ABSTRACT
Youth suicide is an urgent public health concern. Emergency Departments (EDs) often serve as the first line of
contact for large numbers of suicidal adolescents, many of whom do not link to outpatient treatment and
continue to be at high risk for post-discharge suicidal crises (suicide attempts, ED visits due to suicidal ideation
and/or behavior). Thus, there is a critical need for efficacious continuity of care strategies for adolescents at
elevated suicide risk who transition from ED care. One such promising, yet understudied, approach is to
intervene with parents of suicidal adolescents. Parents of these high-risk youth are at the forefront of suicide
prevention and are tasked with implementing post-discharge suicide prevention recommendations (e.g., lethal
means restriction, attending to suicide warning signs, providing support, encouraging healthy coping, etc.). At
the same time, in addition to feeling overwhelmed, parents report low confidence in their ability to engage in
recommended suicide prevention activities. This proposal seeks to develop and pilot an adaptive, text-based
intervention for parents of suicidal youth transitioning from ED care. The intervention will be comprised of two
texting components targeting interrelated domains: (1) parental provision of adolescent-focused (A-F) support
to promote safety and well-being of suicidal adolescents and (2) parent-focused support (P-F) directed at
enhancing parents’ own well-being. Because suicidal youth are highly heterogeneous—and parents’ caregiving
challenges and stress may vary in the post-discharge period—a texting intervention should ideally be tailored
to meet parents’ unique and changing needs. In particular, while all elements of A-F support are considered
essential, P-F support may require greater personalization to optimize post-discharge outcomes. Designed to
address the dynamically changing needs of individuals, Just-In-Time Adaptive Interventions (JITAIs) adapt the
provision of mobile-based interventions to maximize outcomes while minimizing burden. To this end, the P-F
texting component will include an embedded micro-randomized trial (MRT)—an experimental design used for
developing high-quality JITAIs. Our primary aims are to: (1) finalize A-F and P-F texting components with
parents’ input (N=25); (2) pilot the text-based intervention with 90 parents randomized to a control group or to
one of two six-week intervention groups receiving either the A-F or the A-F plus P-F texting components; and
(3) pilot the embedded MRT, wherein parents will be randomized twice daily to P-F message or no message
condition, to inform the development of a JITAI. In addition to feasibility and acceptability, the proposed
mechanism (parental self-efficacy) and relevant distal outcomes will be assessed over 2,- 6-, and 12-weeks
post discharge. Setting the stage for a full-scale trial, this study offers innovation as the first to incorporate text
messaging and an MRT to guide the development of an adaptive text-based intervention for parents of suicidal
adolescents discharged from EDs. By addressing an urgent need for efficacious continuity of care strategies
for suicidal youth post ED care, and by proposing a scalable approach, this study has potential for high impact.