Funder: NIMH (MHRN III Feasibility Pilot Program)
Grant Number: U19MH121738
Project Period: 7/1/2022 – 6/30/2023
Background: Adolescent suicide is an urgent public health crisis. Suicide is currently the second leading cause of death among adolescents ages 10-24. Despite decades of research, suicide attempt rates continue to rise across the U.S., particularly among adolescents. Furthermore, new data suggests that adolescents were disparately impacted by the COVID-19 pandemic, with some states reporting increased rates of suicide among youth, galvanizing the urgency for increased prevention. People who die by suicide often see healthcare providers, and specifically primary care providers prior to death, including adolescents. Therefore, identifying suicide risk in healthcare settings among adolescents is an important prevention opportunity.
Mental Health Research Network (MHRN) researchers (led by Greg Simon) have developed suicide risk prediction algorithms that have potential to vastly improve identification of individuals at high risk of suicide, including adolescents. While promising, there is very little evidence to guide routine use of this powerful suicide risk identification method during healthcare encounters with adolescents. A recently completed MHRN project (led by Bobbi Jo Yarborough) explored barriers and facilitators of the use of suicide risk algorithms among adult patients, clinicians, and administrators across three MHRN systems. These stakeholders were generally supportive of implementation, but some patient participants expressed concerns about suicide risk information resulting in coercive treatment, and clinician participants expressed desire for opportunities supporting their role in implementation decision-making.
No studies (to our knowledge) have explored perspectives of adolescents, their parents/guardians or adolescent providers about how suicide risk prediction models should be implemented. Therefore, we plan to build from prior MHRN work and qualitatively elicit adolescent care providers’ perceived barriers and facilitators to implementation of these models in care delivery and their ideologies regarding risk thresholds and risk-concordant care. Simultaneously, we plan to build a qualitative understanding adolescents and family perceptions, ideas, and preferences regarding the use of suicide risk prediction models in their care.
Research questions: (1) What perspectives do primary care providers have on suicide risk prediction algorithms and what suggestions or considerations do they have for clinical practice? (2) How do primary care providers envision risk concordant care delivery to look like in clinical practice? (3) What are adolescent and parent/caregiver perceptions and preferences on the use of suicide risk predications models as a tool for enhanced clinical care? (4) What ideas or suggestions do adolescents and parents/caregivers have for comfortable and effective implementation of risk prediction algorithms in primary care?
Methods: Provider interview guides will be developed based on interview findings by the prior qualitative MHRN study (described above) which used the Consolidated Framework for Implementation Research (CFIR), with additional questions aimed at understanding risk thresholds and associated concordant care. Caregiver and adolescent interviews will explore their thoughts, ideas, and preferences regarding EHR-based suicide risk prediction models as part of patient standard of care. We will aim to interview 10-15 adolescent care providers and 10-15 caregiver-adolescent dyads across the two sites. Care providers will be purposively selected in consultation with KPWA leaders involved in an initiative to improve adolescent access to timely mental health care. The suicide risk prediction algorithm will be used to purposively sample adolescents at high risk of suicide and their parent/guardian caregivers. Identified dyads will be recruited via mailed and telephone invitation materials (developed from a prior project recruiting adolescents & caregivers). Interviews will be audio-recorded, transcribed and double-coded to support thematic content analysis.
Planned products: A synthesis of stakeholder needs/perspectives to support suicide risk prediction model implementation in routine care delivery for adolescents. This key deliverable will be used to support: 1) current predictive analytic implementation efforts across MHRN sites 2) an external grant submission to NIMH focused on application of Human-Centered Design methods to design, build, and test clinical decision support for identifying and engaging adolescents at high-risk of suicide in evidence-based healthcare, 2) a peer-reviewed manuscript submission led by Taylor Ryan, MS (PhD student in Health Systems & Population Health at the University of Washington) & Julie Richards, MPH, PhD (MHRN researcher and faculty advisor at UW).
Lead Site: KPWA (PI Julie Richards)
Participating Sites: N/A