Developing and Implementing an Adolescent Suicide Prevention Program in a Community Mental Health Setting
Condition: Suicide, Attempted; Suicidal Ideation
MeSH terms: Suicide; Suicidal Ideation; Suicide Prevention; Suicide, Attempted
Study type: Interventional

Summary: 
      This is a three phase study to develop and implement an adolescent suicide prevention program
      in a community mental health setting. In Phase 1, needs assessments using qualitative
      interviews will be conducted at in a community mental health clinic with suicidal teens and
      their parents, and with community experts including therapy staff who serve patients at a
      community mental health clinic. In Phase 2, the investigators will develop a new treatment
      manual that is guided by information obtained in the previously completed needs assessment.
      The investigators will pilot the program with one group of adolescents (N=10), and make
      iterative revisions based on feedback. Training sessions will be implemented. In Phase 3, the
      investigators will conduct an open trial of a group for 40 adolescents at the community
      mental health clinic to assess feasibility of recruitment, implementation, satisfaction, and
      outcome. Program outcomes will be utilization, patient and family satisfaction ratings, and
      improvement in depression and suicide risk measures at discharge from the program and at one
      month and six months follow-up. In addition, rate of suicidal events (suicide attempt,
      hospitalization) at one month and six months post-discharge will be compared to historical
      controls.
    

Detailed description: 
      In Phase 1, the investigators will develop interviews and data collection guides. The
      investigators will interview 10 current patients and parents at a community mental health
      clinic (for a total of 20 individuals). The investigators will elicit respondent perspectives
      relating to: (a) utilization of care (b) treatment targets (c); parent/family participation
      and (d) session format. Also, as part of Phase 1, the investigators will conduct interviews
      with the 8 treatment providers at a community mental health clinic. In addition to exploring
      the content of treatment modules of the intensive outpatient program (IOP) program, the
      investigators will share responses from patients and parents, and will solicit provider
      feedback regarding those responses. Building on patient-reported needs, the investigators
      will solicit provider expectations, requisite elements and other concerns regarding
      implementation of an intensive treatment program in community mental health clinic settings.
      Coders will independently read the transcripts and code for common elements. Developing a
      codebook to document procedures, the investigators will compare and contrast codes and
      respective quotations across respondents. Coding discrepancies will be discussed and
      conflicts between raters resolved using a third investigator. The investigators will present
      the preliminary manual content to clinician respondents to explore feasibility of the
      proposed intervention. Data will be coded and analyzed using standard qualitative approaches
      and will guide the manual development and intervention components to be used in Phases 2 and
      3.

      In Phase 2, the investigators will incorporate responses into a draft of treatment manual,
      and train a group of community mental health clinic staff to deliver treatment. The
      investigators will test this adapted manual with an open trial to test feasibility and
      piloting of the intervention and outcome measures. Patients and parents will complete the
      Quick Inventory of Depressive Symptomatology - Adolescents (QIDS-A). Client Satisfaction
      Questionnaire (CSQ) will be obtained at discharge. Participants will complete the
      Interpersonal Needs Questionnaire (INQ), Concise Health Risk Tracking (CHRT) , and the
      Acquired Capability for Suicide Scale (ACSS) at both intake and discharge, Clinicians will
      complete the Clinician Checklist and the Columbia Suicide Severity Rating Scale (C-SSRS) at
      baseline and discharge. The investigators will conduct exit interviews completed with both
      the parent and patient, to assess the acceptability of treatment. The investigators will
      obtain feedback about perceived effectiveness of the treatment, the appropriateness of
      treatment targets, identification of other targets or approaches that would have been more
      helpful, and barriers to participation. The investigators will obtain similar feedback from
      the treating clinicians. Based on patient, family, and clinician feedback, a satisfaction
      questionnaire (patient and parent), and outcome data from the open trial, the manual,
      treatment program structure can be modified in Phase 3 to improve feasibility and
      acceptability. The investigators will collect follow-up information at 1 month and 6 months
      following the patient's final session.

      In Phase 3, participants will be 40 adolescents who present to the community mental health
      clinic with a recent suicide attempt or significant suicidal ideation with a plan or intent.
      Participants must be English-speaking, although parents must be able to speak Spanish.
      Participants can have unipolar or bipolar disorder, conduct or oppositional disorder, eating
      disorder, or alcohol or substance use or abuse, all of which are common comorbidities in the
      suicidal adolescent sample. Excluded are those with current psychosis, mania, alcohol or
      substance dependence, autism spectrum disorders, <80% of ideal body weight, or low
      intelligence quotient (IQ) based on clinical judgement (if concerns about intellectual
      capabilities are evident at assessment), as these conditions may require more intensive
      interventions or limit comprehension of the intervention components. The program will include
      1-2 hours of group therapy once weekly, and utilize Cognitive Behavioral Therapy and
      Dialectical Behavior Therapy components focusing on skills to reduce risk factors associated
      with suicidal behaviors. The selection and emphasis on specific skills will be based on input
      during the early phases of the project. Length of treatment is expected to be 6-8 weeks,
      depending on individual patient need. Adolescents also will receive individual and/or family
      therapy, and will be referred to a psychiatrist for medication management as needed. In
      addition, parents will attend a 1-hour biweekly skills-based parent group.

      Outcome Measures. Patients and parents will complete the Quick Inventory of Depressive
      Symptomatology - Adolescents (QIDS-A). Client Satisfaction Questionnaire (CSQ) will be
      obtained at discharge. Participants will complete the Interpersonal Needs Questionnaire
      (INQ), Concise Health Risk Tracking (CHRT), and the Acquired Capability for Suicide Scale
      (ACSS) at both intake and discharge, Clinicians will complete the Clinician Checklist and the
      Columbia Suicide Severity Rating Scale (C-SSRS) at baseline and discharge. The investigators
      will collect follow-up information at 1 month and 6 months following each patient's final
      session.
    

Intervention name(s): Suicide Prevention Intensive Outpatient Program
Intervention type(s): Behavioral
Intervention description(s): participation in a suicide prevention intensive outpatient program
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: Phase 1: Treatment Development Phase 2: Pilot Group Phase 3: Open Trial
Masking: None (Open Label)
Primary purpose: Health Services Research