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Background Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments – a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach. Methods After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants’ perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed. Results Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term. Conclusions Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life. Trial registration This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.
Background Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments – a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach. Methods After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants’ perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed. Results Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term. Conclusions Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life. Trial registration This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.
BACKGROUND Suicide is responsible for the deaths of more children than any single major medical illness and the second leading cause of death among children 10-14 years old. Universal suicide risk screening is recommended for all children 12 and older, and for those under 12 when clinically indicated. Virtual outpatient care represents a critical suicide risk screening point. OBJECTIVE To determine whether childhood suicide risk can be assessed and treated through virtual mental healthcare. METHODS This retrospective cohort study used electronic health record data from patients served at a virtual mental health care platform serving children and their families from May 2023 to February 2024. The sample included patients aged 3 - 14 who completed screening and a comprehensive diagnostic assessment (n=1434) and a subset who completed 12 or more treatment sessions (n=660). Mean age was 9.1 years. Patients 8 and older completed a universal suicide risk screening and children under 8 completed screening based on established criteria as a part of the standard of care. Current and lifetime suicide risk was assessed using caregiver-report (ASQ) and child-report (C-SSRS) measures. Associations with age, sex, race/ethnicity, severity of illness (CGI-S), depression (MFQ), and clinical improvement after 12 or more sessions (CGI-I) were examined. Data was analyzed for the entire cohort and two age subgroups (ages 3-7 and 8-14). RESULTS 100% of children ages 8-14 were screened at stage one or two. 15.5% of children ages 3-7 were screened. Overall, 19.0% (193/1016) of children ages 8-14 and 6.5% (27/418) of children 3-7 screened positive for current suicide risk with a mean age of 10 (SD=2.2; range 5-14). Lifetime suicide risk was 27.7% (281/1016) for children 8-14. Age, sex, and race/ethnicity differences were found. Current suicide risk was significantly associated with depression and greater severity of illness. After 12 or more sessions of evidence-based virtual care, there was no significant difference in improvement by suicide risk status (75% with positive screen versus 79% with negative screen improved). CONCLUSIONS Childhood suicide risk assessment is feasible and effective within a virtual care setting. Suicide risk is significant for children seeking virtual mental health care. Evidence-based virtual care is as effective for children with suicidal ideation and/or behaviors as for those without suicide risk. Universal screening for suicide risk for all children 8 and older presenting for mental healthcare is feasible and clinically indicated.
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