1 fashion to either the peer safety planning group, in which they will complete the safety plan with a 
peer, or the clinical personnel safety planning group, in which they will complete the safety plan with 
clinical personnel as usual (please see Figure 2). Participants will be randomized using the REDCap 
functionality for this purpose. All participants will be allowed to complete the written safety plans in the 
privacy of their ED treatment room. Please note that participants will be given a $25 gift card for 
participating regardless of which group they are randomized into for the study. 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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     When a peer-delivered safety plan is 
completed, the UAMS ED psychiatric 
registered nurse or social worker will 
review and, if approved, enter the 
safety plan into the EMR. (Please see 
“Description of intervention” above.) 
Please note that the study will not 
otherwise modify care in the ED. It is 
possible, although not likely, that 
psychiatry consultants could choose to 
revise, edit, or otherwise start anew 
with safety planning for a particular 
patient. If such occurs, the participant 
will be removed from the study. 
 
                        Figure 2. Study flow. 
      
Other measures: All participants will complete a brief survey regarding their demographics and 
satisfaction with the safety planning process. After the visit, the electronic medical record will be 
searched for the following data: date/time of ED triage and disposition; length of ED stay; ED chief 
complaint or reason for visit; patient disposition (observation/admission/discharge/transfer); psychiatric 
diagnoses; and frequency of ED visits 3 months before and after the intervention. Length of ED stay will 
be compared against two control groups (obtained using AR-CDR): a) length of stay of all ED patients 
during a similar time period; and b) length of stay of ED patients who presented for SI during a similar 
time period. No PHI will be recorded for either of these deidentified control groups. Peers and clinical 
staff will also be asked to record the total amount of time that they spent performing the safety plan 
intervention. 
     Study retention: The study duration is limited to the ED visit (typically <6 hours for SI patients), with 
participation in the study limited to the safety planning intervention above. Consequently, no special 
measures designed to increase retention are planned. 
 
Grading of safety plan quality 
     Safety plans created by peers will be approved by existing ED clinical staff after being created (see 
“Study design and procedures” above). Safety plans will also later be graded on a numerical rating scale 
(0-2 or 0-3, depending on grading component) by the investigators using materials developed by 
Gamarra et al for this purpose.25 Using a “safety checklist,” responses for each of the 6 safety plan steps 
(with step 3 divided into two parts) and the “most important thing worth living for” section will be rated 
according to the personalization of the information in each section. In addition, each section will be 
independently rated for “completeness” (0=not complete, 1=partially complete, 2=complete) and 
“quality” (0=blank, 1=boilerplate, 2=some evidence of personalization, 3=highly personalized and 
specific). For example, warning signs (step 1) may be rated as “1” if the plan refers to non-specific 
thoughts such as “thinking about the future.” Responses may be classified as “3” if they contain fairly 
specific descriptions, such as “feel useless.” Each of the sections in a participant’s safety plan will be 
graded in this manner, with completeness having a maximum score of 16 and quality having a maximum 
score of 24. An overall score for the safety plan will be derived by adding the scores for all sections in a 
participant’s safety plan. Peers will be trained to coach participants towards higher-quality answers 
(please see “Training of peers” above). 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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Monitoring: Adverse events or in case of psychiatric emergency 
     By definition, all patients have presented to the ED for an acute mental health crisis and will be under 
the care of trained ED physicians, trained ED nurses, trained psychiatric ED nurses who typically 
complete the safety plan, and other psychiatric personnel as appropriate. In the unlikely event of 
psychiatric decompensation, peers will be instructed to stop the intervention and seek help from 
qualified personnel in the ED. The intervention will then not be continued. 
     Although adverse events (AEs) are not expected and are unlikely, the peers and mental health 
personnel who are responsible for approving the safety plan will nonetheless be instructed to 
communicate any and all AEs to the PI (Wilson). The PI will communicate any adverse events to the 
UAMS IRB, consistent with IRB policies & regulations. 
 
Risks and Benefits 
     The main potential risk to study participants is loss of confidentiality. The researchers take 
confidentiality very seriously, and measures to protect the confidentiality of study participants will be 
implemented as described in the Data Handling and Recordkeeping section below. Adverse events will 
be handled as above (please see “Monitoring: Adverse events or in case of psychiatric emergency” 
above). 
 
Data Handling and Recordkeeping 
     The Principal Investigators will carefully monitor study procedures to protect the safety of research 
participants, the quality of the data, and the integrity of the study. All study participant material will be 
assigned a unique identifying code or number in REDCap. Only Dr. Wilson and select study staff will have 
access to the code and information that identifies the participant in this study. However, audits of 
deidentified data may be performed by the study sponsor at their discretion. Safety plan material of 
patients will also be kept in a locked file in the office of the PI or co-investigator. Access will be strictly 
limited to study staff. However, to guard against the very real possibility that these plans may allow 
identification of a particular patient despite having no identifying information, safety plans will not 
require the patient to record their name. 
     Records will be maintained for 7 years per IRB requirements. At the discretion of the PI, records may 
be scanned and maintained in electronic format instead of paper format once the study is complete. If 
so, electronic records will be audited to ensure high fidelity with the originals. REDCap data will be 
maintained on secure password-protected UAMS servers. When eventually destroyed, paper copies of 
safety plans will be shredded per UAMS disposal guidelines. 
     Data collection will be performed through both the CARS screener and the Research Electronic Data 
Capture (REDCap) system, and will be set up in cooperation with the UAMS Translational Research 
Institute (TRI) in order to assure 21 CFR Part 11 and HIPAA compliance. 
 
Data Analysis 
      Outcome 1: Evaluate the proportion of SI patients approached in the ED who agree to receive a peer-
delivered safety plan. This number is currently unknown. 
     Outcome 2: Evaluate the proportion of patients approached who meet all inclusion/exclusion criteria. 
This number may be lower than the number of patients willing to participate in safety planning. 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Date: 05/07/21 
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     Outcome 3: Evaluate the quality of the completed safety plans. This will be done by retrospective 
review after the patient has left the ED. The number of safety plans that must be repeated or redone by 
the ED mental health clinician will also be tracked. 
     Outcome 4: Patient satisfaction with safety planning. This will be assessed by having the patient rate 
their experience with the safety planning process on a 7-point Likert scale (strongly disagree; disagree; 
moderately disagree; neutral; moderately agree; agree; strongly agree). 
 
     Power calculations and sample size: As this is a pilot study, no formal sample size calculation is 
planned. The investigators plan a priori to enroll up to 37 patients. The investigators therefore ask for 
permission to approach a maximum of 100 patients. 
     Initially, the randomization scheme will be validated by comparing the groups on key variables that 
could be associate with outcome (e.g., age, race, prior suicide attempts, prior completion of safety plan). 
Where we identify significant differences between groups, we will either adjust for these variables in 
analysis or conduct stratified analyses. Categorical variables will be analyzed with chi-square. 
Continuous variable will be analyzed by ANOVAs. Sub-analyses of potential prognosticators, including 
biological variables such as sex, will be descriptively presented, as the sample size will not likely permit 
sufficient testing of these variables. 
 
Ethical Considerations 
     Written consent will be required for any study procedures. (Please see “consent form.”) Please note 
that all study procedures will be conducted in accordance with all applicable government regulations 
and University of Arkansas for Medical Sciences research policies and procedures. This protocol and any 
amendments will be submitted and approved by the UAMS Institutional Review Board (IRB) to conduct 
the study.  
     Potential participants will be identified from the ED track board and/or patient triage note. This 
requires a partial waiver of HIPAA for recruitment purposes only. No PHI will be recorded or disclosed 
without patient consent. Please see study flow above. 
     Research staff will approach the patient in an ED treatment room only if this can be done privately 
and safely (please see “Training of peers” above). The consent process will also be done privately in the 
same room. No patients will be approached in the waiting room or in a hall bed. The formal consent of 
each participant, using the IRB-approved consent form, will be obtained before that participant 
performs any study procedure. All participants for this study will be provided a consent form describing 
this study and providing sufficient information in language suitable for participants to make an informed 
decision about their participation in this study. The person obtaining consent will thoroughly explain 
each element of the document and outline the risks and benefits, alternate treatment(s), and 
requirements of the study. The consent process will take place as described above, and participants may 
take as much time as needed to make a decision about their participation.  
     Participation privacy will be maintained and questions regarding participation will be answered. No 
coercion or undue influence will be used in the consent process, including the fact that the PI will not be 
involved in the recruitment process if he is working in the ED at the time as an attending physician. This 
consent form must be signed by the participant and the individual obtaining the consent. A copy of the 
signed consent will be given to the participant, and the informed consent process will be documented in 
each participant’s research record. 
 
 

Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
intervention 
PI: Wilson, University of Arkansas for Medical Sciences 
 
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Dissemination of Data 
     Results of this study may be used for presentations, posters, or publications. The publications will not 
contain any identifiable information that could be linked to a participant. 
 
References 
1. 
United States Centers for Disease Control. Web-based injury statistics query and 
reporting system (WISQARS): Leading causes of death reports, 1981-2016.  
https://webappa.cdc.gov/sasweb/ncipc/leadcause.html. Accessed August 19, 
2018. 
2. 
Hedegaard H, Curtin SC, Warner M. Suicide mortality in the United States, 1999-
2017. Hyattsville, MD: National Center for Health Statistics; 2018. 
3. 
Betz ME, Boudreaux ED. Managing Suicidal Patients in the Emergency 
Department. Ann Emerg Med. 2016;67(2):276-282. 
4. 
Stanley B, Brown GK. Safety planning intervention: A brief intervention to 
mitigate suicide risk. Cog Beh Pract. 2012;19:256-264. 
5. 
Stanley B, Brown GK, Brenner LA, et al. Comparison of the Safety Planning 
Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the 
Emergency Department. JAMA Psychiatry. 2018;75(9):894-900. 
6. 
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Title: The acceptability and feasibility of an ED-based, peer-delivered, suicide safety planning 
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PI: Wilson, University of Arkansas for Medical Sciences 
 
Version #: 10 
Date: 05/07/21 
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