Coping long term with active suicide in adolescents: Results from a pilot randomized controlled trial

Abstract

Background: To adapt the Coping Long Term with Active Suicide Program (CLASP) for use with adolescents (CLASP-A) and to assess its feasibility and acceptability on an inpatient psychiatric unit. CLASP-A entailed three individual sessions and one family session, followed by a series of outpatient phone calls to adolescent and a designated parent/guardian over 6 months of follow-up. Methods: The open trial phase involved 17 adolescent/parent pairs, followed by a pilot randomized controlled trial (RCT) in which adolescent/parent pairs were randomized to CLASP-A ( n = 25) or enhanced treatment as usual (ETAU; n = 25). Assessments were completed at baseline, 3- and 6-month follow-ups. Results: In the open trial, average in-person session attendance was 67%, and study treatment satisfaction was high. To enhance feasibility, we adapted CLASP-A to be completed in three individual sessions for the RCT; 77% of the sessions were completed and study satisfaction remained high in adolescents (3.32/4.0) and parents (3.62/4.0). There were no significant differences between groups in number of suicide attempts or readmissions during follow-up. Conclusion: Data indicate feasibility and acceptability of CLASP-A. However, the absence of treatment effects between groups raises questions regarding CLASP’s potential efficacy with adolescents or the need for more extensive adaptations for adolescents.

Not a fad: Nonsuicidal self-injury and suicide attempts

“…A third article in this issue of CCPP evaluates a pilot randomized controlled trial (RCT) of a brief intervention designed to reduce risk for suicide attempts among adolescents following discharge from a psychiatric inpatient program to which they were admitted for suicidal thoughts and behaviors (Yen et al, 2019). Results reveal adequate feasibility and acceptability of the intervention but no treatment effects between the intervention group and the enhanced treatment-as-usual group.…”

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes

“…The interventions represented were: Signs of Suicide (SOS), a universal prevention program for high school (Aseltine and Demartino, 2004) and middle school students (Schilling et al, 2014); Brief Intervention and Contact (BIC; Bertolote et al, 2010); MI-SafeCope (Czyz et al, 2019), a motivational interviewenhanced safety planning intervention; ProHelp (Han et al, 2018), a brief psychoeducational online program; ReFrame-IT (Hetrick et al, 2017), an internet-based CBT program; Electronic Bridge to Mental Health Services (eBridge; King et al, 2015), which provided personalized feedback and optional online counseling for university students; the Youth Nominated Support Team Version Two (YST-II; King et al, 2009), a psychoeducation and follow-up intervention following psychiatric hospitalization; Dialectical Behavior Therapy for Adolescents (DBT-A; Mehlum et al, 2014); the Family Intervention for Suicide Prevention (FISP; Rosenbaum et al, 2011), an adaptation of an emergency room intervention; Sources of Strength (Wyman et al, 2010), a school-based suicide prevention program; Coping Long-Term with Active Suicide Program for Adolescents (CLASP-A; Yen et al, 2019), an adapted program for the post-discharge transition period. Table 1 provides additional study characteristics.…”

“…Nine studies described interventions that could be categorized as adjunctive technology-enhanced interventions (Aseltine and Demartino, 2004;King et al, 2009;Bertolote et al, 2010;Wyman et al, 2010;Rosenbaum et al, 2011;Mehlum et al, 2014;Schilling et al, 2014;Czyz et al, 2019;Yen et al, 2019). This means that these studies featured a technological component to supplement an intervention delivered by a provider (Hermes et al, 2019).…”

“…Feasibility was measured by the number or proportion of youth participants recruited, enrolled, and retained in the study or lost to dropout. Eight studies measured adoption of the intervention (Aseltine and Demartino, 2004;King et al, 2009King et al, , 2015Wyman et al, 2010;Mehlum et al, 2014;Hetrick et al, 2017;Czyz et al, 2019;Yen et al, 2019), and, overall, studies recorded session attendance and participant engagement with online intervention tools and modules. Five studies measured intervention fidelity by using adherence rating scales for session evaluation (King et al, 2009;Mehlum et al, 2014;Czyz et al, 2019;Yen et al, 2019), interrater reliability of psychometric outcomes and session checklists (King et al, 2009) and verification of completion of intervention components by additional sources (Wyman et al, 2010).…”

“…Four studies measured acceptability of the intervention and its components by using participant ratings or responses to open-ended questions about intervention satisfaction (Aseltine, 2003;Han et al, 2018;Czyz et al, 2019;Yen et al, 2019). One study also measured acceptability by using the Internet Evaluation and Utility Questionnaire (IEUQ; Ritterband et al, 2008;Thorndike et al, 2008), which assesses usability, likeability, and usefulness of an online intervention (Han et al, 2018).…”