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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve the management of suicide risk in teens by testing two treatments: Collaborative Assessment and Management of Suicidality (CAMS) and Safety Planning Intervention+ (SPI+). CAMS involves working with teens to address the issues that lead to suicidal feelings, while SPI+ focuses on creating personalized plans to handle suicidal crises. Teens admitted to acute care due to suicidal thoughts or actions might be suitable candidates for this trial. As an unphased trial, this study offers teens the chance to contribute to important research that could enhance suicide prevention strategies.

Will I have to stop taking my current medications?

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

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the Collaborative Assessment and Management of Suicidality (CAMS) effectively reduces suicidal thoughts. Studies have found it to be both effective and safe for individuals experiencing serious self-harm thoughts. No major safety issues have been reported, indicating CAMS is well-tolerated.

For the Safety Planning Intervention+ (SPI+), less research is available. However, it helps individuals by providing coping strategies and support resources during a crisis. Reports of negative effects from using SPI+ are insignificant, suggesting it is generally safe for teenagers.

Both CAMS and SPI+ aim to reduce suicide risk and appear safe based on current research. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about the treatments for suicide prevention in teens because they offer a fresh approach to managing suicidal thoughts and behaviors. Unlike traditional methods that might focus solely on crisis intervention or medication, CAMS involves a collaborative process where therapists work together with teens to identify and address the specific problems driving their suicidal thoughts. This method empowers teens to play a central role in their recovery. On the other hand, SPI+ provides a structured safety plan that helps teens recognize early warning signs and implement personalized strategies during a crisis, potentially leading to quicker and more sustainable outcomes. These approaches offer hope for more tailored and effective solutions in preventing teen suicide.

What evidence suggests that this trial's treatments could be effective for suicide prevention in teens?

In this trial, participants will be assigned to different treatment arms to evaluate their effectiveness in suicide prevention for teens. Research has shown that the Collaborative Assessment and Management of Suicidality (CAMS), one of the treatments in this trial, effectively reduces suicidal thoughts. Studies indicate that people using CAMS have better relationships with their therapists and attempt suicide less often in a short time. CAMS helps by focusing on the specific issues that make someone feel suicidal and works together with them to address these issues.

Another treatment arm in this trial is the Safety Planning Intervention+ (SPI+). Strong support exists for its use in adults, but evidence for its effectiveness in teens is still being gathered. SPI+ involves creating a personalized plan to manage crisis moments, including strategies and contact information for support when feeling at risk. Early results suggest that having a plan ready can be crucial for preventing suicidal behavior in high-risk situations. ^{1 6 7 8 9}

Who Is on the Research Team?

Molly Adrian

Principal Investigator

Seattle Childrens

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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 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]

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 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 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 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 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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9211019/

Collaborative Assessment and Management of Suicidality ... This pilot open trial examined the feasibility, acceptability, and preliminary outcomes of the Collaborative Assessment and Management of Suicidality for teens ...

2. cams-care.com cams-care.com/the-cams-framework/evidence-based-framework/

CAMS: Evidence-Based Suicide Treatment Training CAMS is widely acknowledged as the most effective treatment for suicidal thoughts. It's supported by numerous publications globally.

3. frontiersin.org frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1038302/full

The Collaborative Assessment and Management of ... CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165178116307788

Outcomes at discharge and six-month follow-up This controlled comparison trial evaluated a suicide-specific intervention, the Collaborative Assessment and Management of Suicidality (CAMS), ...

5. mirecc.va.gov mirecc.va.gov/visn19/cpg/recs/8/

Collaborative Assessment and Management of Suicidality ... CAMS is a suicide-focused therapeutic framework aimed at decreasing suicidal ideation while increasing hope and reasons for living.

6. cams-care.com cams-care.com/the-cams-framework/

CAMS-care: Evidence-Based Suicide Treatment The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based approach to treating people suffering from serious thoughts of self-harm.

7. cams-care.com cams-care.com/resources/educational-content/adolescent-and-teen-suicide-by-the-numbers/

Adolescent and Teen Suicide By the Numbers Click to view facts & statistics around suicide in teens & adolescents. View suicide rates by age group, and learn more about training & education by state.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5048411/

Collaborative Assessment and Management of Suicidality ... In this pragmatic randomized controlled trial (RCT) we will investigate if CAMS is more effective than treatment as usual (TAU) in reducing suicidal thoughts ...

9. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02589-x

study protocol for a randomized controlled trial | BMC Psychiatry The Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that has been shown to reduce suicidal ideation ...