Pilot Study of a Modified Safety Planning Intervention for Elementary School-aged Children

Background: Suicide rates in children have been rising in recent years, emphasizing the need for an evidence-based suicide prevention intervention appropriate for children. The Safety Planning Intervention (SPI) is a brief, evidence-based and personally tailored intervention created in collaboration with the patient. As such, the SPI could also be a good fit for pre-adolescent children. However, it requires modifications for the unique characteristics of this age group. The proposed project is the next step in the development of this modified intervention - to finalize the protocol for the Child-SPI (C-SPI), using an in-depth understanding of the suicide crisis in children, and collect data to assist in planning a large-scale study evaluating C-SPI's efficacy. Specific Aims: 1. To create a C-SPI that will be appropriate for 6-12 years old children; 2. To create a C-SPI that will answer the needs of suicidal children's caregivers; 3. To examine the feasibility and acceptability of the C-SPI among children and their caregivers, as well as its clinical utility, safety, and preliminary efficacy; 4. To explore whether reminders to use the C-SPI (daily Ecological Momentary Assessment (EMA) reports of events and the use of the C-SPI) affect its utilization over 1-month; 5. Collect data that will inform the planning of future larger Randomized Control Trial and to evaluate the feasibility of recruitment from the high suicide risk population of this age, its randomization and follow-up assessment. Method: The study will be comprised of two sub-studies and one main study. Sub-study 1 will include 14 children who will be administered the C-SPI to evaluate their understanding of the intervention. Sub-study 2 will include interviews with parents of 10 suicidal children to better understand their experience and needs. The main study sample will include 90 6-12-year-old children who had suicidal thoughts/threats or behaviors in the last month. Children will be randomized into the C-SPI+TAU vs. C-SPI+TAU+EMA vs. TAU only groups. All participants will be assessed at baseline and 1- and 3-month follow-up meetings. Parents of children in the C-SPI+TAU+EMA will also report their experience with the C-SPI in a 1-month daily EMA. Children will be interviewed at baseline regarding their perception of death and suicide. Assessment at baseline and follow-ups will include the Columbia-Suicide Severity Rating Scale and report of utilization of mental health services. Additionally, the C-SPI groups will fill measures of feasibility, acceptability and utilization of the C-SPI. Impact and next steps: This project will result in a C-SPI protocol that will advance research-informed suicide prevention policy and guidance for children. The results will help create a large-scale study to evaluate the efficacy of the C-SPI in reducing suicidal ideation and behaviors in children. In addition, as this is the first RCT with elementary school aged children at high risk for suicide, it will provide critical data on the feasibility of multiple aspects of an intervention study in this population, which will inform future intervention studies.