Although suicide rates for children under the age of 12 are increasing,2 and approximately 13 percent of 9- and 10-year-old children report that they have experienced suicidal thoughts,1 there are currently no evidence-based suicide prevention approaches for children under the age of 10. Current clinical practice with elementary-aged children who experience suicide risk often includes safety planning due to the efficacy of this approach with older age groups; however, there is no substantive evidence to support this practice. It is highly important to create, test, and implement a developmentally sensitive safety planning approach for this age group.
The purpose of the proposed project is to design and test the feasibility and acceptability of safety plans that are specialized to fit with the cognitive and emotional development of elementary-aged children. This project will be led by Dr. Katherine Sarkisian, a clinical psychology postdoctoral fellow with extensive training in developmental psychopathology and youth suicide prevention, and will be mentored by Dr. Jennifer Hughes, who has internationally recognized expertise in designing, evaluating, and implementing cognitive-behavioral interventions for child and adolescent suicidality. Co-Investigator Menendez is a developmental psychologist who studies influences on children’s understanding of death and pedagogical approaches to teaching scientific concepts to children. Co-Investigator Donna Ruch has extensive experience with analyzing epidemiological trends related to child suicide and will guide purposive sampling to reflect differences in risk across age, racial, and ethnic groups for qualitative interviews and pilot testing. Co-Investigator Guy Brock specializes in statistical aspects of feasibility studies and clinical trial planning.
First, an expert workgroup comprised of developmental psychologist Consultant Laura Hennefield, clinical psychologist Consultant Martha Tompson, and clinical psychologist Consultant Kelly Green will collaborate with a caregiver workgroup (i.e., meetings alternating between these workgroups) to refine a child safety plan intervention template (Aim 1). Six child-caregiver dyads will give qualitative input, which will be integrated in an intervention finalization meeting with both workgroups (Aim 2). Pilot testing will be conducted to assess the specialized safety plan (Aim 3), which is expected to be viewed as acceptable and feasible by children, caregivers, and providers. Consultant Green has substantial experience with implementing and evaluating safety planning interventions and will give input on assessing and adapting safety plan content. This intervention is hypothesized to yield preliminary improvements in caregivers’ self-efficacy to manage their child’s suicidality, children’s comprehension and use of safety plan content, and children’s openness to help seeking. These gains are expected to be maintained at a one-month follow-up. Hundreds of children in the age range for the proposed project are seen in the Nationwide Children’s Hospital outpatient crisis clinic each year for suicidal thoughts and behaviors, making the proposed project highly feasible.
Evidence of the acceptability, feasibility, and preliminary efficacy of specialized safety plans for elementary-aged children would help to address an urgent need for evidence-based suicide prevention interventions for young children and lay the groundwork for a larger trial regarding the efficacy of this intervention.
