Development & Implementation of Culturally Sensitive Safety Planning to Reduce Suicide Risk in Adolescents Seeking Care in Rural Emergency Departments
Dartmouth-Hitchcock Medical Center
Summary
The goal of this observational study is to determine whether implementing a culturally sensitive, tablet-based safety planning program called Plan \& Protect (P\&P) within rural emergency departments can improve home safety and reduce suicide risk in adolescents presenting with suicidality. The main questions it aims to answer are: * Will implementing P\&P increase caregiver-reported home safety (reduce access to firearms and unsafe medication storage) for adolescents 12-17 years old presenting to rural EDs with suicidal ideation, self-harm, or mental health crisis? * Will implementing P\&P decrease adolescent-reported perceived suicide risk and related outcomes (e.g., suicide events, and attendance at follow-up mental healthcare)? Researchers will compare outcomes for adolescents and caregivers receiving P\&P (implemented as the new standard of care at sites during the intervention periods) to those receiving usual care (prior to P\&P implementation at those hospitals) to see if P\&P increases home safety and decreases suicide risk and related healthcare utilization. Participants will, if clinically appropriate: * Complete the tablet-based P\&P modules during their ED visit * Complete self-report measures at baseline, \~30 days, and \~3 months post-discharge * A subset will also participate in semi-structured interviews
Description
One-in-five children and adolescents in the United States (US) live in rural areas where they are more likely to live in poverty, have neurodevelopmental, behavioral and mental health conditions, and die during childhood than their urban-residing peers. Suicide is a leading cause of childhood mortality, and rural-residing youth are two times more likely to die from suicide than urban-residing youth. Nearly half of children and adolescents with mental health conditions do not receive treatment, and those in rural areas face unique barriers to care due to geographic isolation, stigma, and shorta…
Eligibility
- Age range
- 12–17 years
- Sex
- All
- Healthy volunteers
- No
Inclusion criteria for children: * 12-17 years of age (and their parent/caregiver(s)) * Ability to speak and complete surveys in English * History of emergency department visit for suicidality, self-harm or mental health crisis * Medically stable Exclusion criteria for children: * Cognitive or developmental delays that preclude program participation based on clinical team assessment * Diagnosis of psychosis * Primary diagnosis of an eating disorder * Parent/guardian not able to provide consent in English * Clinical team concern for patient or staff safety based upon active behavioral concer…
Interventions
- BehavioralPlan & Protect safety planning intervention
Plan and Protect (P\&P) is a tablet-based, family-centered quality improvement program targeted to rural Northern New England that combines a youth-facing safety-planning module with a caregiver-facing home safety decision aid and youth safety information. The goal is to help adolescents and their caregivers develop concrete, culturally-sensitive safety plans during emergency department visits.
- BehavioralCare as usual
Adolescents and caregivers will receive treatment as usual at the Emergency Department.
Locations (4)
- Cheshire Medical CenterKeene, New Hampshire
- Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire
- Alice Peck Day Memorial HospitalLebanon, New Hampshire
- New London HospitalNew London, New Hampshire