Optimizing Suicide Prevention Strategies for Pediatric Primary Care
Purpose
Increasing rates of suicidal thoughts and behaviors among adolescents must be addressed. The study will adapt and collect preliminary effectiveness data on a digital suicide prevention intervention that can be delivered in pediatric primary care settings by front line pediatricians. The study has the potential to offer a low-cost and scalable primary care intervention that may decrease risk of suicide among at-risk youth.
Conditions
- Suicidal Ideation
- Suicidal and Self-injurious Behavior
- Depression
Eligibility
- Eligible Ages
- Between 12 Years and 17 Years
- Eligible Sex
- All
- Accepts Healthy Volunteers
- No
Criteria
Youth Inclusion:
- 12-17 years old
- Parent/legal guardian consents for youth to be in study
- English fluency and literacy-own a smart phone or device
- PHQ-9M score indicating moderate or severe depression or suicidal ideation in past
month, past 2 weeks, or an attempt in their lifetime
Caregiver/Parent inclusion:
-English fluency and literacy
Youth Exclusion:
- evidence of intellectual delay
- pervasive developmental disorder
- other condition from medical history that would prohibit comprehension of questions
or modules
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Sequential Assignment
- Intervention Model Description
- This study will utilize a stepped wedge design in which 4 PROS practices start with usual care initially and are randomly chosen to transition to iCHART-cASAP at different times in such a way as half of the participants will receive TAU and half will receive iCHART-cASAP. All sites will be initially monitored for at least 3 months during TAU. This will be followed by a staggered adoption of iCHART-cASAP. At each time period, a new site will begin implementing the intervention. Block randomization determines the order each site begins the intervention phase. Each time period (approximately 3 months), a web-based system will be used to assign the next clinic to begin using iCHART-cASAP. Research staff will be available to assist with consenting participants and assisting with study procedures.
- Primary Purpose
- Prevention
- Masking
- Double (Investigator, Outcomes Assessor)
- Masking Description
- The assessor and the investigator will be blinded to whether or not the participant received the iCHART/cASAP intervention or if they are receiving treatment as usual.
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental iCHART/cASAP |
An intervention previously studied in the ETUDES Center along with a computerized version of our As Safe As Possible intervention. 1. Safety Planning App for suicidal youth which enables a primary care provider to streamline the gold standard of care for those with current suicidality symptoms through an app; 2. Mental Health Screener questionnaire that gathers additional mental health symptoms, treatment preferences, and family's readiness for treatment engagement to help a primary care provider make a personalized, tailored treatment plan a suicidal youth is more likely to adhere to; 3. Text Messages which aims to provide texts for 2-3 weeks to motivate you to engage with the safety plan and recommended treatment following the patient visit. 4. cASAP is a computerized version of the As Safe As Possible intervention that offers self-led modules with psychoeducation about safety planning, cognitive-behavioral skills to cope with distress, and facilitate collaboration with parents. |
|
|
Active Comparator Treatment as usual |
When patients disclose suicidal ideation on the PHQ-9, a treatment as usual approach will be given to the patient and their parent by the pediatrician which includes a paper safety plan will be completed and given to the patient and a referral placed for the patient to begin behavioral health services. |
|
Recruiting Locations
More Details
- Status
- Recruiting
- Sponsor
- University of Pittsburgh
Detailed Description
The study proposed is a treatment development study to enhance the capacity of pediatric primary care (PPC) to identify and manage suicidal youth by adapting iCHART for PPC settings that lack onsite behavioral health (BH) providers. Stepped Wedge Cluster Randomized Pilot Trial: Conduct a stepped wedge cluster randomized pilot trial of iCHART-cASAP vs. usual care across 4 PROS practices (across urban, suburban, and rural settings). Up to 20 providers (up to 5 providers per practice) will be enrolled. Following a 3-month baseline period when all practices provide usual care, practices will be randomized to onset to offering the intervention at one of the four, 3-month intervention onset intervals. Each practice will enroll a total of 15 youth across the 15-month pilot trial period for a total of 60 youth. 30 youth will receive usual care and 30 youth will receive iCHART-cASAP. Delivery of Intervention Intervention will be delivered to adolescent patients and their caregivers receiving services at pediatric primary care practices within the PROS network.When PPC providers are assigned to the usual condition, patients will receive usual practices following identification of suicide risk on the PHQ-9-M. When PPC providers have crossed over to the iCHART- cASAP intervention condition, patients who are identified as suicidal will receive links from PPC providers/office staff to complete cASAP + onboard BRITE app to receive the safety planning and skills training intervention for adolescent and parent/caregiver. Once that is completed, PPC providers receive a summary report and review the safety plan with the patient and parent/caregiver, making revisions as needed. The provider then reviews treatment plan, including behavioral health referrals and schedules follow-up appointment. Next, the PPC provider/office staff enters referral recommendations and follow-up appointment reminders into iCHART's Text2Connect feature, which will increase engagement with the safety plan and facilitate adherence with treatment recommendations. Providers will approach patients and parents/caregivers about the research study during their office visit, and interested families will complete a permission to contact form for research staff. Research staff will contact and describe the study, answer any questions, and obtain parental consent/youth assent. Sample Size and Power Considerations Once usability testing is complete, 60 participants will be recruited from 4 practices randomized to begin utilizing iCHART during one of the 3-month intervention intervals. At the end of the trial, 30 participants will be enrolled when practices were delivering usual care and 30 participants will be enrolled when practices were delivering iCHART- cASAP. Sample size and power considerations center on the precision of confidence interval (CI) width estimation for feasibility outcomes. Based on best practices for feasibility studies, and given the sample size of 60 and 5% type I error rate, there is ability to estimate 95% confidence interval with margin-of-errors ≤0.33 for the primary outcomes of depression and suicidal thoughts and behaviors.
