An Implementation Pilot of Delivering BCBT for Suicide Prevention on an Adolescent Inpatient Unit

Suicide is the second leading cause of death among U.S. teenagers. One of the highest risk times for a teenager to attempt or die by suicide are the weeks and months following psychiatric hospitalization, yet there is a dearth of evidence-based interventions for inpatient adolescent care. Those that have been developed have had limited implementation, in part due to implementation barriers like the time and resource intensity of existing interventions. This project addresses this critical gap by conducting the first pilot evaluation of Brief Cognitive Behavioral Therapy for Suicide Prevention adapted for adolescent inpatients (BCBT-IA). BCBT is an effective suicide prevention therapy, and in adult inpatients is associated with a 60% reduction in suicide attempts in the 6 months following discharge. No systematic adaptation, however, of BCBT has yet been designed or evaluated for adolescents. This study will examine the potential of BCBT-IA as an inpatient intervention with adolescents within a safety-net hospital system that serves linguistically, culturally, and socioeconomically diverse youth. We will explore BCBT-IAs potential for feasibility, acceptability to young people and inpatient staff, and potential barriers to and facilitators of its implementation and a future hybrid implementation-effectiveness trial.

Aim 1 is an open trial to assess the feasibility and acceptability of BCBT-IA in a safety-net hospital. 30 12- 17 year-olds with history of suicidal thoughts or behaviors will complete up to 4 sessions of BCBT-IA during their admission. Participants will then complete a semi-structured interview with a research assistant, contributing to the iterative adaptation of BCBT-IA and completing implementation measures. We hypothesize that at least half of eligible adolescents will choose to participate and 70% will rate it as acceptable and feasible. Exploratory hypotheses will explore any change to suicidal thoughts and behaviors compared to pre-treatment and if attendance at 7-day post-discharge follow up is improved compared to overall inpatient unit average.

Aim 2 is to evaluate the implementation potential of BCBT-IA through interviews with 20 clinical staff and administrators. Semi-structured interviews will be guided by implementation frameworks and explore their perspectives on the feasibility, acceptability, and implementation potential of BCBT-IA in a safety-net setting. Staff will also complete implementation measures. Research questions will include how staff and administrators perceive BCBT-IA, its appropriateness of fit, and the barriers and facilitators to both implementation and a future hybrid implementation-effectiveness trial.

This study has strong potential to advance suicide prevention science. If BCBT-IA is found to be feasible and acceptable in this setting, it will provide a critical foundation for a fully powered, hybrid effectiveness-implementation trial. Through this research program we aim to increase the availability of effective suicide prevention psychotherapy to diverse youths, reducing suicide mortality and improving health equity. Additionally, findings will offer essential learnings on the implementation of evidence-based suicide prevention treatment in safety-net settings. This study aims to support the translation of evidence-based care into practice for high-risk youth and aligns with AFSPs goals for research directly targeting reduced mortality from suicide.