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

400 Participants Needed

Trial Summary

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 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 health care. These calls are part of a broader strategy to keep patients connected to support and treatment, which has been shown to be effective in preventing further suicidal behavior. ^{1 2 3 4 5}

Is it safe for adolescents to receive follow-up calls after being discharged from psychiatric care?

Research shows that follow-up calls, including automated and structured telephone assessments, are generally safe for adolescents discharged from psychiatric care. These methods are used to collect data and monitor patients without reported safety issues. ^{1 2 5 6 7}

How is the Follow-up Call treatment for youth suicide risk different from other treatments?

The Follow-up Call treatment is unique because it involves routine phone calls to check on adolescents after they have been discharged from emergency or hospital care, aiming to reduce the risk of further suicidal behavior. This approach is different from other treatments as it focuses on maintaining contact and providing support during the critical period after discharge, rather than relying solely on medication or in-person therapy sessions. ^{1 2 8 9 10}

What is the purpose of this trial?

The goal of this clinical trial is to learn if a social work led follow up program helps caregivers of youths with suicide risk access mental health resources. Primary aims include: 1. To formalize a mental health follow up protocol that assists youths with engagement of mental health services after a hospital visit. 2. To evaluate and standardize the optimal timing for the follow up phone calls. 3. To assess the proportion of patients with suicide risk who connect with community mental health care within a month after a pediatric emergency department (ED) visit at Johns Hopkins Hospital. 4. To assess the proportion of patients with suicide risk who have repeat ED visits within 3 and 6 months. The primary outcome of interest is the proportion of youths referred to a community provider who successfully connect to community mental health resources 5 to 10 business days after an ED visit. The secondary outcome will involve repeat ED visits within 3 and 6 months.

Research Team

Hanae Fujii-Rios, MD MPH

Principal Investigator

Johns Hopkins University

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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 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]

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]

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]

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]

References

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

Reduction of Postdischarge Suicidal Behavior Among Adolescents Through a Telephone-Based Intervention. [2022]

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

Adolescents in mental health crisis: the role of routine follow-up calls after emergency department visits. [2011]

3. France pubmed.ncbi.nlm.nih.gov

[Follow-up interventions after suicide attempt. What tools, what effects and how to assess them?] [2022]

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

Follow-Up Timing After Discharge and Suicide Risk Among Patients Hospitalized With Psychiatric Illness. [2023]

5. France 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. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Using structured telephone follow-up assessments to improve suicide-related adverse event detection. [2021]

7. Switzerland 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. [2021]

8. England 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. [2023]

9. Netherlands pubmed.ncbi.nlm.nih.gov

A review of evidence-based follow-up care for suicide prevention: where do we go from here? [2022]

10. Canada pubmed.ncbi.nlm.nih.gov

Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study. [2020]