An Adaptive Intervention to Increase Engagement to Community-Based Care After an ED Admission

Rhode Island Hospital186 enrolled

Overview

The goal of this study is to develop a feasible brief, family-based adaptive intervention, via SMART design, for youth with suicidal and non-suicidal self-injurious behavior (SSIB) to increase community-based mental health (MH) care attendance and reduce SSIB risk post emergency department (ED) admission. The intervention will focus to increase understanding on youth MH literacy, MH communication, and MH engagement. Integrating an adaptive intervention via a SMART design in the ED could address subsequent barriers to youth obtaining appropriate level of community-based MH care and therefore reduce ED readmissions.

This adaptive intervention allows for two stages of randomization to address treatment non-response. First, youth and caregivers (dyads) will be randomized to receive 1st-stage interventions in the ED, either the digital psychosocial-only condition or the psychosocial with digital health communication via text messages condition. If after two weeks, youth are identified as non-response, then dyads will be re-randomized to 2nd-stage intervention(s) that will include the use of a family navigation model.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Enrollment

186

Conditions

Suicidal and Self-injurious Behavior Linkage to Care

Interventions

adaptive interventionBEHAVIORAL

We will utilize an adaptive interventions via Sequential Multiple Assignment Randomized Trial (SMART) design provide a tailored, stepped-care approach for the type, intensity, and dose of treatment, thus, providing the most intensive care to only those who need it, particularly treatment non-response. First, youth and caregivers (dyads) will be randomized to receive 1st-stage interventions in the ED, either the digital psychosocial-only (PS) condition or the psychosocial with digital health communication (PS+text) condition. If identified as non-response at 2-weeks, then dyads will be re-randomized to 2nd-stage intervention(s). Specifically, the PS condition non-responders will be re-randomized to the PS+text condition or the PS+text+FN condition. The 1st-stage PS+text condition non-responders will receive the PS+text+FN condition only.

Eligibility

Sex: ALLMin age: 8 YearsMax age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Youth 8 to 17 years * Youth presenting to the ED with suicide and self-injurious behavior * Youth living at home with at least one legal guardian/caregiver Exclusion Criteria: * Youth presenting to the ED with psychosis, sexual assault, child abuse * Youth in police custody, * Youth with an active investigation with the department of child and youth services (DCYF) * Youth unable to assent due to severity of illness or developmental disabilities, * Youth who cannot communicate in English or Spanish, * Youth without a caregiver/legal guardian who can provide consent

Outcomes

Primary Outcomes

Intervention Feasibility

Recruitment rate (% of ppl who agree to be in the study), Study completion (% of ppl who complete entire study)

Time frame: 3-month & 6-month follow-up assessments

Child and Adolescent Service Assessment (CASA)

Youth Attendance to Community-based Mental Health Care. CASA question and caregiver report of youth attendance in behavioral health care/community-based mental health services (yes or no) after discharge from emergency department admission.

Time frame: 3-month and 6-month follow-up assessments

Intervention Acceptability

Client Satisfaction Questionnaire. An 8-item questionnaire that provides (positive \& negative) feedback from user opinion. Higher scores = greater satisfaction with intervention.