Suicide in Teens: Pediatric Research and Clinical Trials

Family-Based Crisis Intervention (FBCI) for Suicidal Adolescents and their Families in the Emergency Department: Open and randomized clinical trials (PI: Wharff)

In their work with many suicidal adolescents and their families, Emergency Psychiatry staff at Boston Children’s Hospital observed that a breakdown in communication within the family is often a contributing (and sometimes precipitating factor) to suicidal ideation or attempt. They noted that most parents and caregiver(s), even when in acute distress, do wish to help their adolescent but lack the skills and tools to do so and found that, frequently, an effective emergency family intervention can prevent the need for inpatient hospitalization and can provide families with tools to help them through current and future crises.

As a result of these observations, the these clinician researchers developed FBCI. FBCI is guided by the following ideas: 1) an inpatient hospitalization is not necessarily the most helpful psychiatric disposition for adolescents with suicidal ideation, 2) families/caregiver(s) are able to provide support to an adolescent family member if given both an opportunity and effective tools to utilize, and 3) a family that learns to support their adolescent while s/he is in crisis will be empowered to continue to provide ongoing support once the acute psychiatric crisis subsides. Based upon the integration of cognitive-behavioral skill building, psycho-education, therapeutic readiness, and safety-planning, FBCI utilizes non-judgmental collaboration to stabilize patients and provide psychiatric intervention in the Emergency Department (ED) for both the adolescent and family, thereby decreasing the patient’s level of risk and increasing the capacity of the family to maintain the patient at home with appropriate therapeutic supports. The goal of FBCI is to effect changes that will enable adolescents and their families to feel and be safe at home, thereby avoiding inpatient admissions.

The research team at Boston Children’s Hospital conducted open and randomized clinical trials of FBCI with suicidal adolescents presenting to the Boston Children's Hospital Emergency Department and their families. People in both of these studies received follow up telephone calls for a month after their visit to the Emergency Department. FBCI was shown to be feasible, safe. Results of the study show that significantly more adolescents in the FBCI group were discharged home from the ED compared to the group who received a standard Emergency Psychiatry evaluation. Nobody in either study completed suicide during the one month time period after their Emergency Department visit. This intervention is now being disseminated so that it will become standard care at the Boston Children's Hospital Emergency Department.

The ASK Suicide Screening Questions Validation Study (PI: Wharff)

Early detection is a critical suicide prevention strategy. Universal screening may be a way to detect suicide risk in children and adolescents, including those who have a physical or medical illness. The purpose of this study is to test whether the a new suicide screening tool, the Ask Suicide Screening Questions (ASQ) instrument is a valid way to screen for suicide risk in children and adolescents who have been hospitalized at Boston Children’s Hospital for medical (as opposed to psychiatric) reasons. The ASQ is a 4 item questionnaire that asks the following questions: In the past few weeks, have you wished you were dead? In the past few weeks, have you felt that you or your family would be better off if you were dead? In the past week, have you been having thoughts about killing yourself? Have you ever tried to kill yourself? If someone answered ‘yes’ to any of these questions, further psychiatric evaluation was arranged and additional resources were provided. The ASQ was previously validated in the BCH Emergency Department by the same research team. The ASQ will be tested in Adolescent Medicine at Boston Children's Hospital in 2015.

Crisis Care: Smartphone Application Intervention for Suicidal Adolescents (PI: Wharff)

Boston Children's Hospital clinical researchers have wanted to develop ways to help suicidal adolescents maintain their coping skills after discharge from the Emergency Department or Inpatient Psychiatry Unit. They have developed a web-based prototype of a smartphone application (app) intervention, Crisis Care, for use at time of discharge from acute care settings that treat suicidal adolescents. There are two modes of the app—one for the adolescent and one for the teen’s parent/caregiver. When the adolescent uses the app in a time of crisis, he/she is able to access a set of personalized skills selected by him/her and the clinician and parents during their safety planning which have been identified as helpful in either reducing suicidal thoughts or receiving help to cope with these thoughts. When parents use the app they are able to access this same set of skills so they can help coach the adolescent through the suicidal crisis. This intervention is currently being piloted in Outpatient Psychiatry at Boston Children's Hospital. If you and your child would be interested in being recruited, talk to your Boston Children's Hospital Outpatient Psychiatry clinician.