The SAFETY Program: A Family Intervention for Emergency Departments

the-safety-program-a-family-intervention-for-emergency-departments_medium_smallThe Question
Can engaging family help prevent repeat suicide attempts among youth seen in the emergency department for a suicide attempt?

Few interventions have been shown to be effective in reducing repeat suicidal behavior among youth. One difficulty is engaging the child or adolescent in treatment after a suicide attempt, though in-home visits have been shown to be helpful, and interventions that engage family in the treatment have shown promise.

Dr. Jennifer Hughes and her mentor Dr. Joan Asarnow developed the SAFETY Program, a novel social-ecological treatment that includes cognitive behavioral therapy. The 12-week treatment starts in the emergency department after a suicide attempt and continues in outpatient care. The program includes a youth therapist and a parent therapist, as well as a family component where parents and their children work together to practice skills designed to prevent future suicide attempts.

The Study
The study assessed the SAFTEY Program’s impact on suicidal behavior, as well youth and parent depression, hopelessness and social adjustment.

Thirty-five youth ages 11-18 (mean age 14. 9) participated in the study. Each had made a suicide attempt in the previous three months (mean time <7 days prior) and had a stable living situation. Youth who were experiencing psychosis or who had a substance use disorder were not included. 46 percent of participants reported multiple suicide attempts and 40 percent had a major depressive episode in the past year.

Measures for baseline and 3-month follow-up:

  • Diagnosis: Diagnostic Interview Schedule for Children & Adolescents (NIMH DISC IV)
  • Suicidal behavior:  Columbia Suicide History Form and the HASS I
  • Depression & Hopelessness: Center for Epidemiological Studies –Depression Scale (CES-D) and the Beck Hopelessness Scale
  • Social Adjustment: Social Adjustment Scale- Self –Report for Youth and parent completed Child Behavior Checklist

The treatment
The SAFETY Program has three phases:

  1. Safety and treatment planning;
  2. Skill building through implementation of the treatment plan; and
  3. Consolidation of skills and relapse prevention.

The first session took place in the home when families agreed.


  • Suicidal ideation and behavior were reduced after following the SAFETY Program
    • Suicide attempts after treatment were rare: At three months after treatment one youth had made a suicide attempt; at six months a second youth had made an attempt
    • The Active Suicidal Behavior and Ideation Scale and the Passive Suicidal Ideation on the HASS I decreased significantly
  • Significant improvements in youth hopelessness, parent and youth depression, and social adjustment
  • Four participants were seen in the  emergency department or hospitalized for suicidal ideation
  • Parents and their children were very satisfied with the treatment


  • Interventions that immediately address suicidal behavior bring youth and parents together, and offer skills for managing suicidal ideation and behavior can be effective and are well-received.

Publications from AFSP grant

  • Hughes JL, Asarnow JR.  Enhanced Mental Health Interventions in Emergency Department: Suicide and suicide attempt prevention.  Clinical Pediatric Emergency Medicine 03/2013; 14(1):28–34. DOI:10.1016/j.cpem.2013.01.002.
  • Asarnow JR, Berk M, Hughes JL, Anderson NL. The SAFETY Program: a treatment-development trial of a cognitive-behavioral family treatment for adolescent suicide attempters. J Clin Child Adolesc Psychol. 2015;44(1):194-203. doi: 10.1080/15374416.2014.940624. Epub 2014 Sep 25.

Dr. Hughes is an Assistant Professor in the Department of Psychiatry at the University of Southwestern Texas. Click here to read about Dr. Hughes’s Young Investigator Grant.


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