Coping Long Term With Attempted Suicide - Adolescents

The purpose of this R34 treatment development grant is to develop the "Coping Long-term with
Attempted Suicide Program - Adolescents (CLASP-A)," an integrated, adjunctive intervention
program for adolescents who have made a previous suicide attempt. The goals of CLASP-A are
to reduce continued suicidal behavior and ideation, reduce risk behaviors for suicide, and
improve adherence to psychosocial and psychopharmacologic treatments. It is comprised of
three major components: a) three individual meetings while the patient is in the hospital,
b) one in-person meeting with the patient and his/her parent/guardian in the hospital and c)
a series of scheduled telephone contacts with the patient and parent/guardian for six months
following discharge from the hospital. CLASP-A is based on a risk reduction model, and
specifically targets four generic and potentially modifiable risk factors: hopelessness,
impaired family support, problem solving deficits, and treatment non-adherence. The overall
aim of this proposal is to further develop the CLASP-A intervention to address the needs of
adolescents and to examine the feasibility and acceptability of this intervention program in
adolescents. More specifically:

The development aims of this R34 proposal are to:

1. Develop CLASP-A - a multi-modal intervention that integrates strategies from
cognitive-behavioral and values-based psychotherapies and family interventions, for use
with suicidal adolescents.

2. Develop and implement adherence and competence rating scales to evaluate provider
adherence to the intervention manual and their competence in delivering the
intervention.

3. Improve the clarity, structure, content, acceptability, and feasibility of the
intervention using information gathered from a small open trial (n=20) of adolescents,
ages 12-18, who have made a recent suicide attempt.

The pilot study aims of this R34 proposal are to:

1. Conduct a randomized controlled pilot study in a sample of adolescent inpatients
(n=50), ages 12-18, with a recent suicide attempt to assess the feasibility and
acceptability of the proposed intervention and the randomization process.

2. To examine in an exploratory manner, preliminary evidence for the following hypotheses.
It is expected that over a 6 month intervention period, compared to an enhanced
treatment as usual (E-TAU) condition, adolescents assigned to CLASP-A + ETAU will have:

1. fewer suicidal events, operationalized as a dichotomous composite score of suicide
attempts, emergency department visits and inpatient hospital admissions due to
suicide risk, and study rescue procedures due to suicide risk;

2. lower suicidal ideation and less chronic suicidal ideation;

3. To examine in exploratory analyses potential mechanisms of change including treatment
adherence to other forms of treatment as well as improvement in the hypothesized risk
factors (i.e., hopelessness, problem-solving, and family functioning) addressed in the
intervention.

Based on the findings, CLASP-A will be revised, with the objective of creating a flexible
protocol in which emphasis can be shifted based on the presenting problems of the
patient/family, and strategies can be selected to accommodate the developmental stage of the
patient. CLASP-A is innovative in that it targets the highest risk adolescents during their
highest risk period, i.e. transition from inpatient to outpatient care. It is also
innovative in employing multiple modalities (in-person sessions and phone calls) that
involve both the patient and the parent, thus targeting frequently cited barriers in the
treatment of adolescent patients. The availability of a low-cost, easily implemented,
adjunctive intervention that successfully reduces the rate of suicide attempts in
adolescents could improve quality of life and productivity on both individual and societal
levels.

Inclusion Criteria:

- Admission to an inpatient unit due to suicide risk

- English speaking

Exclusion Criteria:

- Active psychosis

- Cognitive Disability