Follow-up Calls for Youth Suicide Risk

Overseen By Hanae Fujii-Rios, MD MPH

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Johns Hopkins University

Disqualifiers: Direct admissions, others

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

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if follow-up phone calls (routine follow-up contacts) assist caregivers of young people at risk of suicide in connecting with mental health resources. Researchers seek to identify the optimal timing for these calls after a hospital visit to maximize effectiveness. The study will also monitor whether these young people experience fewer emergency department visits after receiving follow-up support. Young people aged 8 to 21, who have visited Johns Hopkins Hospital's emergency department for suicide risk and have a mental health referral, may be eligible to participate. As an unphased trial, this study offers participants the chance to contribute to important research that could enhance mental health support strategies for young people.

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 prior data suggests that this follow-up protocol is safe for youths with suicide risk?

Research has shown that follow-up calls can safely support young people at risk of suicide. Some studies have explored similar methods, such as safety planning and follow-up calls, which are well-received and help connect young people with mental health resources. These approaches typically involve checking in by phone and guiding youths to additional help, making them a low-risk way to prevent future crises. No reports of serious problems have been linked to these follow-up calls, suggesting they are a safe way to support families during difficult times. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the impact of follow-up calls as a method to support youth at risk of suicide. Unlike traditional treatments that might focus on medication or therapy sessions, this approach provides timely, personalized contact shortly after a crisis incident. What's unique here is the comparison of call timing—within 5 days versus within 10 days—which could reveal how quickly follow-up is needed to make a meaningful difference. This trial could uncover simple, effective ways to enhance care and potentially save lives by improving how we connect with and support vulnerable youth.

What evidence suggests that this follow-up call protocol is effective for youth suicide risk?

Research has shown that follow-up phone calls after hospital discharge can greatly reduce suicide attempts among teenagers. In this trial, participants will receive follow-up calls within either 5 days or 10 days after discharge. One study found that almost 98% of teens who called a crisis line felt the call was helpful, and 88.1% said it stopped them from thinking about suicide. These calls keep young people connected to mental health services, which is crucial for their recovery. Additionally, follow-up calls can link them to local mental health resources, reducing the likelihood of returning to the emergency room. This method has shown promise in supporting young people at risk for suicide. ^{1 3 6 7 8}

Who Is on the Research Team?

Hanae Fujii-Rios, MD MPH

Principal Investigator

Johns Hopkins University

Are You a Good Fit for This Trial?

This trial is for caregivers of youths who have shown suicide risk and visited the pediatric emergency department (ED) at Johns Hopkins Hospital. It aims to help these young individuals connect with mental health services after their hospital visit.

Inclusion Criteria

I am between 8 and 21 years old.

Patients who present to the emergency department (ED) and are assessed with suicide risk

Patients who are discharged from the Johns Hopkins Hospital (Pediatric inpatient psychiatric unit, Pediatric Day Hospital, or Pediatric ED) with a mental health referral

Exclusion Criteria

Direct admissions, bypassing the hospital's ED

Patients who were directly transferred to the inpatient psychiatry unit or the Day Hospital from an outside hospital, bypassing the hospital's ED

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Follow-up Call

Social work staff conduct follow-up calls with caregivers to assist with barriers in accessing mental health resources

5 to 10 days

Phone call

Follow-up

Participants are monitored for engagement with community mental health services and repeat ED visits

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Follow up call

Trial Overview The intervention being tested is a follow-up program led by social workers, which includes phone calls to assist in engaging youths with mental health services post-ED visit. The study will determine the best timing for these calls and measure success by how many youths connect with care.

How Is the Trial Designed?

Group I: Follow up call within 5 days Experimental Treatment 1 Intervention

Follow up call within 5 days

Group II: Follow up call within 10 days Active Control 1 Intervention

Follow up call within 10 days

Who Is Running the Clinical Trial?

Johns Hopkins University

Lead Sponsor

Trials

2,366

Recruited

15,160,000+

Published Research Related to This Trial

In a study of 76,462 psychiatric patients, those who received outpatient follow-up care within 7 days of discharge had a significantly lower risk of suicide (hazard ratio of 0.82) compared to those who did not receive follow-up within 30 days.

The findings indicate that early outpatient follow-up care is crucial for reducing suicide risk, particularly for patients with conditions like substance use disorder, schizophrenia, and depression, highlighting the need for intensive support immediately after hospital discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Follow-Up Timing After Discharge and Suicide Risk Among Patients Hospitalized With Psychiatric Illness. Che, SE., Gwon, YG., Kim, KH.[2023]

A text-based intervention for adolescents at high risk of suicide, developed and tested with 40 participants, showed strong acceptability and potential effectiveness in supporting their transition after psychiatric hospitalization.

Feedback indicated that the text messages could help remind adolescents to use coping strategies and improve their mood, although some participants felt that the messages might not be sufficient for all teens or situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study. Czyz, EK., Arango, A., Healy, N., et al.[2020]

A study involving 142 adolescents hospitalized for suicidal thoughts or attempts found that multiple follow-up telephone calls significantly reduced suicidal behavior (6% in the multiple calls group vs. 17% in the single call group).

The adolescents who received multiple calls also reported greater confidence in their safety plans (95% vs. 74%), which was linked to a lower rate of suicidal behavior, suggesting that ongoing support can enhance safety planning effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reduction of Postdischarge Suicidal Behavior Among Adolescents Through a Telephone-Based Intervention. Rengasamy, M., Sparks, G.[2022]

A partnered suicide prevention follow-up program between an academic medical center and a regional suicide prevention center was found to be valuable by both psychiatry residents and crisis counselors, highlighting its potential benefits for patients after hospital discharge.

Participants identified the need for improved communication and coordination between the two organizations to enhance the referral process and better understand which patients would benefit from the program, indicating areas for future implementation improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bridging the gap: a qualitative study of providers' perceptions of a partnered crisis follow-up program for suicidal patients post-emergency department discharge. Soderlund, PD., Cheung, EH., Cadiz, MP., et al.[2023]

Follow-up services are crucial for suicide prevention, and recent reviews highlight the need for effective care strategies, although research in this area is still limited.

The paper identifies promising approaches that have shown effectiveness in reducing suicide attempts and suicidal ideation, while also calling attention to the methodological flaws in existing studies and the need for further research to validate positive findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of evidence-based follow-up care for suicide prevention: where do we go from here? Brown, GK., Green, KL.[2022]

In a study of 113 adolescents discharged from the emergency department for mental health crises, 83% followed their referral plans without needing follow-up calls, indicating high initial compliance.

Routine follow-up calls by emergency department staff only persuaded 3% of patients to attend outpatient care, suggesting that such calls may not be necessary in all cases for improving attendance at referral sites.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adolescents in mental health crisis: the role of routine follow-up calls after emergency department visits. Hopper, SM., Pangestu, I., Cations, J., et al.[2011]

A one-year follow-up phone-call program for adolescents and young adults who attempted suicide showed promise in enhancing compliance with aftercare treatment, as 93 out of 173 participants were successfully contacted after one year.

Despite the positive feedback about the intervention, a significant challenge was identified, as nearly half of the participants were unreachable at the one-year follow-up, particularly those with higher rates of school dropout and migration history.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How to stay in touch with adolescents and young adults after a suicide attempt? Implementation of a 4-phones-calls procedure over 1 year after discharge from hospital, in a Parisian suburb. Normand, D., Colin, S., Gaboulaud, V., et al.[2019]

In the ED-SAFE study, structured telephone follow-up assessments were crucial for identifying adverse events (AEs), detecting 45% of total AEs that were missed by chart reviews alone.

The detection of suicide attempts varied significantly by method, with structured follow-ups identifying 59% of attempts compared to only 18% through chart reviews, highlighting the importance of using multiple detection methods in suicide research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using structured telephone follow-up assessments to improve suicide-related adverse event detection. Arias, SA., Zhang, Z., Hillerns, C., et al.[2021]

Follow-up interventions, such as phone calls and letters, have shown promise in reducing the risk of suicide reattempts among patients discharged after a suicide attempt, with some studies reporting significant decreases in reattempt rates.

Despite the positive outcomes, the variability in study methods and definitions makes it difficult to draw firm conclusions about the effectiveness of these interventions, highlighting the need for more standardized research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Follow-up interventions after suicide attempt. What tools, what effects and how to assess them?] Castaigne, E., Hardy, P., Mouaffak, F.[2022]

Interactive Voice Response (IVR) is an effective and feasible method for collecting self-reported mood data from adolescents after discharge from a psychiatric emergency unit, achieving an impressive average response rate of 91%.

The study found that boys reported their mood significantly higher than girls, with an average difference of 3.52 units, indicating potential gender differences in mood assessment among young patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interactive voice response - an automated follow-up technique for adolescents discharged from acute psychiatric inpatient care: a randomised controlled trial. Johansson, BA., Remvall, S., Malgerud, R., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12378765/

Suicide Prevention in Youth - PMC This review presents new research pertinent to youth suicide prevention with a focus on suicide risk screening; therapeutic interventions, ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12099483/

Evaluation of Crisis Call Outcomes for Suicidal Callers The vast majority of suicidal Lifeline callers thought their crisis call helped them (nearly 98%) and stopped them from killing themselves (88.1%).

3. withpower.com withpower.com/trial/phase-suicide-10-2023-56f61

Follow-up Calls for Youth Suicide Risk Research shows that follow-up phone calls after a hospital discharge can reduce suicide attempts in adolescents and help them stay engaged in their mental ...

4. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/emp2.13322

Retrospective evaluation of implementation of caring ... Prospective studies are needed to assess Caring Contacts' effectiveness in reducing suicide risk among adolescents following an ED visit.

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1551714424000661

Safety planning intervention and follow-up: A telehealth ... We developed a telehealth model for ED staff to connect patients at risk for suicide to clinicians in an external Suicide Prevention Consultation Center (SPCC).

6. jamanetwork.com jamanetwork.com/journals/jamapediatrics/fullarticle/2834286

Safety Planning Interventions for Suicide Prevention in ... This systematic review and meta-analysis investigates the effectiveness of safety planning as a standalone intervention for suicide ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10530453/

Comparative effectiveness of safety planning intervention ... Two follow-up models to augment usual care including the Safety Planning Intervention have high efficacy: Instrumental Support Calls (ISC) and Caring Contacts ( ...

8. publications.aap.org publications.aap.org/pediatrics/article/153/1/e2023064800/196189/Suicide-and-Suicide-Risk-in-Adolescents

Suicide and Suicide Risk in Adolescents | Pediatrics Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue.