Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people? – A systematic scoping review

Abstract

Accessible SummaryWhat is known on the subject? Suicide prevention is an international healthcare priority. There is an urgent need to use approaches that are helpful and follow research evidence. Safety planning is now widely used in suicide prevention; however, it was developed for use with adults, and little is known about its effectiveness for children/young people. What the paper adds to existing knowledge? This systematic scoping review brings together all research evidence since 2008 that reported how effective safety planning is for children/young people. Findings highlight that when healthcare professionals help children/young people who are suicidal, they need to ensure that the safety plan is completed collaboratively with healthcare professionals and children/young people and that it is appropriate for their age and development. There is also need for healthcare professionals to better recognize and respond to the needs of parents/carers who are caring for a child/young person with suicidal ideations/behaviours. What are the implications for practice? There is some research indicating that safety planning is effective for use with children/young people, but such evidence has primarily been obtained from females and there is need for more evidence from male study populations. Further research on its use is needed for certain groups of children/young people including those who are care experienced, or identify as lesbian, gay, bisexual and transgender. This review highlighted that healthcare professionals need specific training before they deliver safety planning for children/young people. It was identified that parents/carers have additional needs and should be involved in safety planning. An additional resource specifically for parents/carers should be developed. AbstractIntroductionSuicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people.AimTo synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations.Inclusion criteriaThe review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc), any geographical location or social economic status and inclusivity around the method of delivery.MethodsA systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre‐registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA‐ScR checklist.Data analysis and presentationFifteen studies were reported during 2008–2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub‐groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement.Discussion and implications for practiceFurther research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed.

Suicide prevention: Introducing the Lothian Safekeeping Plan© for parents as a clinical innovation for use alongside safety plans for children and young people

“…The involvement of parents is critical when working with suicidal CYP but, whilst parents/carers have a crucial role in safety planning they are often left out of the process (Berk, 2019). Although our recent scoping review found that that no safety plans designed for use by parents of suicidal children existed, we were able to identify six elements to support safety planning by parents for CYP (Abbott-Smith et al, 2023). Findings from the scoping review and these F I G U R E 1 This is the Lothian Safekeeping Plan and the Lothian Safety Plan.…”

“…However, until recently safety plans for parents did not exist (Berk, 2019). A recent systematic scoping review (Abbott-Smith et al, 2023) revealed other studies within this field of safety planning with CYP. Asarnow et al (2015) and Berk (2019) identified that although some brief interventions included parents, there remained a need to include them in a collaborative manner within safety planning.…”

“…Asarnow et al (2015) and Berk (2019) identified that although some brief interventions included parents, there remained a need to include them in a collaborative manner within safety planning. This scoping review also revealed an absence of any stand-alone framework for HCPs to work with parents around safety planning for their child (Abbott-Smith et al, 2023). This paper describes firstly, an innovative evidencebased nurse-led approach to adapting safety plans used within a Child and Adolescent Mental Health (CAMH) Service in one Scottish area of the UK's National Health Service (NHS) and secondly, the subsequent development of a complementary plan for use by parents of children using this service for suicidal behavior.…”

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

“…Safety planning has shown potential to decrease suicidal behaviors in adults [81][82][83] and may help reduce the risk of suicide in youth. 84 Components of safety planning include: recognizing warning signs of an impending crisis; employing internal coping strategies; utilizing social contacts as a means of distraction from suicidal thoughts; contacting family members or friends who may help to resolve the crisis; contacting MBH professionals. 82,85 Tools such as the Stanley-Brown Safety Plan can assist EPs with discharge planning.…”

What Is Helpful and What Is Challenging for the Caregivers of Young People Receiving Interventions to Prevent Suicide? Caregivers’ Perspectives—A Rapid Scoping Review

“…Psychotherapy may be delivered face to face, but web-based programs are increasing in popularity [15]. Usually, clinicians also work with young people and their caregiver/s to develop and implement a safety or management plan, which aims to keep a young person safe as other interventions are being implemented [16,17].…”