Adapting the Suicide Safety Planning Intervention for Delivery to Adolescents in Mozambican Primary Care Settings
Condition: Suicide; Adolescent Behavior
MeSH terms: Suicide
Study type: Interventional

Summary: 
      Globally, suicide is ranked as the second leading cause of death for youth ages 10-24 years,
      and more than 75% of all deaths by suicide occur in low- and middle-income countries (LMIC).
      However, the vast majority of adolescents in LMIC do not have access to mental health care,
      and contextually appropriate strategies for delivering evidence-based interventions for
      managing suicide risk are needed to expand services to these areas. In the present study, the
      investigators will adapt and pilot test the Suicide Safety Planning Intervention for
      Adolescents (SPI-A) delivered by primary care providers in Mozambique, an LMIC in
      southeastern Africa.
    

Detailed description: 
      The investigators will provide a day-long training in SPI-A to 12 adolescent healthcare
      providers at 2 primary care clinics. Following the training, the providers will participate
      in a workshop with the research team to adapt SPI-A to their clinic setting, focusing on any
      SPI-A content modifications required for local adolescents (e.g. relevant examples of suicide
      risk warning signs), developing procedures for safe management of adolescents with imminent
      suicide risk in their clinic, strategies for engaging caregivers, and follow-up procedures.
      Providers will then be certified in SPI-A following 6-weeks of supervision.

      After providers are certified in SPI-A, the intervention will be pilot tested in their
      primary care facilities. Providers will use a standardized questionnaire to screen included
      adolescents for suicide risk at the end of their clinic visit. Adolescents with moderate risk
      will receive the SPI-A intervention from the provider. Adolescents with high risk will be
      immediately taken to the mental health specialist (psychologist or psychiatrist) at the
      primary care clinic. Enrollment of participants will continue until each of the 12 primary
      care providers has completed SPI-A with 2 adolescents (n=24 adolescents completing SPI-A in
      total). Based on previous research exploring the prevalence of suicide risk in this
      adolescent population, the investigators anticipate needing to include 200 adolescents in
      total to be screened for suicide risk to identify 24 with moderate risk that will participate
      in SPI-A. Following completion of the pilot, the investigators will interview all included
      providers as well as 18 adolescents who participated in SPI-A and their caregivers. The goal
      of the trial is to determine 1) how primary care providers feel about delivering SPI-A, 2)
      how adolescents feel about participating in SPI-A, and 3) whether SPI-A results in reduced
      suicide risk levels in Mozambican adolescents.
    

Intervention name(s): Suicide Prevention Intervention for Adolescents
Intervention type(s): Behavioral
Intervention description(s): Suicide Safety Planning Intervention (SPI). SPI is a very brief intervention (20-45 minutes) that provides patients with specific strategies to use to decrease the risk of suicidal behavior. SPI begins with psychoeducation about suicide risk, then the clinician and patient collaboratively create a stepwise plan that includes a simple list of individually tailored, concrete coping mechanisms to be enacted during or leading up to a crisis. The steps of the safety plan include: 1) recognizing warning signs of a crisis; 2) employing internal coping strategies; 3) using social contacts and settings to distract from suicidal thoughts; 4) seeking help from family members or close friends; 5) contacting healthcare or emergency services; and 6) reducing access to means. SPI providers work with caregivers to help them monitor warning signs of suicide risk, encourage the use of the safety plan by their adolescent, and reduce access to lethal means in the home.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention