Adapted Visual Safety Plan for Autistic Youth (VSP-AY) to Address Self-harm, Suicidal Ideation, and Suicide Behaviors

Feasibility as Measured by Recruitment, Completion, and Dropout Rates

Feasibility is evaluated through three key parameters that assess whether the study can be successfully conducted and whether a future definitive trial is warranted: recruitment rate, completion rate, and dropout rate. Together, these metrics provide essential information about the practicality of conducting a larger-scale efficacy trial. Recruitment rate is calculated as the number of participants recruited divided by the number of eligible individuals approached. Detailed tracking includes the number screened, meeting criteria, approached, consenting, and reasons for non-participation. A target of 60% or higher indicates successful recruitment feasibility. Completion rate is calculated as the percentage of enrolled participants completing all procedures (baseline, post-intervention, and follow-up assessments). Tracking includes partial completion patterns to identify where attrition occurs. A target of 70% or higher indicates acceptable retention. Dropout rate is calculated as the p

Acceptability

Acceptability is evaluated through both quantitative and qualitative methods to comprehensively assess stakeholder perspectives on the Visual Safety Plan for Autistic Youth intervention. Satisfaction questionnaires adapted from the Client Satisfaction Questionnaire assess perceived quality, helpfulness, whether the intervention met participant needs, and willingness to recommend the intervention to others or use it again. These questionnaires are administered to youth participants, their caregivers, and mental health professionals who delivered the intervention. Scores range from 8 to 32, with higher scores indicating greater satisfaction.

Acceptability

Semi-structured interviews are conducted with purposive samples of youth participants, caregivers, and professionals to explore experiences in depth. Interview topics include overall experiences with the intervention, perceived benefits and helpful aspects, challenges or difficulties encountered, barriers to implementation, and suggestions for improvement. Interviews are analyzed using a collaborative, reflexive thematic analysis conducted by autistic and non-autistic researchers to identify key themes regarding acceptability and user experience.

Preliminary Effectiveness of Suicidal Ideation

Suicidal ideation is assessed using the Columbia Suicide Severity Rating Scale (C-SSRS), a clinician-administered structured interview that evaluates the severity and intensity of suicidal thoughts. The severity subscale assesses the highest level of ideation endorsed over the past two weeks, ranging from passive wish to be dead without specific suicidal thoughts, through increasingly severe levels including non-specific active suicidal thoughts, suicidal thoughts with a method but without intent, suicidal intent without a specific plan, and suicidal intent with a specific plan. Scores range from 0 (no suicidal ideation) to 5 (active suicidal ideation with specific plan and intent), with higher scores indicating more severe ideation. The intensity subscale assesses frequency, duration, controllability, deterrents, and reasons for ideation. The C-SSRS also evaluates suicidal behavior including actual attempts, interrupted attempts, aborted attempts, and preparatory acts.

Preliminary Effectiveness of Non-Suicidal Self-Injury

Non-suicidal self-injury is assessed using the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), which evaluates deliberate self-harm behaviors without suicidal intent. The tool assesses the presence and frequency of NSSI behaviors over the past two weeks, specific methods used such as cutting, scratching, burning, hitting oneself, head-banging, picking at skin or wounds, or interfering with wound healing. The assessment also examines the functions or motivations for NSSI including affect regulation, self-punishment, anti-dissociation, interpersonal influence, anti-suicide, or sensation seeking, as well as contextual factors such as typical locations on the body and situations that precede NSSI episodes. Lower frequency counts indicate improvement in self-injury behaviors.

Preliminary Effectiveness of

Depression symptoms are assessed using the Children's Depression Inventory 2nd Edition Self-Report Short Form (CDI 2:SR), a standardized 12-item measure designed for youth aged 7-17 years. The measure evaluates depressive symptoms over the past two weeks across cognitive, affective, and behavioral domains. Each item presents three statements representing increasing severity of a symptom, with participants selecting the statement that best describes their experience. The CDI 2:SR generates three scores: the Emotional Problems subscale, assessing sadness, hopelessness, and anhedonia; the Functional Problems subscale, assessing interpersonal difficulties and school problems; and the Total Depression score, combining all items. Raw scores are converted to T-scores based on age and gender norms, with a mean of 50 and standard deviation of 10. T-scores of 60 or above (84th percentile) indicate elevated symptoms, and T-scores of 70 or above (98th percentile) indicate very elevated symptoms.