Developing an Adaptive Intervention for Suicidal Adolescents Following Inpatient Hospitalization: A Pilot SMART

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ABSTRACT This 4-year K23 Mentored Career Development Award application proposes a program of focused research and training to facilitate the applicant's transition to an independent career in patient-oriented research with a specialization in adaptive and technology-enhanced interventions for youth at risk for suicide. CONTEXT: Despite the public health significance of youth suicide, efficacious interventions for suicidal teens are lacking. In particular, a critical need exists for effective interventions for psychiatrically hospitalized adolescents who are at a high risk for repeated suicidal behavior and related crises. Because suicidal youth are highly heterogeneous in terms of varying levels of post-discharge suicide risk and response to intervention, optimizing post-discharge outcomes (preventing relapse of suicidal crises) requires a personalized approach. Adaptive interventions (AIs), which can individualize the type, intensity, and timing of treatment, are ideally suited for addressing this heterogeneity. In addition, given the ubiquity and youth preferences for mobile communication (text messaging), integrating technology to augment interventions for suicidal youth can potentially strengthen their impact. RESEARCH STRATEGY: To inform the development of a technology-augmented AI for suicidal teens, the applicant proposes to conduct a Sequential, Multiple Assignment, Randomized Trial (SMART) pilot of a Motivational Interview (MI)-enhanced safety planning intervention (MI-SafeCope). Building on the applicant's pilot research, Aim 1 will focus on finalizing the intervention components (MI-enhanced safety plan delivered at hospitalization; post-discharge daily text message boosters; post-discharge telephone booster call), implementation protocol, and fidelity assessment tools in preparation for the SMART pilot. Specifically, the applicant will develop the text message booster component through a process of iterative refinement based on feedback from experts and adolescent focus groups (N=20). Aim 2 will focus on conducting the SMART pilot (N=80) with suicidal adolescent inpatients (ages 13-17) to refine and demonstrate acceptability and feasibility of study procedures and MI-SafeCope components and their sequence to guide the implementation of a full-scale SMART (R01 proposal). The full-scale SMART will, in turn, lead to the construction of the AI for suicidal teens following acute care. TRAINING PLAN: To facilitate the applicant's career goal of becoming an independent clinical scientist developing interventions to prevent youth suicide, the specific training goals are to: (1) gain expertise in intervention science with a focus on developing, implementing, and evaluating AIs for youth at risk for suicide; (2) develop skills in integrating technology to augment and deliver interventions for these youth; and (3) obtain training in analytic strategies for SMART studies and analytic approaches that can inform the development of AIs. These goals will be accomplished through close mentorship from experts in these content areas; via carefully selected didactic activities and conference attendance; via applied research experiences; and via manuscript and grant proposal (i.e. an R01 for a fully-powered SMART) preparation.