Brief Intervention for Suicide Risk Reduction in High Risk Adolescents
Condition: Adolescent Behavior
MeSH terms: Suicide
Study type: Interventional
Phase: Phase 1

Summary: 
      Adolescent suicide is the 2nd leading cause of death in this age group. There are no
      validated treatments to decrease the risk of adolescent suicidal behavior, and there are
      especially no interventions to target the highest risk period for adolescent suicide and
      suicidal behavior, namely during the time of transition from inpatient to outpatient care.
      This purpose of this project was to develop a novel, brief intervention that can be delivered
      on an inpatient unit prior to the transition to outpatient care, and augment known factors to
      protect adolescents from suicidal behavior, and extend the impact of treatment by liaison
      with the outpatient therapist and the development of a personalized safety plan phone
      application. This treatment, ASAP, focuses on augmenting adherence to the components of ASAP
      and outpatient aftercare, development of a personalized Safety Plan, and Affect Protection,
      through helping the teen and family promote a positive mood, tolerate distress, engage in
      healthy emotion regulation and access social support.
    

Detailed description: 
      This 2-site R34 project developed a brief, flexible, manualized intervention with supporting
      phone app with the purpose of reducing the risk of suicidal behavior in adolescents with high
      suicidal ideation or a recent suicide attempt, during the transition from inpatient to
      outpatient care. This transition period is the highest risk period for attempted and
      completed suicide. Suicide is the 2nd leading cause of adolescent mortality, and there are
      currently no established interventions for suicidal teens. By developing a treatment that can
      be delivered on an inpatient unit prior to the transition to outpatient treatment, we
      anticipated being able to lower suicidal risk and increase the likelihood that participants
      will attend subsequent outpatient treatment. In keeping with the priorities of NIMH, this
      intervention aimed at reducing the risk of suicide and suicidal behavior was
      trans-diagnostic. We term the intervention ASAP, with anticipated components: (1)
      Adherence-promoting engagement and adherence to treatment through motivational interviewing;
      (2) Safety planning; and (3) Affect Protection- selecting from a menu of techniques for
      maintaining positive affect (e.g. savoring and switching strategies, mobilizing social
      support, engaging in emotion regulation and distress tolerance skills). Each of these
      components was delivered within a Motivational Interviewing framework for enhancing intrinsic
      motivation for change. Treatment was brief (3-5 hours), and flexibly delivered on inpatient
      units prior to initiation of outpatient treatment.

      ASAP included the family in the treatment, and a safety plan phone app to extend the impact
      of treatment was also developed. Innovative features included: (1) delivery of an
      intervention at a time and place when suicidal risk is highest; (2) augmentation of
      protective factors against recurrent suicidal behavior, specifically by promoting development
      of positive affect, emotion regulation, distress tolerance, and social support; (3) a Safety
      plan phone app to extend the impact of treatment; and (4) liaison with the outpatient
      therapist to ensure continuity of care.

      This project conducted an RCT of ASAP followed by Aftercare (AC) vs. AC alone to determine
      ASAP's feasibility, acceptability, impact on proximal targets (e.g., adherence to outpatient
      care, sleep, positive affect, substance use), suicidal ideation and behavior. In total 68
      suicidal adolescents were enrolled, 2 of whom were withdrawn following baseline assessment
      and were excluded from analyses, resulting in the final study sample size of 66. ASAP,
      developed with and intended for community clinicians, has the potential to be a sustainable
      intervention to reduce the burden of adolescent suicidality. Data analyses have been
      completed and results are being finalized.
    

Intervention name(s): As Safe As Possible; Brite; Treatment as Usual
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The ASAP (As Safe As Possible) treatment is a brief, intensive intervention initiated during inpatient care and transitioning to outpatient care. The intervention focuses on 1) using motivational interviewing (MI) strategies throughout care; 2) developing a safety plan, including adapting the plan to an interactive safety plan phone app, Brite); and 3) using treatment modules to target specific risk factors that are selected based on individual need.; Brite is a HIPAA-compliant mobile application designed to provide the participants with emotion regulation and distress tolerance skills, social support, and convenient access to safety plan resources via the patients' phone.; Participants received usual treatment for suicidal adolescents as they transition from inpatient hospitalization to outpatient therapy, which included a paper safety plan.
Other intervention name(s): ASAP
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: adolescence; suicidality; depression