Integrated Intervention for Caregivers--Open Trial

Adolescents who have been hospitalized after attempting suicide are at high risk for engaging
in additional suicidal behavior. Following hospitalization, parents or guardians are
typically tasked with helping to prevent further suicidal episodes by monitoring youth,
ensuring safety in the home, helping youth receive needed care, and parenting in a way that
balances expectations for appropriate behavior with recognition of the vulnerable status of
the adolescents. Despite parental efforts, adolescents often have additional crises, which
sometimes culminate in emergency department visits and repeat hospitalizations. Findings from
the principal investigators' recent longitudinal study of mothers after adolescent
hospitalization for suicide attempts (Impact of Adolescent Hospitalization on Parents)
suggested that the period of time following discharge from the hospital can be a very
important time for providing services and supports to youth and families. Parents in that
study described emotional distress (e.g., depression, anxiety) and reduced parenting
self-efficacy, and indicated a need for more information about suicidal youth and the
treatment needs of these youth, parenting and monitoring of suicidal youth, and support in
navigating the treatment system.

Given these needs, the purpose of this study is to develop, refine, and preliminarily test an
integrated electronic (mHealth) and care support service intervention for caregivers of
adolescents who have made a recent suicide attempt. It is expected that such an intervention
will provide needed information and supports to parents, increase parenting self-efficacy,
increase parents' ability to follow safety plans in the home, reduce parents' emotional
distress, and help parents access needed services in the community. As a consequence of these
proximal outcomes, it is expected that the intervention will help facilitate treatment
engagement and follow through for youth and caregiver, and reduce use of emergency mental
health services and hospitalizations.

In the context of an open trial, the primary aim is to assess the feasibility of this
intervention, and to use experiences from implementing the intervention and feedback from
caregivers and care support managers to refine the intervention.

Inclusion Criteria:

- Biological, adoptive, or step-parent (step-parent defined as by marriage or live-in
partner of at least 5 years) of an adolescent. If an adolescent has more than one
parent, parents will be asked to designate the primary contact or participant for this
study (only one parent for an adolescent may participate).

- The adolescent is 13-19 years of age

- The adolescent was psychiatrically hospitalized due to any range of suicidal behaviors
(i.e., suicide attempt, interrupted suicide attempt, aborted suicide attempt) in the
last two weeks

- The parent lives with the adolescent

- The parent has a cell phone and is capable of texting (i.e., has knowledge of how to
text and has a data plan that allows for texting)

Exclusion Criteria:

- Parents whose primary language is not English and are unable to read or speak English,
as all materials will be initially developed in English only

- Parents who have a reported intellectual disability (per inpatient staff)

- Parents whose adolescent is not discharged directly home (e.g., adolescent is sent to
a group home, residential treatment facility, or home of a relative following
hospitalization)

- Adolescents who have an intellectual disability (per inpatient staff or as reflected
by current school placement) or have active psychosis, as the needs of both parent and
youth may be different than those without an intellectual disability or active
psychosis and are not specifically addressed in the proposed developing intervention