Feasibility and acceptability of EDBridge: A brief contact intervention for adolescents at risk of suicide and their parents

EDBridge involves three intervention components including safety planning (for teen participants), a psychoeducative factsheet (for parent participants), and an automated text message support program (for teen and parent participants). All teens who enrol in this study will be given access to the safety planning and text message intervention components. All parents who enrol in this study will be given access to the psychoeducative factsheet and text message intervention components. All intervention components will be delivered in the participating ED for seven months. 1. Safety planning (for adolescents) Adolescent participants will develop a collaborative safety plan with a trained paediatric emergency psychiatry clinician during their routine assessment in the Paediatric Emergency Department (ED). Adolescents will first be offered to develop a safety plan using the Beyond Now smartphone app, with a paper or verbal safety plan offered as alternatives. Beyond Now is a suicide safety planning smartphone application initially developed by Beyond Blue (now owned by Lifeline) that is freely available to the public on all major app stores. It has not been specifically designed for this study. The Beyond Now safety planning app contains seven steps for managing a suicidal crisis, including 1. identifying warning signs of a suicidal crisis, 2. making the environment safe (e.g., removing access to lethal means), 3. reasons for living, 4. internal coping strategies, 5. social contacts and places for distraction, 6. social support for help with a suicidal crisis, and 7. professional supports. The paper based safety plan will follow the same format as Beyond Now. If adolescents already have a safety plan developed, they will have the option to transition the plan to Beyond Now or an alternative. After developing a safety plan (with or without Beyond Now), adolescent participants will engage with their safety plan at their own discretion and will not be asked to use the app or their safety plan for any minimum duration once discharged from the ED (however some text messages as part of the text message intervention will encourage engagement with their safety plan). Clinicians will receive training on developing safety plans using Beyond Now two weeks prior to the anticipated first enrolment. Clinicians will record whether a participant safety plan was developed with Beyond Now, paper-based format, or verbally. Adherence to app usage will not be directly monitored (e.g., via app analytics). Adolescent participants will be surveyed on their engagement with their safety plan during follow up surveys at Week 2 and Week 12 post enrolment. Because participants are only eligible for the study if they are discharged out of the hospital system, and there is no follow up appointments with the ED clinician (due to the nature of cross-sectional ED assessments), participants will not have their safety plan reviewed by ED clinicians unless they return to the ED or discuss their safety plan with a community-based clinician (e.g., private psychologist). Reviewing of safety plans is not within the scope of the current research protocol. 2. Parent/caregiver psychoeducative factsheet (for parents/carers) Parents/caregivers of adolescents presenting to the ED will receive a paper-based psycho-educative factsheet resource from the trained paediatric emergency psychiatry clinician (or a researcher) upon discharge from the ED. The two-sided A4 factsheet includes strategies for managing adolescent suicide risk in the 24-48 hours post-discharge, options for seeking treatment and caregiver support, and psycho-education. The factsheet is tailored to the recruitment site and was co-designed by researchers, young people with lived experience and their parents, and clinicians. 3. Text message support (for adolescents and parents) Both adolescents and parents will receive a one-way, automated follow-up text message support program post-discharge from the ED. The trained paediatric emergency psychiatry clinician will activate the text message program using a web platform developed for the trial. Participants will be randomly allocated to one of two text-message intervention arms: a short-term (2-week) or long-term (3-month) arm. Parents in the short-term arm will receive 14 messages and adolescents in the short-term arm will receive 12 messages. For adolescents, text messages contain information and strategies about managing a suicidal crisis, safety planning, transitioning back to school/work, problem solving, places to get support (e.g., online support, crisis support, longer term mental health treatment), and psychoeducation about suicide and suicide risk factors (e.g., self-harm). Parents will receive information and strategies about safety planning for their teen, how to monitor for and respond to changes in suicide risk, connecting with their teen, places their teen can get mental health support (including crisis support), and options for parent/caregiver support. The long-term intervention arm does not contain additional or new information for parents or adolescents but rather involves reminders about previously delivering strategies and information. Text message delivery will be monitored via Twilio, a cloud-based communication service that is being used to deliver text messages.