e-Connect for Suicide Prevention

Recruiting at 1 trial location

Overseen By Shelly Qu

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: New York State Psychiatric Institute

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

Compensation: Varies

Number of Visits: Unknown

12838 Participants Needed

Trial Summary

What is the purpose of this trial?

The investigators propose to create e-Connect, a new service delivery model that will enable real time identification and targeted, county-specific referral and linkage of participants with suicidal behavior (SB) and related behavioral health (BH) problems. e-Connect will: (i) establish and formalize interagency referral decisions based on clinical need, jointly derived by JJ (juvenile justice) and BH agencies; (ii) train probation staff to increase BH/SB understanding; (iii) utilize an existing evidence-based (EB) BH/SB screen; and (iv) develop a mobile application to seamlessly integrate screening, classification of clinical need and development of a related referral plan. There are 4 project phases: Development, Baseline, Implementation, and Sustainment/Evaluation. After development, activities take place in 10 NY (New York) counties and all study counties will begin the intervention at the same time. The investigators will examine changes in outcomes (e.g., service use) relative to baseline in (i) identification of participants service need (SB and BH correlates) in juvenile probationers; (ii) cross-system (probation-BH agency) referral; and (iii) participants BH service use (access and engagement). Analyses will further consider contributions of multi-level factors (e.g., staff, organizational, family, and community) that influence implementation (feasibility, acceptability, sustainability) of e-Connect across various probation department processing categories (e.g. status offenders, diversion cases). The investigators will consider the role of mediating elements (e.g., probation practices) in explaining the association between e-Connect and identification, referral, and service use.

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 e-Connect for suicide prevention?

Research shows that communication-based interventions, like those using technology such as text messages and phone calls, can effectively prevent repeat suicide attempts by maintaining contact with patients and their families. These methods have been found to help reduce suicidal thoughts and behaviors, especially when patients follow the treatment schedule. ^{1 2 3 4 5}

Is e-Connect for Suicide Prevention safe for humans?

The research highlights the importance of detecting adverse events (unwanted effects) in suicide prevention studies, but it doesn't provide specific safety data for e-Connect. It emphasizes the need for clear definitions and consistent reporting of adverse events to better understand safety in such interventions. ^{6 7 8 9 10}

How is the e-Connect treatment for suicide prevention different from other treatments?

The e-Connect treatment is unique because it likely involves an online or digital component, similar to other interventions like eBridge and SERO, which use online platforms or mobile apps to provide personalized feedback, counseling, and self-management tools for individuals at risk of suicide. This approach can offer more immediate and accessible support compared to traditional in-person therapy. ^{11 12 13 14 15}

Research Team

Katherine Elkington, PhD

Principal Investigator

Columbia University/New York State Psychiatric Institute

Eligibility Criteria

The e-Connect trial is for probation officers aged 21-70 who are actively employed in juvenile justice departments. They must work directly with youth or supervise those who do, focusing on probation supervision, assessment, and referral activities in one of the selected 10 New York counties.

Inclusion Criteria

Only certain people who work in the probation system, such as leaders and officers, are eligible to participate in the study.

You are currently employed as a probation officer working with youth, or you supervise those who work with youth in a probation department. This study is being conducted in 10 specific counties. You must be between the ages of 21-70.

Timeline

Development

Development of the e-Connect service delivery model, including training materials and mobile application

Not specified

Baseline

Baseline data collection to assess current practices and outcomes before implementation of e-Connect

Not specified

Implementation

Implementation of the e-Connect intervention across all study counties, including training and use of the mobile application

18 months

Sustainment

Ongoing use and evaluation of e-Connect to assess sustainability and long-term outcomes

Monthly evaluations from end of implementation through sustainment period

Treatment Details

Interventions

• e-Connect

Trial Overview e-Connect aims to improve real-time identification and targeted referrals for youths at risk of suicide within the juvenile justice system. It involves training staff, using an evidence-based behavioral health screen, and a mobile app to integrate screening and referrals.

Participant Groups

Group I: e-Connect Experimental Treatment 1 Intervention

County receives training and materials and subsequently begins the e-Connect intervention

Group II: Standard of care Active Control 1 Intervention

Counties use the standard of care and there is no intervention in practices.

Who Is Running the Clinical Trial?

New York State Psychiatric Institute

Lead Sponsor

Trials

481

Recruited

154,000+

Columbia University

Lead Sponsor

Trials

1,529

Recruited

2,832,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Chestnut Health Systems

Collaborator

Trials

27

Recruited

24,500+

George Mason University

Collaborator

Trials

60

Recruited

50,200+

Findings from Research

Emphasizing early intervention and ongoing low-intensity contact with individuals at risk of suicide can be more effective than solely focusing on those deemed 'highest risk', suggesting a shift in treatment strategy.

The use of advanced interactive computer programs can enhance screening and training for healthcare providers, improving access to mental health services and continuity of care for suicidal individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide prevention in a treatment setting. Litman, RE.[2022]

In a study analyzing 420 messages from 149 patients who had recent emergency department visits or hospitalizations for depression or suicidality, messages from at-risk patients were significantly more likely to express a depressed mood, suicidal thoughts, or emotional distress compared to a control group.

Despite the ability of patient portal messages to convey signs of distress, only a small percentage of patients who died by suicide (23%) sent messages in the month prior to their death, indicating that portal communication may not effectively identify all at-risk individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Portal Message Language Use Prior to Suicide, Suicide Attempts, and Hospitalization for Depression. Duvall, MJ., Miller, NE., North, F., et al.[2022]

A pilot study of a text-messaging intervention for youths discharged from the hospital after suicidal thoughts showed it was feasible and well-received, helping to reduce suicidal thoughts and behaviors.

The positive results of this intervention led to the Maryland Department of Health expanding the program to offer similar support to all Maryland residents, highlighting its potential effectiveness in suicide prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Brief Text-Messaging Intervention for Suicidal Youths After Emergency Department Discharge. Ryan, TC., Chambers, S., Gravey, M., et al.[2022]

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]

A qualitative study involving experienced suicide researchers revealed significant challenges in defining and reporting adverse events (AEs) and serious adverse events (SAEs) in suicide prevention trials, which complicates safety evaluations.

Participants emphasized the urgent need for clear and consistent definitions and reporting standards for AEs and SAEs to improve the comparability of studies and enhance safety monitoring in at-risk populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution. Oquendo, MA., Feldman, S., Silverman, E., et al.[2022]

The implementation of an electronic Web-based system at a pediatric hospital significantly improved the completion rate of interventions related to adverse drug events (ADEs), increasing from 21% to 44.7% after the system was introduced over a 5-month evaluation period.

The new system also enhanced documentation accuracy, reducing the rate of incomplete interventions from 77% to 43.7%, indicating that a streamlined electronic approach can effectively enhance patient safety in medication management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvement of medication event interventions through use of an electronic database. Merandi, J., Morvay, S., Lewe, D., et al.[2019]

The web-based adverse event tracking system (eAETS) has effectively supported 175 clinical protocols over four years, capturing 2,440 adverse event reports, including minor symptoms that could indicate serious issues.

Out of the reported AEs, 1,053 did not align with the initial risk profiles, leading to corrective recommendations in 13% of the protocols, highlighting the system's role in enhancing subject safety by identifying unanticipated patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of minor adverse event tracking on subject safety: a web-based system. Shenvi, NV., Gebhart, SS.[2009]

The Lifeline Crisis Chat Network significantly reduced distress among users, with two-thirds of suicidal chatters finding the chat helpful and nearly half reporting decreased suicidal thoughts after the intervention.

This study provides strong evidence for the effectiveness of online crisis interventions, which is especially important as the Lifeline prepares to expand its services with the new 988 nationwide number for mental health crises.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters' perceptions of effectiveness. Gould, MS., Chowdhury, S., Lake, AM., et al.[2022]

The mobile app developed as part of the SERO suicide prevention program aims to reduce suicides and suicide attempts by enhancing self-management for individuals at risk, incorporating strategies like safety planning and mood tracking.

The app's design was informed by collaboration among health professionals, individuals at risk, and their families, ensuring it addresses real needs and integrates essential suicide prevention strategies effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SERO - A New Mobile App for Suicide Prevention. Meier, L., Gurtner, C., Nuessli, S., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Suicide prevention in a treatment setting. [2022]

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

Portal Message Language Use Prior to Suicide, Suicide Attempts, and Hospitalization for Depression. [2022]

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

A Brief Text-Messaging Intervention for Suicidal Youths After Emergency Department Discharge. [2022]

4. Greece pubmed.ncbi.nlm.nih.gov

Communication-based suicide prevention after the first attempt. A systematic review. [2021]

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

Telecommunication and suicide prevention: hopes and challenges for the new century. [2022]

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

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

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

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution. [2022]

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

A systematic review of validated suicide outcome classification in observational studies. [2020]

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

Improvement of medication event interventions through use of an electronic database. [2019]

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

The impact of minor adverse event tracking on subject safety: a web-based system. [2009]

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

Online suicide risk screening and intervention with college students: a pilot randomized controlled trial. [2022]

12. Canada pubmed.ncbi.nlm.nih.gov

Suicide prevention e-learning modules designed for gatekeepers: a descriptive review. [2022]

13. England pubmed.ncbi.nlm.nih.gov

National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters' perceptions of effectiveness. [2022]

14. England pubmed.ncbi.nlm.nih.gov

Effectiveness of adolescent suicide prevention e-learning modules that aim to improve knowledge and self-confidence of gatekeepers: study protocol for a randomized controlled trial. [2022]

15. Netherlands pubmed.ncbi.nlm.nih.gov

SERO - A New Mobile App for Suicide Prevention. [2022]