Preventing youth suicide requires implementing complete care pathways in health systems with evidence-based practices to identify those at risk, stabilize, and connect youth and their families to care. Zero Suicide is a framework to support healthcare systems to successfully implement these practices. A current gap is the need for readily accessible treatments. In an effort to fill this gap, our team created a telehealth risk management intervention for caregivers based on principles of Dialectical Behavior Therapy (DBT), which is an evidence-based approach for decreasing self-harming behaviors (i.e., suicide attempts (SAs), non-suicidal self-injury (NSSI), and self-harm with ambiguous intent).
Our team completed an initial study of this DBT-informed risk management service (RMS) with caregivers of youth who were already connected to outpatient behavioral health services. The initial results showed promise; caregivers demonstrated improved knowledge of how to keep their children safe at home and provided positive feedback. As part of this initial effort, we interviewed providers and leaders in our healthcare system about what is needed to evaluate and implement this intervention with the goal of reaching caregivers in need throughout our healthcare system. The proposed pilot study is the next step in the iterative development of this intervention as we integrate this intervention into our system’s Zero Suicide effort, gather stakeholder perspectives, and explore potential adaptations needed for successful implementation systemwide. We plan to run an open trial where we will review our methods, data, and the intervention with stakeholders and recruit caregivers of youth identified at risk for self-harm throughout our system of care for 3 different rounds of the RMS with the following aims:
Aim 1: Obtain stakeholder input to inform clinical utility and plan for successful implementation. Our stakeholder advisory board includes DBT clinicians, suicide researchers, caregivers and youth with lived experience of DBT and self-harm. They will meet prior to each round of the pilot study to review data and challenges in order to provide input on all aspects of this effort; input will be guided by the RE-AIM implementation framework where the Reach, Efficacy, Adoption, Implementation, and Maintenance are considered to maximize the public health impact.
Aim 2: Iteratively evaluate the acceptability and feasibility of implementing the DBT-Informed RMS. Through study team, interviews with caregiver participants, and system level data, we will evaluate and iteratively improve the acceptability and feasibly of the RMS. We will collect qualitative and quantitative data to describe the reach (referral sources, caregiver and youth characteristics), adoption (referral rates, session attendance), and implementation process (clinician hours, numbers of times safety concerns are address, time and barriers to coordinate with other providers).
Aim 3: Iteratively evaluate the feasibility of measuring clinically significant mechanisms and outcomes. Through surveys and interviews with youth and caregivers we will collect data to evaluate the feasibility of our methods to evaluate the efficacy of our DBT-informed caregiver RMS. Our methods include measurement of the hypothesized mechanisms of change (increase caregiver knowledge and caregiver-child connection) and clinically meaningful outcomes (decrease repeated youth self-harm and crisis service use).
