SAFETY-A Program for Suicide Prevention in Schools

Overseen By Ashley Flores

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Los Angeles

Disqualifiers: Imminent danger, Intellectual disability, Psychosis, others

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

Compensation: Varies

Number of Visits: Unknown

347 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will adapt Safe Alternatives For Teens and Youth - Acute (SAFETY-A) for implementation in low-resourced school districts to reduce racial/ethnic disparities in mental health service use (MHS) following identification of suicide risk in youth. SAFETY-A will be adapted to fit the organizational context of school districts and to reduce mistrust of MHS, internalized stigma, and concealment of youth emotional distress that arise in school suicide risk assessments with Asian American and Latinx students. Following a prototyping case series, a feasibility trial will assign four districts to the timing of SAFETY-A implementation to generate preliminary data on feasibility and impacts on proposed mechanisms and youth MHS utilization and clinical outcomes across racial/ethnic groups.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Safe Alternatives for Teens and Youth-Acute for Schools (SAFETY-A for Schools) in preventing suicide?

The SAFETY-A treatment, which is a brief, strengths-based, cognitive-behavioral family intervention, has shown positive effects in improving care linkage for racial-ethnic minority youths receiving emergency department treatment for suicidality, suggesting its potential effectiveness in school settings as well. ^{1 2 3 4 5}

Is the SAFETY-A program safe for use in humans?

The SAFETY-A program, which is a cognitive-behavioral family treatment, has been evaluated for its use in preventing suicide attempts among youths. While the studies focus on its effectiveness, they do not report any specific safety concerns, suggesting it is generally safe for use in humans. ^{5 6 7 8 9}

How is the SAFETY-A for Schools treatment different from other suicide prevention treatments?

SAFETY-A for Schools is unique because it combines cognitive-behavioral therapy (a type of talk therapy) with dialectical behavior therapy (a therapy that helps manage emotions) in a family-focused approach, specifically designed to promote safety among young people at risk of suicide. Unlike other treatments, it is tailored for use in schools, aiming to involve both the educational environment and family in the prevention process. ^{6 9 10 11 12}

Research Team

Anna Lau, PhD

Principal Investigator

University of California, Los Angeles

Eligibility Criteria

This trial is for students aged 11-19 in certain school districts who have shown suicidal thoughts or behaviors. They must have a caregiver to participate with them. It's not for those with intellectual disabilities, psychosis, intoxication, or at immediate risk needing emergency care.

Inclusion Criteria

Have an identified caregiver who can participate in the intervention

I am between 11 and 19 years old.

Enrolled in participating school district

Exclusion Criteria

School personnel determine the student to be at such imminent risk of danger to self that they are unable to benefit from the intervention and must be immediately transported for emergency care

Student is unable to participate in the intervention due to indications of intellectual disability, psychosis, or intoxication

Timeline

Stakeholder Engagement

Stakeholders are engaged to design adaptations to the intervention and implementation strategy.

4-6 weeks

Prototyping Case Series

A prototyping case series will inform iterative refinements of SAFETY-A in one school district.

8 weeks

Pilot Feasibility Trial

A pilot feasibility trial will assign school districts to the timing of implementation to provide preliminary data on implementation outcomes.

6 months

Follow-up

Participants are monitored for safety and effectiveness after the intervention.

6 months

Treatment Details

Interventions

• Safe Alternatives for Teens and Youth-Acute for Schools (SAFETY-A for Schools)

Trial Overview The SAFETY-A program is being adapted for schools to help reduce suicide risks among youth, especially Asian American and Latinx students. The study will test how well it works in low-resource districts and if it can improve mental health service use and clinical outcomes.

Participant Groups

Group I: Safe Alternatives for Teens and Youth-Acute for Schools (SAFETY-A for Schools) Experimental Treatment 1 Intervention

SAFETY-A is a brief, family centered, cognitive-behavioral approach to therapeutic risk assessment and safety planning that can be delivered via school-based providers. The intervention is delivered in one session during which the youth at risk for suicidal behavior works with the provider to identify strengths, supports, understand emotional antecedents and warning signs, identify alternative coping behaviors and thoughts, and ways to keep the environment safe. Youth and families receive follow-up contacts after the SAFETY-A session. The primary focus is on the therapeutic mechanisms of hope, reduced intensity of suicidal urges, increased confidence in ability to keep safe. Adaptation of SAFETY-A for Schools will target mechanisms that are presumed to drive disparities in mental health service use among Asian American and Latinx youth: (1) trust in mental health services, (2) internalized stigma, and (3) comfort communicating distress.

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

Duke University

Collaborator

Trials

2,495

Recruited

5,912,000+

Findings from Research

The pilot study involving 66 adolescents showed that the ASAP intervention, which includes a smartphone app for emotion regulation, did not significantly reduce suicide attempts post-discharge, but indicated a trend towards fewer attempts (16% vs. 31%).

Participants with a history of previous suicide attempts may benefit more from the ASAP intervention, suggesting that this program could be tailored for those at higher risk, and overall, the intervention and app were well-received by users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents. Kennard, BD., Goldstein, T., Foxwell, AA., et al.[2023]

A realist review of school-based suicide prevention interventions suggests that understanding local needs and contexts is crucial for developing effective programs.

The study indicates that it is feasible to create evidence-based suicide interventions in schools by analyzing the various factors that influence their success or failure in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding the effectiveness of school-based interventions to prevent suicide: a realist review. Balaguru, V., Sharma, J., Waheed, W.[2020]

The study successfully implemented the Safety Planning Intervention (SPI) for adolescent suicidality in emergency services, showing that training significantly improved providers' attitudes and knowledge about the intervention.

Collaboration with stakeholders and brief training were effective strategies for integrating structured safety planning into pediatric emergency settings, which is crucial for enhancing care for suicidal youths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. Bettis, AH., Donise, KR., MacPherson, HA., et al.[2022]

Over 90% of adolescents recently hospitalized for suicide risk reported having access to their safety plans after discharge, indicating high retention and potential for use during critical periods.

While safety plan use and suicidal ideation both declined over time, the relationship between them varied by sex: girls showed a correlation in changes, while boys' safety plan use decreased regardless of their suicidal ideation changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety plan use in the daily lives of adolescents after psychiatric hospitalization. May, AM., Al-Dajani, N., Ballard, ED., et al.[2023]

The SAFETY-A intervention significantly improved treatment linkage rates for racial-ethnic minority youths after emergency department treatment for suicidal episodes, compared to those receiving enhanced usual care.

This study involved 105 participants and suggests that SAFETY-A is an effective approach to promote mental health equity and continuity of care for at-risk youths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Care Linkage for Racial-Ethnic Minority Youths Receiving Emergency Department Treatment for Suicidality: SAFETY-A. Kodish, T., Lau, AS., Belin, TR., et al.[2023]

The SafePlan mobile app is being evaluated for its feasibility and acceptability among young people (ages 16-35) experiencing suicidal thoughts, with 80 participants set to be randomized to either the app plus usual treatment or a paper-based safety plan plus usual treatment.

The study aims to assess not only the app's usability but also its potential impact on reducing suicidal ideation over an 8-week period, with follow-up assessments at 6 months, which could inform future research and policy on integrating digital safety planning tools in mental health services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial. Melia, R., Francis, K., Duggan, J., et al.[2023]

Health-related research in alternative high schools (AHSs) has increased from 2010 to 2015, highlighting the growing recognition of health issues among at-risk students.

Despite this increase, AHS students still face significant health disparities, and only 42% of studies reported participation rates, indicating challenges in engaging this vulnerable population in research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Systematic Review of Consent Procedures, Participation Rates, and Main Findings of Health-Related Research in Alternative High Schools From 2010 to 2015. Johnson, KE., Morris, M., Rew, L., et al.[2018]

The Safer Choices intervention is a comprehensive program aimed at reducing risky sexual behaviors among high school students to prevent HIV, STDs, and pregnancy, involving multiple stakeholders like school staff, parents, and community members.

The program includes various components such as curriculum development, peer education, and parent education, all designed to create a supportive school environment and promote protective behaviors among adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safer Choices: a multicomponent school-based HIV/STD and pregnancy prevention program for adolescents. Coyle, K., Kirby, D., Parcel, G., et al.[2004]

The SAFETY program, a cognitive-behavioral and family-focused treatment, significantly reduced the likelihood of suicide attempts in adolescents aged 12-18 who had recently engaged in self-harm, with a 100% survival rate without attempts in the SAFETY group compared to 67% in the control group at the 3-month follow-up.

This study, involving a randomized controlled trial, is the second to show that combining cognitive-behavioral therapy with family involvement can effectively protect high-risk youths from suicide attempts, highlighting the importance of family support in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. Asarnow, JR., Hughes, JL., Babeva, KN., et al.[2023]

School-based youth suicide prevention programs should focus on both specific educational strategies and broader systemic changes to enhance student engagement and support, as these approaches have shown effectiveness in addressing various youth issues, including suicidal behavior.

A comprehensive strategy that combines targeted interventions with a supportive school environment is essential to effectively reduce alienation and withdrawal among students, which are key factors in suicidal behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide prevention in an educational context: broad and narrow foci. Kalafat, J., Elias, MJ.[2022]

The adolescent suicide rate has more than tripled since the 1950s, making it a critical issue as it is now the third-leading cause of death among 15-to-24 year-olds.

Comprehensive school suicide prevention programs should include primary, secondary, and tertiary prevention strategies, with practical steps provided for school professionals to effectively address prevention, intervention, and postvention in cases of adolescent suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a comprehensive school suicide prevention program. King, KA.[2022]

A systematic review of community and school-based suicide prevention programs in Canada found that none of the commonly applied interventions have proven effective or safe in preventing youth suicide.

Despite the implementation of these programs, the suicide rate among young women in Canada has increased, highlighting a concerning trend and the need for reevaluation of current strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

School- and Community-Based Youth Suicide Prevention Interventions: Hot Idea, Hot Air, or Sham? Kutcher, S., Wei, Y., Behzadi, P.[2022]

References

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

As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents. [2023]

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

Understanding the effectiveness of school-based interventions to prevent suicide: a realist review. [2020]

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

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Safety plan use in the daily lives of adolescents after psychiatric hospitalization. [2023]

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

Improving Care Linkage for Racial-Ethnic Minority Youths Receiving Emergency Department Treatment for Suicidality: SAFETY-A. [2023]

6. Canada pubmed.ncbi.nlm.nih.gov

Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial. [2023]

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

A Systematic Review of Consent Procedures, Participation Rates, and Main Findings of Health-Related Research in Alternative High Schools From 2010 to 2015. [2018]

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

Safer Choices: a multicomponent school-based HIV/STD and pregnancy prevention program for adolescents. [2004]

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

Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Suicide prevention in an educational context: broad and narrow foci. [2022]

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

Developing a comprehensive school suicide prevention program. [2022]

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

School- and Community-Based Youth Suicide Prevention Interventions: Hot Idea, Hot Air, or Sham? [2022]