Safe treatment for emergency presentation for suicidal ideation and behavior (SAFE STEPS): Protocol for randomized...

Suicide is currently the second leading cause of death among youth ages 13-24 in the United States. Youths presenting to Emergency Departments (EDs) with suicidal ideation and/or behavior have elevated risk for subsequent suicide attempts and deaths, yet optimal approaches to emergency care remain unclear and too many youths receive inadequate follow-up treatment after discharge.

Using a community partnered participatory research model, this multi-site single-blinded randomized comparative effectiveness trial investigates two strategies for enhancing emergency care for 1600 adolescents and young adults (ages 13-24) presenting with suicide attempts and/or suicidal ideation: 1) ED care enhanced by increased access to a developmentally tailored approach to safety planning; and 2) a combined approach that supplements enhanced ED care with brief therapeutic contacts with youths and parents/significant others for 12 months after ED-discharge. These contacts by phone/video/text/letter feature support, brief intervention, and case management. Youths will be recruited from four geographically diverse locations, and assessed at baseline and 3, 6, and 12-month follow-ups. Parent assessments will be at: baseline; 12-month follow-ups; and when youth report is unavailable. Outcomes will be assessed in two domains: 1) clinical [suicide attempts primary, self-harm (suicide attempts+nonsuicidal self-harm) secondary]; 2) service use (linkage to outpatient mental health care primary, treatment dose secondary). Exploratory outcomes and heterogeneity of treatment effects will be evaluated.

The trial is designed to have public health impact by clarifying the added value of therapeutic follow-up contacts after discharge, relative to ED care emphasizing evaluation, safety planning, and referral for follow-up care.