Coping Long Term With Attempted Suicide - Adolescents
Condition: Suicide
MeSH terms: Suicide; Suicide, Attempted
Study type: Interventional

Summary: 
      This study is to develop an adjunctive intervention for acutely suicidal adolescents who have
      been admitted to a psychiatric inpatient unit. The study intervention is comprised of: 1) two
      to three individual sessions delivered in an inpatient setting or immediately upon discharge;
      2) one family session; 3) six months of follow-up phone interventions. The investigators
      hypothesize that those who receive the study intervention will have lower rates of suicide
      events and greater decreases in suicidal ideation after six months.
    

Detailed description: 
      The purpose of this R34 treatment development grant is to develop the "Coping Long-term with
      Attempted Suicide Program - Adolescents (CLASP-A)," an integrated, adjunctive intervention
      program for adolescents who have made a previous suicide attempt. The goals of CLASP-A are to
      reduce continued suicidal behavior and ideation, reduce risk behaviors for suicide, and
      improve adherence to psychosocial and psychopharmacologic treatments. It is comprised of
      three major components: a) three individual meetings while the patient is in the hospital, b)
      one in-person meeting with the patient and his/her parent/guardian in the hospital and c) a
      series of scheduled telephone contacts with the patient and parent/guardian for six months
      following discharge from the hospital. CLASP-A is based on a risk reduction model, and
      specifically targets four generic and potentially modifiable risk factors: hopelessness,
      impaired family support, problem solving deficits, and treatment non-adherence. The overall
      aim of this proposal is to further develop the CLASP-A intervention to address the needs of
      adolescents and to examine the feasibility and acceptability of this intervention program in
      adolescents. More specifically:

      The development aims of this R34 proposal are to:

        1. Develop CLASP-A - a multi-modal intervention that integrates strategies from
           cognitive-behavioral and values-based psychotherapies and family interventions, for use
           with suicidal adolescents.

        2. Develop and implement adherence and competence rating scales to evaluate provider
           adherence to the intervention manual and their competence in delivering the
           intervention.

        3. Improve the clarity, structure, content, acceptability, and feasibility of the
           intervention using information gathered from a small open trial (n=20) of adolescents,
           ages 12-18, who have made a recent suicide attempt.

      The pilot study aims of this R34 proposal are to:

        1. Conduct a randomized controlled pilot study in a sample of adolescent inpatients (n=50),
           ages 12-18, with a recent suicide attempt to assess the feasibility and acceptability of
           the proposed intervention and the randomization process.

        2. To examine in an exploratory manner, preliminary evidence for the following hypotheses.
           It is expected that over a 6 month intervention period, compared to an enhanced
           treatment as usual (E-TAU) condition, adolescents assigned to CLASP-A + ETAU will have:

             1. fewer suicidal events, operationalized as a dichotomous composite score of suicide
                attempts, emergency department visits and inpatient hospital admissions due to
                suicide risk, and study rescue procedures due to suicide risk;

             2. lower suicidal ideation and less chronic suicidal ideation;

        3. To examine in exploratory analyses potential mechanisms of change including treatment
           adherence to other forms of treatment as well as improvement in the hypothesized risk
           factors (i.e., hopelessness, problem-solving, and family functioning) addressed in the
           intervention.

      Based on the findings, CLASP-A will be revised, with the objective of creating a flexible
      protocol in which emphasis can be shifted based on the presenting problems of the
      patient/family, and strategies can be selected to accommodate the developmental stage of the
      patient. CLASP-A is innovative in that it targets the highest risk adolescents during their
      highest risk period, i.e. transition from inpatient to outpatient care. It is also innovative
      in employing multiple modalities (in-person sessions and phone calls) that involve both the
      patient and the parent, thus targeting frequently cited barriers in the treatment of
      adolescent patients. The availability of a low-cost, easily implemented, adjunctive
      intervention that successfully reduces the rate of suicide attempts in adolescents could
      improve quality of life and productivity on both individual and societal levels.
    

Intervention name(s): CLASP-A intervention; Treatment as Usual
Intervention type(s): Behavioral; Other
Intervention description(s): Three individual sessions with adolescent patient using acceptance based strategies and motivational interviewing techniques. Sessions focused on identifying personalized risk factors for suicidal behavior, identifying values and goals, and development of personalized safety plan.; Referral to outpatient treatment as part of routine discharge planning.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Suicide Attempts; Suicidal Ideation