Patient Population: Young Adults

This project outlines a comprehensive two-year initiative aimed at enhancing suicide care services in primary care settings. The project addresses a critical gap in the continuum of care by providing interim crisis support for at-risk patients who are waiting to be connected to specialty mental health. The main objectives of this project are to develop two innovative interventions intended to be delivered in a primary care setting: an adapted caring contacts protocol and a system to provide short-term, centralized remote monitoring of patient’s suicide risk. In designing these interventions, we intend to leverage technology such as digital/online platforms and remote monitoring systems that will support asynchronous patient check-ins. Finding innovative ways to offer support to patients in primary care settings where there is limited clinician time and typically an even more limited behavioral health workforce is imperative to creating a sustainable program. Therefore, our proposal intends to maximize the use of technology and focuses on self-guided and/or automated approaches.

This project uses a co-design approach to develop these interventions, where we will elicit input directly from patients and caregivers on the acceptability, feasibility, and appropriateness of these interventions. We hope this project will improve the timely support and management of suicide risk among primary care patients, ultimately enhancing services in outpatient settings while supporting the Least Restrictive Environment Framework, to enhance patient outcomes, reduce unnecessary referrals to overburdened emergency departments, and promote the overall well-being of patients and their families.

Suicide is a leading cause of death among 10-to-24-year-olds. Primary Care (PC) often serves as a trusted resource for adolescents and young adults (AYA) and their families; and routine wellness visits provide important opportunities for early detection of suicide risk. Importantly, nearly half of those who die by suicide contact their PC clinic within one month prior to suicide. Unfortunately, suicide prevention resources for PC are limited, with a particular gap in short-term risk management and intervention services for lower risk patients and patients with STB who are waiting to be connected to specialty mental health care. Furthermore, parents/caregivers (hereafter referred to as parents) represent a key protective factor for suicidal AYA. Yet, few interventions have been developed to leverage parent support and increase parental self-efficacy to prevent AYA suicide. The current project partners with a digital mental health app, iKinnect, to adapt it for use in PC. iKinnect is designed to improve parent and AYA communication and parental selfefficacy to prevent risk behaviors, including suicide behaviors. The tool uses a parent and AYA paired interface and was originally designed for implementation with high-risk youth involved in the juvenile justice system. Intervention components include parent and AYA content including safety planning, skills for emotion management, parent coaching on lethal means restriction, expectation and goal setting, earning/providing rewards and praise, and modeling videos for parents. While promising, the program has yet to be tested with AYA presenting with suicide risk in PC.