Enhancing motivation and self-efficacy for safety plan use: Incorporating motivational interviewing strategies in a brief safety planning intervention for adolescents at risk for suicide.

Abstract

Suicide is one of the leading causes of death among adolescents in the United States, and risk for recurring suicidal thoughts and behavior remains high after discharge from psychiatric hospitals. Safety planning, a brief intervention wherein the main focus is on identifying personal coping strategies and resources to mitigate suicidal crises, is a recommended best practice approach for intervening with individuals at risk for suicide. However, anecdotal as well as emerging empirical evidence indicate that adolescents at risk for suicide often do not use their safety plan during the high-risk postdischarge period. Thus, to be maximally effective, we argue that safety planning should be augmented with additional strategies for increasing safety plan use to prevent recurrent crises during high-risk transitions. The current article describes an adjunctive intervention for adolescents at elevated suicide risk that enhances safety planning with motivational interviewing (MI) strategies, with the goal of increasing adolescents' motivation and strengthening self-efficacy for safety plan use after discharge. We provide an overview of the intervention and its components, focusing the discussion on the in-person individual and family sessions delivered during hospitalization, and describe the theoretical basis for the MI-enhanced intervention. We then provide examples of applying MI during the process of safety planning, including example strategies that aim to elicit motivation and strengthen self-efficacy for safety plan use. We conclude with clinical case material and highlight how these strategies may be incorporated into the safety planning session. Clinical Impact StatementQuestion: This article describes how motivational interviewing (MI) strategies can be applied in a safety planning session. Findings: This article provides example strategies illustrating how MI might be applied to guide the process of developing a safety plan. Meaning: MI strategies may offer a useful approach for facilitating client engagement during the process of safety planning. Next Valerie J. Micol served as lead for conceptualization and writingoriginal draft, review, and editing. David Prouty served in a supporting role for writingreview and editing. Ewa K. Czyz served as lead for funding acquisition and supervision and served in a supporting role for conceptualization and writingoriginal draft, review, and editing. The authors have no conflict of interest to declare.

Implementing and evaluating a veterans crisis line quality improvement initiative: The safety planning pilot program.

“…Of those eligible for a safety plan, less than one third completed one, often due to call interruptions or the caller declining. Additional training may be necessary to enhance responders’ ability to explain the safety planning process and benefits, or training in motivational enhancement may be beneficial (e.g., Czyz et al, 2019; Micol et al, 2022). Previous research (Labouliere et al, 2020) has demonstrated that crisis line counselors reported safety planning was feasible and helpful, but that utilization was predicted by baseline self-efficacy, feasibility, and helpfulness.…”

Prevalence of suicidal behavior in patients with chronic pain: a systematic review and meta-analysis of observational studies

“…In particular, self-efficacy plays a role in managing SI and impulses, potentially contributing to the prevention of SB ( Czyz et al, 2014 ). Accordingly, some researchers have suggested that suicide prevention interventions can be provided to adolescents at risk of suicide by enhancing motivation and self-efficacy ( Micol et al, 2022 ). On the other hand, unmodifiable factors included older age and certain race/ethnicity groups, which could be used to identify vulnerability to SB in individuals with chronic pain.…”

Advancing Suicide Intervention Strategies for Teens (ASSIST): study protocol for a multisite randomised controlled trial

“…SPI+10–12 has demonstrated efficacy in reducing suicide attempts and greater treatment engagement compared with UC for military and veteran populations. Pilot feasibility and acceptability in adolescent settings with adolescents has also been demonstrated 13–15.…”