An Adaptive Intervention for Adolescents at Risk for Suicide: A Pilot SMART
Condition: Suicide; Self Harm
MeSH terms: Suicide; Self-Injurious Behavior
Study type: Interventional

Summary: 
      To inform the development of a technology-augmented adaptive intervention for adolescents at
      risk for suicide, the goal of this study is to conduct a Sequential, Multiple Assignment,
      Randomized Trial (SMART) pilot of a Motivational Interview (MI)-enhanced safety planning
      intervention (MI-SafeCope). Findings from this study will provide the groundwork for the
      construction of a technology-augmented adaptive intervention that could lead to a reduction
      in suicidal behaviors and related events during the high-risk post-discharge period-an
      important suicide prevention target.
    


Intervention name(s): MI-Enhanced Safety Plan at Hospitalization (1st Component); MI-Enhanced Text Boosters (2nd Component); MI-Enhanced Booster Call (3rd Component)
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The MI-enhanced safety plan intervention component is delivered during hospitalization and includes an individual and family meetings. The goal of the individual meeting with the adolescent is to develop an individualized safety plan for use during a suicidal crisis. This "best practices" approach of safety planning is augmented with Motivational Interviewing (MI) as a core strategy to explicitly elicit adolescents' motivation and commitment to behavior change (i.e. use safety plan; adaptive coping), address barriers or ambivalence, and strengthen self-efficacy. The focus of the family meeting, which is similarly guided by MI, is to prepare parents/guardians, with input from the adolescent, for how they may support the adolescent in implementing the individualized safety plan after discharge and on strengthening parents' commitment and self-efficacy.; For participants randomized to receive text boosters, booster text messages will be sent daily for 4 weeks. The messages will be tailored to encourage use of individualized coping strategies identified as part of safety planning at hospitalization and will include additional adaptive coping tools and resources. The text message content and tone will be consistent with principles of MI.; The focus of the post-discharge booster phone call with adolescent and with parent, each conducted separately, will be to to further adjust the safety plan to better meet post-discharge needs, to further enhance adolescents' motivation and commitment to use coping strategies, and to further support adolescents' and parents' self-efficacy to manage suicidal crises.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: This Sequential, Multiple Assignment, Randomized Trial (SMART) pilot of a Motivational Interview (MI)-enhanced safety planning intervention is designed to inform the development of a technology-augmented adaptive intervention for youth at risk for suicide. The MI-SafeCope intervention includes three components: (1) MI-enhanced safety plan delivered during hospitalization (encompassing individual and family meetings); (2) post-discharge booster call; and (3) post-discharge daily text message boosters. In this SMART pilot, adolescents will be randomized to either MI-enhanced safety plan alone or in combination with text boosters for two weeks after discharge (Phase 1 intervention). At the end of week 2, adolescents will be re-randomized to two additional weeks of either: continuation of Phase 1 intervention or continuation of Phase 1 intervention with the addition of post-discharge booster call. Thus, participants will receive one of four treatment sequences (Groups A-D).
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Adaptive Intervention; Sequential, Multiple Assignment, Randomized Trial (SMART); Adolescent; Motivational Interviewing; Suicide attempt; Safety planning; mobile technology