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Publications

Journal Article Ahead of print

PubMed: 42031228 DOI: 10.1016/j.cct.2026.108325

Safe treatment for emergency presentation for suicidal ideation and behavior (SAFE STEPS): Protocol for randomized controlled trial.

Contemp Clin Trials

Authors: Joan R Asarnow, David B Goldston, Anthony Spirito, Brooks Keeshin, Ivan Miller, Tom Belin, Naser Ahmadi, Jocelyn Meza, Carla Carlisle, Shayna Cheek, Bowen Chung, W Scott Comulada, Rosa Elena Garcia, Chantel Garrett, Brandon Gaudiano, Lisa Giles, Felica Jones, Roberto López, Kenneth Wells, Lucas Zullo

Affiliations

  • Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 1236, Los Angeles, CA 90095, United States of America.
  • Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3527, Durham, NC 27710, United States of America.
  • Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI 02912, United States of America.
  • Department of Pediatrics, University of Utah, 81 North Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America; Department of Public Health and Caring Science, Child Health and Parenting, Uppsala University, Box 564, 751 22 Uppsala, Sweden.
  • Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI 02912, United States of America; Psychosocial Research Program, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02916, United States of America.
  • Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 1236, Los Angeles, CA 90095, United States of America; Department of Biostatistics, University of California, Los Angeles, 51-254 CHS, Box 951772, Los Angeles, CA 90095, United States of America.
  • Olive View UCLA Medical Center, 14445 Olive View Drive, Sylmar, CA 91342, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, United States of America.
  • Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 1236, Los Angeles, CA 90095, United States of America.
  • Carla A Carlisle, LLC dba the Compassionate Companion, United States of America.
  • Olive View UCLA Medical Center, 14445 Olive View Drive, Sylmar, CA 91342, United States of America; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Box 177220, Suite 16-035 CHS, Los Angeles, CA 90095, United States of America.
  • Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 1236, Los Angeles, CA 90095, United States of America; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Box 177220, Suite 16-035 CHS, Los Angeles, CA 90095, United States of America.
  • RAND Survey Research Group (SRG), P.O. Box 2138, 1776 Main Street, Santa Monica, CA 90401, United States of America.
  • Strong365 Lab LLC, United States of America.
  • Department of Pediatrics, University of Utah, 81 North Mario Capecchi Dr, Salt Lake City, UT 84113, United States of America.
  • Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 1236, Los Angeles, CA 90095, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024, United States of America.

Abstract

BACKGROUND

Suicide is currently the second leading cause of death among youth ages 13-24 in the United States. Youths presenting to Emergency Departments (EDs) with suicidal ideation and/or behavior have elevated risk for subsequent suicide attempts and deaths, yet optimal approaches to emergency care remain unclear and too many youths receive inadequate follow-up treatment after discharge.

METHODS

Using a community partnered participatory research model, this multi-site single-blinded randomized comparative effectiveness trial investigates two strategies for enhancing emergency care for 1600 adolescents and young adults (ages 13-24) presenting with suicide attempts and/or suicidal ideation: 1) ED care enhanced by increased access to a developmentally tailored approach to safety planning; and 2) a combined approach that supplements enhanced ED care with brief therapeutic contacts with youths and parents/significant others for 12 months after ED-discharge. These contacts by phone/video/text/letter feature support, brief intervention, and case management. Youths will be recruited from four geographically diverse locations, and assessed at baseline and 3, 6, and 12-month follow-ups. Parent assessments will be at: baseline; 12-month follow-ups; and when youth report is unavailable. Outcomes will be assessed in two domains: 1) clinical [suicide attempts primary, self-harm (suicide attempts+nonsuicidal self-harm) secondary]; 2) service use (linkage to outpatient mental health care primary, treatment dose secondary). Exploratory outcomes and heterogeneity of treatment effects will be evaluated.

DISCUSSION

The trial is designed to have public health impact by clarifying the added value of therapeutic follow-up contacts after discharge, relative to ED care emphasizing evaluation, safety planning, and referral for follow-up care.

MeSH

Safety, Emergencies, Therapeutics, Suicidal Ideation, Suicide