SPI+ and CAMS for Suicide Prevention in Teens

(ASSIST Trial)

Recruiting at 1 trial location

Overseen By Molly Adrian

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Seattle Children's Hospital

Disqualifiers: Psychosis, Intellectual disability, Autism, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4-8 weeks

306 Participants Needed

Trial Summary

What is the purpose of this trial?

To inform the effective management of adolescent suicide risk by evaluating promising treatments and developing the evidence-base for interventions that are well suited for widespread adoption, sustained quality, and impact.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Collaborative Assessment and Management of Suicidality (CAMS) for suicide prevention in teens?

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based treatment that has shown effectiveness in adults and is being adapted for adolescents. It focuses on a collaborative approach between the patient and clinician to address suicidal thoughts and behaviors, supported by several studies and ongoing research. ^{1 2 3 4 5}

Is the CAMS approach generally safe for use in humans?

The CAMS approach has been studied for over 25 years and is considered a safe therapeutic framework for managing suicidal risk, with research supporting its use in both adults and adolescents. ^{2 3 6 7 8}

How is the CAMS treatment for suicide prevention in teens different from other treatments?

The CAMS treatment is unique because it focuses on a collaborative approach between the patient and clinician to assess and manage suicidal thoughts, using a tool called the Suicide Status Form (SSF) to track and plan treatment. This method aims to enhance the therapeutic relationship and directly address the underlying reasons for suicidal thoughts, which is different from traditional treatments that may not involve such a personalized and interactive process. ^{2 3 7 8 9}

Research Team

Molly Adrian

Principal Investigator

Seattle Childrens

Eligibility Criteria

This trial is for young people aged 11-17 who are experiencing suicidal thoughts or behaviors and have been admitted to acute care for these reasons. They must be able to give informed consent and understand English well enough for study assessments. It's not open to those with psychosis, intellectual disabilities, autism spectrum disorder, or unstable eating disorders.

Inclusion Criteria

Endorse suicidal ideation and/or behavior

I was admitted to the hospital for feeling suicidal.

Provision of signed and dated informed consent form

Exclusion Criteria

Presence of eating disorder with unstable vitals

Limited English proficiency that would interfere with the ability to complete study assessments

Presence of intellectual disability

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive interventions such as CAMS, SPI+, or Treatment As Usual, with a minimum of 4 sessions and a maximum of 8 sessions

4-8 weeks

Weekly sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at baseline, 2-week, 1-month, 2-month, 6-month, and 12-month timepoints

12 months

Assessments at multiple timepoints

Treatment Details

Interventions

• Collaborative Assessment and Management of Suicidality (CAMS)
• Safety Planning Intervention+ (SPI+)
• Treatment As Usual

Trial Overview The trial is testing two specific interventions against the usual treatment: Safety Planning Intervention+ (SPI+) and Collaborative Assessment and Management of Suicidality (CAMS). The goal is to see which method better helps teens during high-risk periods when they're dealing with suicidal thoughts or actions.

Participant Groups

Group I: Treatment As Usual (TAU) Active Control 1 Intervention

Participants in this group will be studied as they proceed through treatment in the acute care setting and follow the intervention plan laid out in the discharge summary, per usual protocols at each facility. In both settings, the elements of typical care include crisis prevention planning, which outlines potential triggers, skills to use, and people and places to call in crisis, as well as referral to ongoing behavioral health treatment. We will not alter usual care but track recommendations, contacts and care through questionnaires the family completes as well as medical record review in order to understand the impact of the experimental conditions in relation to typical services.

Group II: Collaborative Assessment and Management of Suicidality (CAMS) Active Control 1 Intervention

CAMS strategies focus on collaborative deconstruction and treatment of the patient-defined drivers- the problems that make suicide compelling to the patient- and utilizes these problem-focused treatment sessions to treat the drivers as directly related to wish to die. Participants will be assigned to CAMS for a minimum of 4 sessions and a maximum of eight sessions. This time frame, based on initial data from our pilot work with adolescents and emerging adults (18-25), suggests that a subset of participants resolve their STB in six to eight sessions. CAMS is a clinical intervention designed to modify how clinicians engage, assess and plan treatment with suicidal patients.

Group III: Safety Planning Intervention+ (SPI+) Active Control 1 Intervention

SPI is focused on how the risk of suicidal crisis waxes and wanes over time. At times of heightened risk, a pre-specified and individualized plan targets the internal warning signs that become the cue to use the safety plan. SPI+ strategies focus on patient's narrative of the suicidal crisis and identifying solutions that are antithetical to progressing in a suicidal crisis. The brief structured intervention is conducted in six key steps. Youth in this condition will be offered weekly follow-up, with a minimum of 4 sessions and a maximum of 8 sessions. The goal is to create a crisis response plan to reduce risk when suicidal crises emerge. With adolescents, SPI+ consists of an individual session to elicit crisis narrative and motivation to utilize the safety plan through psychoeducation and follows six steps to achieve the adolescent's goals and return to safety when suicidal urges are high.

Collaborative Assessment and Management of Suicidality (CAMS) is already approved in United States for the following indications:

Approved in United States as CAMS for:

• Suicidal ideation
• Suicidal behavior
• Adolescent suicide risk management

Who Is Running the Clinical Trial?

Seattle Children's Hospital

Lead Sponsor

Trials

319

Recruited

5,232,000+

Nationwide Children's Hospital

Collaborator

Trials

354

Recruited

5,228,000+

Findings from Research

The Collaborative Assessment and Management of Suicidality (CAMS) method significantly reduced five key markers of suicidal behavior in 27 out-patients, indicating its efficacy in treating suicidal patients.

A remarkable 80% of patients reported that the therapeutic sessions were crucial in eliminating their suicidal thoughts, and 92% felt a strong sense of collaboration with their therapist, highlighting the method's positive impact on patient engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Treatment of suicidal patients: The Collaborative Assessment and Management of Suicidality]. Arkov, K., Rosenbaum, B., Christiansen, L., et al.[2022]

The Suicide Status Form (SSF-IV) has been validated for use in adolescents aged 12-17 in inpatient psychiatric settings, showing that it effectively assesses suicide risk without needing modifications for this age group.

The study found that adolescents with a history of suicide attempts scored significantly higher on most SSF items, indicating that the tool can accurately reflect varying levels of suicidality and related psychological factors among different individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validating the Suicide Status Form for the Collaborative Assessment and Management of Suicidality in a Psychiatric Adolescent Sample. Brausch, AM., O'Connor, SS., Powers, JT., et al.[2020]

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based intervention that enhances the therapeutic alliance between clinicians and suicidal patients, focusing on collaborative assessment and treatment planning.

CAMS utilizes the Suicide Status Form (SSF) to assess and track suicidal risk, and has been supported by multiple studies, including one randomized clinical trial, with two more currently underway to further validate its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Jobes, DA.[2022]

The Collaborative Assessment and Management of Suicidality (CAMS) approach has been adapted for use in inpatient psychiatric facilities, marking a significant step in addressing the needs of suicidal patients in these settings.

This initiative aims to improve both the assessment and treatment of at-risk patients while also contributing valuable evidence to the field, which currently lacks sufficient research on effective interventions for suicidal individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing an evidence-based approach to working with suicidal inpatients. Ellis, TE., Allen, JG., Woodson, H., et al.[2009]

The study analyzed responses from 49 patients regarding helpful aspects of their treatment for suicidal risk, leading to the development of a reliable coding system to identify major themes in their experiences.

Insights gained from 52 patients on what they learned from their clinical care can inform future suicide-specific treatments, highlighting the importance of patient feedback in improving therapeutic approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful Treatment of Suicidal Risk. Schembari, BC., Jobes, DA., Horgan, RJ.[2022]

In a study of 150 individuals discharged after a suicide-related crisis, both the Collaborative Assessment and Management of Suicidality (CAMS) and treatment as usual (TAU) led to improvements in suicidal thoughts and psychological distress over 12 months, but CAMS was not found to be superior to TAU for the primary outcomes.

Participants receiving CAMS reported less psychological distress at 12 months compared to their baseline levels, indicating some benefit, but overall, the study suggests that while CAMS is feasible and acceptable, further research is needed to explore its potential advantages over standard treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality. Comtois, KA., Hendricks, KE., DeCou, CR., et al.[2023]

The study evaluated the Collaborative Assessment and Management of Suicidality (CAMS) approach and found limited evidence supporting its effectiveness in reducing suicide risk and deliberate self-harm among adults.

While CAMS shows potential in managing suicidal patients, more comprehensive research is necessary to establish its efficacy and effectiveness in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of efficacy of Collaborative Assessment and Management of Suicidality (CAMS) in managing suicide risk and deliberate self-harm in adult populations. Hanratty, D., Kilicaslan, J., Wilding, H., et al.[2022]

The study will evaluate the effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) framework compared to standard treatment in reducing suicidal thoughts and behaviors among 100 patients with significant suicidal ideation, using a randomized controlled trial design.

This pragmatic trial, conducted in a real-world clinical setting in Norway, aims to provide generalizable results that could support the future implementation of CAMS as a standard practice in specialized mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Collaborative Assessment and Management of Suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: study protocol for a randomized controlled trial. Ryberg, W., Fosse, R., Zahl, PH., et al.[2022]

The Collaborative Assessment and Management of Suicide (CAMS) model is a flexible and evidence-based approach developed over 25 years to help mental health clinicians effectively address suicidality in patients.

CAMS promotes a collaborative and ethically informed process, making it a valuable tool for mental health services worldwide, enhancing the way clinicians engage with service users regarding suicide prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The collaborative assessment and management of suicide (CAMS): an important model for mental health services to consider. Galavan, E.[2019]

References

1. Denmark pubmed.ncbi.nlm.nih.gov

[Treatment of suicidal patients: The Collaborative Assessment and Management of Suicidality]. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Validating the Suicide Status Form for the Collaborative Assessment and Management of Suicidality in a Psychiatric Adolescent Sample. [2020]

3. England pubmed.ncbi.nlm.nih.gov

The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Implementing an evidence-based approach to working with suicidal inpatients. [2009]

5. Canada pubmed.ncbi.nlm.nih.gov

Successful Treatment of Suicidal Risk. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality. [2023]

7. England pubmed.ncbi.nlm.nih.gov

A systematic review of efficacy of Collaborative Assessment and Management of Suicidality (CAMS) in managing suicide risk and deliberate self-harm in adult populations. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Collaborative Assessment and Management of Suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: study protocol for a randomized controlled trial. [2022]

9. England pubmed.ncbi.nlm.nih.gov

The collaborative assessment and management of suicide (CAMS): an important model for mental health services to consider. [2019]