Suicide is a major public health concern in the United States, with more than 1.4 million adults attempting suicide and nearly 50,000 adults dying by suicide each year. The launch of the national 3-digit 988 Suicide \& Crisis Lifeline in 2022 has strengthened the crisis care system by emphasizing the need for people in crisis to have someone to call, someone to respond, and somewhere to go. Community-based Crisis Stabilization Centers (CSCs) are an important part of the crisis care system, providing short-term crisis stabilization services and an alternative to Emergency Department care. However, suicide risk can remain high after discharge from CSCs, and no brief, effective, recovery-focused interventions are currently available for this setting.
This study will evaluate the effectiveness of THRIVE (Toward Hope, Recovery, Interpersonal Growth, Values, and Engagement) in CSCs. THRIVE is a recovery-focused intervention designed for adults receiving care for suicide risk . THRIVE includes one 60-minute psychotherapy group (focused on belonging, giving, meaningful living, and recovery) delivered during the CSC stay and up to six peer-led recovery coaching calls during the weeks following discharge.
This multi-site Hybrid Type 1 randomized effectiveness-implementation trial will enroll 552 participants and compare care as usual (CAU) in CSCs to CAU plus THRIVE (CAU + THRIVE). The primary purpose of this study is to determine whether THRIVE reduces suicide risk events (SREs) following CSC discharge, including crisis care re-admissions, escalation to higher levels of care, suicide attempts, and suicide deaths. The study will also examine barriers and facilitators that may influence the adoption and implementation of THRIVE in community-based crisis settings.
Admission to CSC with suicidal crisis, as defined by active suicide ideation ascertained by the Columbia Suicide-Severity Rating scale (C-SSRS), which the sites already routinely administer
Ability and willingness to provide information and permission to contact at least one person in case of emergency or inability to reach the participant for follow-up.
Under age 18.
Inability to communicate with the researcher in English.
Acute psychiatric instability (e.g., psychotic symptoms) prohibiting participation in psychotherapy.
Parallel
Toward Hope, Recovery, Interpersonal Growth, Values, and Engagement (THRIVE)
BehavioralToward Hope, Recovery, Interpersonal Growth, Values and Engagement (THRIVE), is a brief, suicide-specific, narrative, recovery-focused, 60 minute group psychotherapy intervention followed by up to 6 peer-led recovery coaching phone calls. THRIVE includes five components: 1) Creating a Safe Space for Disclosure; 2) Psychoeducation on Suicide Recovery; 3) Sharing the Suicide narrative; 4) Completing the Meaningful Living Plan; 5) Taking Action on the Meaningful Living Plan in the Community.
Center Care as Usual
BehavioralCare as Usual in the Crisis Stabilization Centers includes medication management, the safety planning Intervention, individual counseling, group psychoeducation, discharge planning, and community referral linkages.
Total Suicide Risk Events (SREs) per Arm
The primary outcome, total Suicide Risk Events (SREs), is a participant's aggregate number of crisis care contacts and events for suicide risk (e.g., crisis re-admissions, escalations, suicidal behaviors including suicide attempts, suicide deaths) in the 12-months post-discharge. The investigative team will discover post-discharge events via: 1) Participant follow-up surveys, including the Columbia Suicide Severity Rating Scale; 2) Electronic Health Record data; 3) Claims data. Blinded, trained, reviewers will apply a pre-set codebook with adjudication rules to determine whether post-discharge events are suicide-related or non-suicide related. Afterward, the unduplicated SREs from all sources up to 12 months post-discharge will be summed to calculate the total SREs for a participant, a count outcome measure.
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University of Alabama at Birmingham
Lead sponsor
National Institute of Mental Health (NIMH)
Collaborator
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