Efficacy of the I-CARE Digital Health Intervention

Dartmouth Health

Status: Enrolling

Conditions: Suicide Attempt; Suicidal Ideation; Mental Health Disorder; Emergency Psychiatric

Treatments: Behavioral: Improving Care, Accelerating Recovery & Education (ICARE)

Study type: Interventional

Funder types: Other

Identifiers

NCT07150832

STUDY02002242 (Other Identifier)

LSRG-1-094-23

2000039368 (Other Identifier)

STUDY00033318 (Other Identifier)

FWA00000093 (Other Identifier)

Details and patient eligibility

About

When presenting to an ED with suicide, self-harm or other mental health crises, youth may also experience "boarding", which is defined by the Joint Commission as "the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made." A recent national survey of 88 US acute care hospitals conducted by our research team found that 98.9% of hospitals were boarding youth awaiting psychiatric hospitalization, for an average of 2-3 days. However, as illustrated in a systemic review, little research has focused on developing interventions to support youth during this highly vulnerable time. 3

I-CARE is a modular, blended digital health intervention facilitated by individuals who are not mental health clinical staff to teach youth evidence-based psychosocial skills during the boarding period. This study will evaluate I-CARE's efficacy using a patient-level randomized clinical trial (RCT), randomizing youth to receive standard safety supervision or I-CARE in addition to standard safety supervision. If found to the efficacious, I-CARE could be scaled-up in new settings with limited resources and has the potential to significantly improve the quality of care received by youth experiencing boarding.

Full description

Suicide is the second leading cause of death among adolescents; from 2007 to 2017 suicide deaths tripled in youth 10 to 14 years. Emergency departments (EDs) at acute care hospitals increasingly serve as portals of care for youth with suicidal ideation or attempt. When these youth are deemed to require psychiatric hospitalization, the demand for beds often exceeds supply, leading to psychiatric boarding. To address this gap, a multidisciplinary team including pediatricians, psychologists and patient partners developed a modular digital intervention and associated training materials to deliver evidence-based psychosocial skills to youth during boarding. This program, entitled I-CARE (Improving Care, Accelerating Recovery & Education), consists of 7 web-based animated videos and workbook exercises, facilitated by licensed nursing assistants who provide 1-on-1 safety supervision during boarding. Given that 1-on-1 safety supervision is the current standard of care at most hospitals, I-CARE requires minimal additional resources beyond those already available in these settings. The psychosocial skills included in I-CARE are grounded in cognitive behavioral therapy and were prioritized through a rigorous Delphi process evaluating their importance and feasibility to deliver during psychiatric boarding.

Enrollment: 173 estimated patients

Sex: All

Ages: 12 to 17 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adolescents of any sex and gender, aged 12-17 years at ED visit or hospital encounter
• Presenting with suicide attempt or ideation, or self-harm
• Medically stable
• English-speaking
• Awaiting transfer for inpatient psychiatric care or disposition.

Exclusion criteria

• Cognitive or developmental delays precluding participation (intellectual functioning <12 years of age)
• Behavioral limitations that preclude program participation
• Active psychosis
• Legal parent/caregiver unable to speak English or unavailable to provide consent (e.g. Wards of the State)

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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173 participants in 2 patient groups

I-CARE

Experimental group

Description:

I-CARE (Improving Care, Accelerating Recovery \& Education) is a tablet-based program designed to deliver evidence-based psychosocial skills to adolescents during mental health boarding. The program consists of 7 web-based animated videos and workbook exercises, facilitated by non mental health professionals.

Treatment:

Behavioral: Improving Care, Accelerating Recovery & Education (ICARE)

Safety Supervision

No Intervention group

Description:

These hospitals currently offer basic safety supervision and medical monitoring for adolescents during mental health boarding. This is the "usual care" condition.