Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults
Condition: Suicidal Behavior; Self-Harm, Deliberate; Suicidal Ideation; Suicide
MeSH terms: Suicide; Suicidal Ideation; Suicide Prevention; Self-Injurious Behavior
Study type: Interventional

Summary: 
      This randomized controlled trial will evaluate two approaches to achieving the aspirational
      goal of Zero Suicide within a health system: 1) Zero Suicide Best Practices initiated through
      a zero suicide quality improvement initiative within a health system; and 2) Zero Suicide
      Best Practices plus an innovative stepped care for suicide prevention intervention for
      adolescents and young adults that matches treatment intensity with risk levels for
      suicide/self-harm. ..
    

Detailed description: 
      We propose a rigorous randomized trial to evaluate an innovative stepped care for suicide
      prevention intervention for adolescents and young adults, compared to a zero suicide program
      initiated by a health system. An effective zero suicide strategy for this age group is
      critically needed because this is a developmental period when: 1) suicide is the second
      leading cause of death, accounting for more deaths than any medical illness; 2) suicidal
      tendencies and behaviors often first occur in this age span; 3) rates of suicide and suicide
      attempts increase dramatically; and 4) effective intervention can reduce risk, suffering, and
      costs over lifetimes.

      The project combines a partnership with a health system that has strong infrastructure and
      commitment to quality improvement for zero suicide with a research team that has successfully
      implemented collaborative stepped care interventions in health systems and has expertise in
      clinical, health services, economics, and policy research and dissemination. We will identify
      and enroll 300 youths ages 12-24 with elevated suicide and suicide attempt risk using a
      multi-stage screening process. Eligible youths will be randomized to: 1) zero suicide best
      practices, which emphasizes health system quality improvement (ZSQI); or 2) ZSQI plus stepped
      care for suicide prevention, which integrates evidence-based suicide prevention with primary
      care and emergency services. Prior research demonstrates the value of similar integrated
      medical-behavioral health interventions for improving patient outcomes, rates of care, and
      continuity of care- a critical issue for zero suicide efforts, as many youths discontinue
      care prematurely despite continuing risk. The ZSQI plus stepped care for suicide prevention
      approach uses: 1) risk assessments to triage youths to appropriate care levels; 2) care
      managers to deliver cognitive behavior therapy and dialectical behavior therapy skills
      training and support primary care and emergency clinicians with patient evaluation and
      treatment; 3) internet-delivered cognitive-behavior therapy and dialectical behavior therapy
      treatment components plus access to coaching support for lower risk youths, with stepped up
      in-person group and/or individual treatment added for higher risk youths; and 4) regular
      monitoring of patient outcomes, with feedback to clinicians to facilitate decision-making and
      use of the stepped care algorithms. The intervention period is 12 months: 6 months of acute
      treatment; and 6 months of continuation treatment. Results will provide critical information
      for health systems and science regarding the potential to achieve zero suicide goals by
      integrating state of the art science with practice quality improvement.
    

Intervention name(s): Stepped Care for Suicide Prevention; Zero Suicide Quality Improvement
Intervention type(s): Behavioral; Behavioral
Intervention description(s): ZSQI plus Stepped Care for Suicide Prevention; ZSQI
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomization to one of two conditions: 1) Zero suicide Best Practices/Quality Improvement; or 2) Zero suicide Best Practices/Quality Improvement plus stepped care for suicide prevention intervention
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: suicide; suicide attempt; self harm; depression