Suicide Treatment & Recovery in Integrated Behavioral Health (STRIBH)
As a design researcher, I support the STRIBH team (also known as The Connections Study) in co-designing a new intervention to support suicide treatment and recovery in integrated behavioral health (IBH) settings. I create research protocols, lead primary data collection, and guide the team through the design process.
My Role
Design Researcher
Timeline of Involvement
October 2023 – Ongoing
Design Phase(s) of Involvement
Discover, Design/Build, & Test
Overview
Policy initiatives like The Joint Commission and Zero Suicide have resulted in substantial improvement in suicide risk screening, assessment, and crisis management. This appears to have decreased the short-term risk of suicide attempts. However, evidence-based treatments for suicidality are uncommon and not widely taught. For many clinicians, it remains unclear where to go next after completing a safety plan. Many worry if they have “done enough”. Recent research has also found that some patients at risk of suicide don’t tell healthcare providers due to fear of overreaction, involuntary treatment, or a history of being assessed repeatedly but not receiving useful treatment.
Goals
The goal of the Connections Study is to develop a brief treatment approach to help adolescent and young adult patients resolve and recover from suicidality. We are partnering with IBH care teams and individuals with lived experience to:
Understand what is and is not working to treat suicidality and help patients recover.
Co-design a model of treatment and recovery services for adolescents and young adults experiencing suicidality that is feasible and appropriate for IBH programs/settings.
Iteratively refine this new model with IBH teams until it works smoothly.
Pilot a clinical trial of the model and compare it to usual care.
Research Team
Kate Comtois, PhD, MPH: Principal Investigator
Julie Richards, PhD, MPH: Co-Investigator
Natalie Crouch, BS: Research Coordinator
Anna Ratzliff, MD, PhD: Consultant
Laura Richardson, MD, MPH: Consultant
Juliann Salisbury, MSW, LSWAA: Consultant
Dave Jobes, PhD, ABPP: Consultant
Methods
I create research protocols, lead primary data collection, and guide the team through the Discover, Design/Build, and Test Phases of the Discover, Design/Build, & Test Framework (DDBT). These phases accomplish the Preparation Phase Goals for the Multiphase Optimization Strategy (MOST) Framework. You can learn more about SCRC’s DDBT + MOST methodological framework here. Learn more about the specific methods we use in the Connections Study below.
© University of Washington Suicide Care Research Center, DDBT graphic adapted with permission from UW ALACRITY Center
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From late May 2024 to the end of August 2024, we conducted 24 semi-structured interviews with clinicians in integrated behavioral health primary care settings. Interviews focused on three areas of interest:
gathering an understanding of clinicians’ clinical setting
specific stories of treating adolescents and young adults experiencing suicidality
clinicians’ opinions on treatment approaches for adolescents and young adults experiencing suicidality.
In addition to open-ended questions, we asked clinicians to rate the acceptability, appropriateness, feasibility, and usability of the current practice for treating adolescents and young adults experiencing suicidality. The Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM),Feasibility of Intervention Measure (FIM), and System Usability Scale (SUS) were used to assess each construct.
From September to mid-November, we conducted a Rapid Group Analysis Process (Rap-GAP) to analyze information collected during these interviews into the following:
A set of user needs for each clinical role: primary care provider, behavioral health care manager, & psychiatric consultant.
A list of usability issues for treating adolescents and young adults experiencing suicidality in integrated behavioral health.
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Using the principles for suicide care treatment developed by the Aeschi Working Group as a building block, we generated numerous “How might we…?” questions to guide brainstorming sessions with clinicians who participated in Discover Phase interviews, as well as young adult patients who had experienced suicidality. The results of these brainstorming sessions informed the development of a low-fidelity prototype of the Connections Intervention – a novel treatment approach emphasizing the importance of an adolescent/young adult patient’s narrative in their suicide treatment. Additionally, we utilized a functionality matrix to map user needs identified during the Discover Phase onto specific functions of the Connections Intervention.
We are in the process of hosting a series of workshops with clinicians and young adults to evaluate and refine this low-fidelity prototype. The workshops will combine co-design approaches with scenario-based usability testing.
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Eventually, the Connections Intervention will be delivered to adolescent and young adult patients experiencing suicidality. We will assess the intervention’s effectiveness in reducing suicidality using a stepped-wedge design.
Results
Results from this study have not yet been published. This section will be updated once results are publicly available.