Swift Outpatient Alternatives for Rapid Stabilization
University of Washington
Summary
The goal of this clinical trial is to improve the effective outpatient management of acute youth suicide risk by optimizing intervention components to build an efficient, evidence-based intervention that is responsive to the needs of, and coordinated with, providers in primary care settings. The main questions are: 1. What is the strongest combination of SOARS components associated with reduction in youth suicidal thoughts and behavior (STB)? 2. Do age and STB history moderate the impact of the effects of the SOARS intervention components? 3. Do therapeutic alliance, youth and caregiver self-efficacy account for changes in youth STBs? 4. What helps medical outpatient providers refer to SOARS and continue care after SOARS?
Description
The investigators are comparing different treatment sequences for suicidal thoughts and behaviors. The treatment package families are assigned will be determined by randomization. All participants will receive 1 session of Collaborative Assessment and Management of Suicidality (CAMS) and care management. CAMS treatment primarily focuses on working with a therapist to understand the reasons why the participants are thinking about suicide Additional components which the participant may be randomly assigned to receive include coping skills training for youth, skills training for parents, and add…
Eligibility
- Age range
- 13–21 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Acute suicidal thoughts or past month suicide attempt as reported on positive responses to the Ask Suicide Screening Questionnaire (ASQ), Exclusion Criteria: * urgent medical care secondary to self-injurious behavior, psychosis, eating disorder that requires full or partial inpatient care, or * intellectual disability warranting a different treatment pathway; * limited English, Spanish, Vietnamese, or Chinese proficiency that would interfere with ability to complete study assessments; * unwillingness to participate in psychotherapy, * caregiver unwilling or ineligible…
Interventions
- BehavioralCAMS Single Session Consultation
CAMS is a clinical intervention designed to modify how clinicians engage, assess and plan treatment with suicidal patients. The foundational brief intervention that all participants will receive includes 1 90-minute session of CAMS assessment and planning interview with follow-up care navigation. CAMS is based around a model of STB which states that youth become suicidal in response to overwhelming pain, and treatment identifies and targets the drivers of suicide as the primary focus of assessment and intervention.
- BehavioralDriver Focused Skills Training
The CAMS approach focuses on therapeutic assessment, collaborative identification and treatment of the patient-defined STB drivers (i.e., the problems that make suicide compelling to the patient) and utilizes problem-focused treatment sessions to address the drivers in order to reduce the wish to die. In the SOARS brief intervention model, specific skills are taught to youth based on CAMS drivers/case conceptualization of suicidality.
- BehavioralCaregiver Skills Training
Caregivers will receive 3, 30-minute modules across 3 sessions that provide explicit coaching in several skills adapted from evidence-based treatments for youth suicidality including DBT and CBT.48,49 Module content will include 1) psychoeducation on suicidality and the escalation cycle and creation of a communication plan related to responding to youth suicidality (i.e., Crisis Escalation and Communication Plan); 2) positive communication and relationship building strategies including reflective listening, validation, and how to implement regular teen-directed one-on-one time; and 3) setting up behavioral expectations, house rules, and using positive reinforcement based contingency management in the home (i.e., targeted praise, using rewards to promote more effective behaviors). All modules will include didactic skill building, role-play of skill use with the therapist, and a check-in with the youth and youth therapist to collaboratively problem-solve barriers to use of skills.
Location
- Seattle Children'sSeattle, Washington