Pediatric Emergency Department Family Navigation, ED_REaCH, for Youth with Suicide and Self-Injurious Behavior: Increasing Support, Education, and Linkage to Mental Health Care - PROJECT SUMMARY/ABSTRACT The prevalence of youth suicidal and non-suicidal self-injurious behaviors (SSIB) is increasing at rapid rates, where suicide is now the second leading cause of death for youth aged 10 to 18. This surge in SSIB coincides with a 60% increase in emergency department (ED) visits related to youth mental health (MH) disorders. EDs do not provide MH treatment, and most youth with mild to moderate (non-urgent) SSIB are released back to their homes following an ED visit with a range of SSIB and MH symptoms. As a result, there is often a gap in care when youth are released from the ED to when they attend the recommended MH treatment. Caregivers of youth discharged from the ED after an SSIB evaluation serve as the safety-ensuring adult in the home, as well as the conduit to youth community-based MH care. In this role, caregivers are responsible for a) contacting and securing their child’s MH services b) following a discharge plan, c) ensuring their child’s safety, and d) identifying and responding to their child’s SSIB symptoms and severity. Problematically, caregivers report high levels of anxiety and low levels of self-efficacy in implementing these tasks due to lack of support and limited MH literacy and strategies needed to effectively fulfill these responsibilities, amplify existing barriers for youth’s MH care. The objective of this research is to conduct a Hybrid Type I trial to examine the effectiveness and optimize future implementation strategies of the Family Navigation intervention, ED_REaCH (Resilience, Education, and Caregiver Help; Cancilliere et al., 2024), for youth who have been discharged from the ED for SSIB and their caregivers. Indeed, pilot work by PI Cancilliere highlights the utility of targeting structural barriers to care, in tandem with enhancing MH literacy and MH communication skills as critical opportunities for enhancing MH engagement strategies for caregivers of youth with non-urgent SSIB discharged from the ED. For this study, a total of N=364 youth (ages 8 to 17) and a caregiver will be recruited to examine ED_REaCH across two pediatric academic medical centers’ EDs (Hasbro Children’s Hospital and Connecticut Children’s Medical Center). This study aims to examine the ED family navigation intervention, ED_REaCH, to improve engagement, implementation, and optimization on primary outcomes of increasing youth linkage to community-based MH care after an ED admission for youth with SSIB, reducing youth MH symptoms and SSIB risk, increasing caregiver self-efficacy to complete tasks associated with successful linkage to care, as well as optimizing future implementation strategies of ED_REaCH to set the stage for a future NIMH R01 Hybrid Type III Trial application.
