ABSTRACT
Prevalence rates for suicidal and non-suicidal self-injurious behavior (SSIB) in youth aged 10 to 14 years
have increased in the past two years at alarming rates. As a result, the NIMH issued two Notice of Special
Interest (NOSI) for the assessment and prevention of SSIB among children and preteens. Pediatric emergency
departments (EDs) have become an essential and often routine mental health (MH) service for youth. While
youth MH has recently been deemed a national public health crisis, overburdened EDs have continued to endure
a two decade-long increase in youth presenting with MH emergencies. Increases in pediatric MH presentations
have been observed throughout the U.S., with suicide rates for youth 10 to 18 years being the second leading
cause of death. However, effective ED interventions to increase linkage to appropriate MH care are lacking.
Adaptive interventions, which provide a tailored approach to the type, intensity, and timing of treatment, are well-
matched for addressing this need and youth heterogeneity. The scientific premise of this application is supported
by youth psychiatric emergency research and gaps in the literature. The purpose of this study is to refine and
pilot a brief, culturally and identity sensitive, adaptive ED intervention via Sequential Multiple
Assignment Randomized Trial (SMART) design that targets individual and systemic barriers to care to
increased linkage to subsequent community-based MH care for youth 10 to 14 years after an ED
admission and referral. This study employs an ecological approach within a socio-cultural theoretic framework
for the study of MH service disparities. This intervention is informed by the literature, ED interventions, a family-
based approach, and directly targets three presumptive mechanisms: 1) MH literacy, 2) MH communication, and
3) MH engagement. Primary outcomes, measured at 2-weeks and 4-, and 6-month, include increased linkage to
MH care (attendance), reduced SSIB symptoms and severity, and the engagement of the purported therapeutic
mechanisms. This study is innovative because it offers a brief, family-based SMART to meet the needs of the
diverse population of youth and caregivers served in the ED. This proposal aligns well with the NIMH Strategic
Plan Objectives 4.1 & 4.3, to “improve the efficiency, effectiveness, and reach of MH services through research”
and “develop innovative service delivery models to dramatically improve the outcomes of MH services received
in diverse communities and populations,” respectively. This research has the potential to directly inform youth
ED settings and has significant implications for dissemination.
