Plan and Protect: Safety Planning for Teens in Rural Emergency Departments

ConditionsSuicide Ideation Suicide Attempt

Trial statusRecruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexAll

Age12+

SponsorDartmouth-Hitchcock Medical Center

About this trial

The goal of this observational study is to determine whether implementing a culturally sensitive, tablet-based safety planning program called Plan \& Protect (P\&P) within rural emergency departments can improve home safety and reduce suicide risk in adolescents presenting to the emergency department with suicide-related concerns.

The main questions it aims to answer are:

* Will implementing P\&P increase caregiver-reported home safety (reduce access to firearms and unsafe medication storage) for adolescents 12-17 years old presenting to rural EDs with suicidal ideation, self-harm, or mental health crisis? * Will implementing P\&P decrease adolescent-reported perceived suicide risk and related outcomes (e.g., suicide events, and attendance at follow-up mental healthcare)?

Researchers will compare outcomes for adolescents and caregivers receiving P\&P (implemented as the new standard of care at sites during the intervention periods) to those receiving usual care (prior to P\&P implementation at those hospitals) to see if P\&P increases home safety and decreases suicide risk and related healthcare utilization.

Participants will, if clinically appropriate:

* Complete the tablet-based P\&P modules during their ED visit * Complete self-report measures at baseline, \~30 days, and \~3 months post-discharge * A subset will also participate in semi-structured interviews

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

12-17 years of age (and their parent/caregiver(s))

Ability to speak and complete surveys in English

History of emergency department visit for suicidality, self-harm or mental health crisis

Medically stable

Disqualifiers

Cognitive or developmental delays that preclude program participation based on clinical team assessment

Diagnosis of psychosis

Primary diagnosis of an eating disorder

Parent/guardian not able to provide consent in English

Trial design

Design model

Parallel

Treatments tested in this trial

Plan & Protect safety planning intervention
Behavioral
Plan and Protect (P\&P) is a tablet-based, family-centered quality improvement program targeted to rural Northern New England that combines a youth-facing safety-planning module with a caregiver-facing home safety decision aid and youth safety information. The goal is to help adolescents and their caregivers develop concrete, culturally-sensitive safety plans during emergency department visits.
Care as usual
Behavioral
Adolescents and caregivers will receive treatment as usual at the Emergency Department.

Treatment groups

550 Participants

are divided into 2 treatment groups

Group A: Plan & ProtectExperimental treatment 1 intervention

Group B: Care as usualOther 1 intervention

Trial outcomes

Primary outcomes

Improved Home Safety (caregiver)

Reduced access to firearms and medications at home. This will be collected with five questions about presence of medications and firearms at home, if they are stored unlocked, and if firearms are loaded. We will measure improvement in safety across the time frame.

Time frame

30 and 90 days after ED visit

Suicide Risk (youth)

The Concise Health Risk Tracking (CHRT) is a 9-item survey that assesses suicidal thoughts and behaviors in the past week, with response options ranging 0-4. Total scores range 0-36, with higher scores indicating more severe suicidality. Primary outcome will be assessed relative to the baseline assessment assessed at the time of study enrollment.

Time frame

30 and 90 days after ED visit

Secondary outcomes

Suicide Events (youth)

A composite measure that includes suicide deaths (ascertained by family report and electronic health record (EHR) review), return ED visits and/or rehospitalization for suicidality (ascertained using survey and EHR review), and suicide attempts (evaluated using four questions from the Youth Risk Behavior Survey augmented by structured EHR review).

Time frame

30 and 90 days after ED visit

Attendance at Follow-up Mental Healthcare (youth and caregiver)

Any mental or emotional health care received after their emergency department visit using a checklist adapted from nationally administered healthcare utilization surveys, augmented by EHR review. Survey response categories (primary care, mental health provider, outpatient/urgent care, emergency department, school based care) were derived from health service use domains captured in the Medical Expenditure Panel Survey.

Time frame

30 and 90 days after ED visit

Reduced Access to Firearms at Home (caregiver)

Improved home safety with respect to firearm access. This will be collected with three questions about presence of firearms at home, if they are stored unlocked, and if they are loaded. We will measure improvement in safety across the time frame.

Time frame

30 and 90 days after ED visit

Reduced Access to Medications at Home (caregiver)

Improved home safety with safer storage of medications. This will be collected with two questions about presence of medications at home and if they are stored unlocked. We will measure improvement in safety across the time frame.

Time frame

30 and 90 days after ED visit

Other outcomes

Change in Efficacy to Cope with Suicidal Thoughts and Urges Scale (primary target mechanism)

The Efficacy to Cope with Suicidal Thoughts and Urges Scale was designed to measure children's abilities to manage suicide-related thoughts and impulses. It contains 10 coping skills and children rate their confidence in their ability to use each coping skill to manage their suicidality. Responses range from 0 to 10 with 0 = Not at all confident, 5 = Somewhat confident, and 10 = Extremely confident.

Time frame

30 and 90 days after ED visit

Change in Parental Perceptions of Teen Suicide Risk (secondary target mechanism)

This 3-item measure looks at parental understanding of their teen's suicide risk. Answer choices range from 0 (not at all confident) to 10 (completely confident), with an anchor of 5 (somewhat confident).

Time frame

30 and 90 days after ED visit

Change in Patient Perceptions of Their Own Suicide Risk (secondary target mechanism)

This 3-item self-report measure examines how at risk a patient believes they are. It is scored on a 5-point Likert from 0-4 where higher = greater perceived risk and has a total possible score of 15.

Time frame

30 and 90 days after ED visit

Change in Parental Self-Efficacy to Support Teens During a Suicidal Crisis (secondary target mechanism)

This 9-item scale measures parent confidence regarding their ability to engage in activities to prevent or assist their child in managing a suicidal crisis. Answer choices range from 0 (not at all confident) to 10 (completely confident), with an anchor of 5 (somewhat confident).

Time frame

30 and 90 days after ED visit