Rates of suicide among adolescents has consistently increased over the past 10 years. Currently, suicide is the 2nd leading cause of death in adolescents. Family adhesion and cohesion are protective factors, highlighting the value of family in suicide prevention. Currently, there are no identified evidence-based psychiatric inpatient treatments that have been found to reduce the frequency of suicide-related behaviors or attempts subsequent to discharge. As such, there is a critical need for the development and testing of intensive brief family-based treatments for suicidal adolescents that are suitable for delivery in acute psychiatric care settings.
The Family-Based Crisis Intervention (FBCI) is a single-session intervention designed to provide adjunctive treatment for suicidal adolescents and their families at the time of crisis. It has been tested in open, randomized clinical, and transportability7 trials based in Emergency Department settings; results show that, compared to treatment as usual (TAU) counterparts, suicidal adolescents receiving FBCI were more likely to be discharged home and less likely to return to the ED for psychiatric concerns during the follow up period. In addition, families randomized to FBCI reported significantly higher levels of family empowerment and satisfaction with care compared to TAU.
The overarching goals of the proposed research are to 1) adapt FBCI for use in inpatient psychiatric settings (FBCI-IP) and 2) pilot test FBCI-IP via a randomized clinical trial (RCT).
The proposed mixed-methods research will be conducted in two phases. Through a formative process evaluation in Phase I, the Investigative Team will explore perspectives of 45 key stakeholders (e.g., patients hospitalized for suicide attempt, their family members, direct service providers, front-line staff, and leadership) on their experiences of receiving and providing care in inpatient settings, with particular attention to family engagement and participation in treatment. Using these findings, we will use the Planned Adaptation Framework (PAF) to adapt of FBCI for use in inpatient psychiatric settings (FBCI-IP) and develop tailored protocols that proactively address any anticipated barriers to implementation. In Phase II, we will pilot test FBCI-IP with N=40 suicidal adolescents and their families through a randomized clinical trial (expected; N=40), focusing particular attention on safety, feasibility, and utility of FBCI-IP. Patient and family outcomes include suicidal behavior, family communication, family empowerment, and satisfaction with care. We will also prospectively collect data on feasibility, acceptability, and appropriateness of FBCI-PC from clinicians. Systems-level outcomes include ED visits and psychiatric readmission during the three-month follow-up period.
Findings from this study will provide evidence of feasibility, acceptability, appropriateness, and preliminary efficacy of FBCI-IP; yielding preliminary pilot data for a larger multisite pragmatic RCT. With its focus on inpatient care and family inclusion, this research is directly aligned with the AFSP mission and specific strategies related to community and stakeholder engagement and translational research. In addition, research on this brief and easily adaptable intervention, addressing a specific gap in current acute inpatient care, is consistent with the Zero Suicide Framework to better equip healthcare systems to prevent suicide and several NIMH and National Action Alliance for Suicide Prevention priority areas.
