More than 5.3 million individuals at risk for suicide seek treatment through emergency departments (EDs) each year despite the fact that EDs are not well suited for their care. Crisis Stabilization Centers (CSCs) have been proposed as a person-centered alternative to EDs. More than 600 CSCs nationwide operate 24 hours per day, accept walk-ins, provide care regardless of ability to pay, and partner with local law enforcement to divert suicidal patients from EDs. However, research outcomes on CSCs are mixed, likely associated with the fact that brief, recovery-oriented interventions with the potency to decrease suicide attempts and deaths are needed in CSCs but do not exist. Toward recovery, hope, recovery, interpersonal growth, values, and engagement (THRIVE) is a 60 minute intervention developed by the Principal Investigator and CSC stakeholders. THRIVE is uniquely tailored to CSC workflows and helps guests increase hopefulness, make meaning from stressful life events, and promote self-efficacy to prevent suicide attempts. In THRIVE, the guest is asked to narrate the suicide crisis, make meaning of the crisis through building an autobiographical timeline, and construct actionable future goals through an building an interactive meaningful living plan. THRIVE is conducted via a tablet so that all materials can be saved electronically in a HIPAA-compliant cloud to support providers in collaborating on care goals during and after discharge. The goal of this project is to fill a critical gap in the crisis stabilization literature by testing THRIVE as a novel solution to maximize the effectiveness of CSCs. Our study will address the following aims: 1) Examine the feasibility, acceptability, and ecological validity of THRIVE as a unique fit for CSC guests (n = 30) and staff; 2) Conduct a pilot randomized trial (n = 150) to examine the degree to which THRIVE engages proposed recovery-oriented mechanisms of change relevant to the unique treatment philosophies of CSC settings; 3) As part of the pilot randomized trial, compare the outcomes of THRIVE + UC to the outcomes of UC delivered in the CSC (i.e., on recovery orientation, suicidal ideation, resolved suicide plans and preparation, treatment engagement, and acute psychiatric re-admissions). In Phase I (Aim 1), Participants will be administered quantitative surveys after experiencing the THRIVE intervention. In Phase II (Aims, 2-3), participants in the RCT will be administered surveys at baseline, discharge, 1 month follow-up, and 3-month follow-up time points. CSCs represent the future of suicide-specific care and THRIVE is a novel intervention with the potential to impact more than 5.3 million individuals in a highly lethal group — suicidal individuals seeking care at EDs diverted to CSCs. This mentored, Young Investigator Innovation Grant, will allow the PI to build on her past programmatic grants, post-doctoral fellowship in suicide research, and experience as the CEO of the nation's largest nonprofit behavioral health organization, to launch a program of research focused on testing suicide-prevention interventions in community-based CSCs.
