Safety Planning Intervention Telehealth Service Model in Emergency Departments

University of Pennsylvania

Status: Invitation-only

Conditions: Suicidal Ideation; Suicide

Treatments: Behavioral: SPI+ Delivered by ED Staff; Behavioral: SPI+ Delivered by SPCC Clinicians

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05307432

1P50MH127511-01 (U.S. NIH Grant/Contract)

850636

Details and patient eligibility

About

The purpose of this study is to evaluate the effectiveness and implementation of a suicide prevention strategy delivered via telehealth in Emergency Departments. We will compare implementation of the Safety Planning Intervention plus follow-up calls (SPI+) delivered by Emergency Department (ED) staff to SPI+ delivered via ED referral to an off-site Suicide Prevention Consultation Center (SPCC).

Full description

Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Patients are at increased risk of suicide attempts and suicide following an ED visit and nearly half do not attend outpatient treatment. Brief, evidence-based clinical interventions, such as the Safety Planning Intervention with post-discharge telephone follow-up (SPI+), can reduce suicide risk, decrease hospitalizations, and increase engagement in outpatient services for suicidal patients discharged from the ED. Leveraging insights from implementation science and collaborative care, we propose a model in which ED staff will connect patients at risk for suicide to ED-credentialed mental health clinicians who are located external to the ED. These off-site clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). All participating EDs will begin in the Enhanced Usual Care phase, in which ED staff will deliver SPI+ to suicidal patients. EDs will then be randomized in pairs to begin referral to the SPCC in 3 month intervals. We will also conduct a cost evaluation to help determine scalability and sustainability.

Enrollment: 2,814 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Aim 1/Aim 3:

Inclusion Criteria:

• ED visit at one of our participating sites for a suicide-related event or determined to be at risk for suicide per the Electronic Health Record (EHR) and ED clinical staff
• 18 years of age or older
• Not admitted to an inpatient hospital following the index ED visit as documented in the EHR

Exclusion Criteria:

• Inpatient admission following the index ED visit per the EHR

Aim 2:

Inclusion Criteria:

• ED clinician or leader at one of our participating sites, or ED patient who was referred to the SPCC
• 18 years of age or older
• Able to communicate in English
• Willing to give informed consent

Exclusion Criteria:

• Patients who are at imminent risk of suicide or acutely psychotic at the time of the interview, requiring emergency services and/or precluding ability to provide informed consent
• Patients without a phone for contact

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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2,814 participants in 2 patient groups

Enhanced Usual Care

Active Comparator group

Description:

ED staff deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to suicidal patients who are not admitted to an inpatient unit.

Treatment:

Behavioral: SPI+ Delivered by ED Staff

Suicide Prevention Consultation Center

Experimental group

Description:

ED staff refer suicidal patients not admitted to an inpatient unit to the off-site Suicide Prevention Consultation Center (SPCC). SPCC clinicians will deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to patients via telehealth.

Treatment:

Behavioral: SPI+ Delivered by SPCC Clinicians