Crisis Response Planning for Suicide Risk
(ASPIS/CRP Trial)
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: United States Naval Medical Center, San Diego
Disqualifiers: Acute intoxication, Psychosis, Mania, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The study is a randomized trial comparing outcomes of active duty service members who present to the emergency department at risk for suicide and receive care from providers trained in crisis response planning versus those providing treatment as usual.
Do I need to stop my current medications for the trial?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Crisis Response Planning for Suicide Risk?
Research on Joint Crisis Plans (JCPs), which are similar to Crisis Response Planning, shows they help patients feel more in control and improve their relationship with healthcare providers. This suggests that Crisis Response Planning could also be effective in managing suicide risk by promoting self-awareness and collaboration with care providers.
12345Is Crisis Response Planning safe for humans?
Crisis Response Planning, also known as Safety Planning, is generally considered safe and is widely used in clinical settings to help prevent suicide. It is a brief intervention that has become an accepted practice, and there is no evidence suggesting it poses any safety risks to participants.
678910How is the Crisis Response Planning treatment different from other treatments for suicide risk?
Crisis Response Planning (CRP) is unique because it involves creating a personalized plan to help individuals manage suicidal thoughts by identifying warning signs, coping strategies, and support networks. Unlike standard treatments, CRP focuses on immediate, practical steps to prevent suicide attempts and is often more effective in reducing suicidal behaviors.
67101112Eligibility Criteria
This trial is for active duty service members over 18 who visit the emergency department at NMCSD with concerns of suicidal thoughts or behaviors, can understand and speak English, and are able to consent. Those with impaired mental status preventing informed consent, like acute intoxication or psychosis, cannot participate.Inclusion Criteria
Able to understand and speak English
Active duty service members
I am over 18 years old.
+2 more
Exclusion Criteria
I am mentally capable of understanding and consenting to participate.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
1 visit (in-person)
Treatment
Participants receive either Crisis Response Planning or Treatment as Usual interventions
Varies
Multiple visits (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment
1 year
Regular follow-up visits
Participant Groups
The study compares two approaches: crisis response planning by specially trained providers versus standard care (treatment as usual) for military personnel at risk of suicide after visiting the emergency department.
2Treatment groups
Experimental Treatment
Active Control
Group I: Crisis Response PlanningExperimental Treatment1 Intervention
CRP is a brief psychotherapeutic intervention that can be provided to patients at risk of suicidal behavior. When using the intervention, a provider works with the patient (1) to conduct a narrative assessment of the events preceding suicidal thoughts or behavior, and (2) to develop a personalized plan for identifying and managing distress that could escalate to a suicide attempt. The CRP, which is typically handwritten by the patient on an index card, includes personal warning signs of distress, emotion regulation strategies, reasons for living, and contact information for friends/family as well as professional (psychological/medical) and emergency resources.
Group II: Treatment as UsualActive Control1 Intervention
Existing clinical practices in the emergency department include the following elements recommended by the VA/DoD Clinical Practice Guidelines: (1) all patients are screened for suicidal ideation at every visit; (2) for those with positive screens, a suicide risk assessment interview is conducted by a mental health professional; (3) a safety planning form with means restriction (such as the Stanley-Brown; Stanley \& Brown, 2012) is completed; and (4) patients are referred for follow-up mental health treatment as needed. Other elements of TAU could include behavioral and psychotropic interventions, referrals to specialty mental healthcare, and admission for psychiatric inpatient care.
Crisis Response Planning is already approved in United States for the following indications:
🇺🇸 Approved in United States as Crisis Response Planning for:
- Suicide Prevention
- Posttraumatic Stress Disorder (PTSD) Management
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Naval Medical Center San DiegoSan Diego, CA
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Who Is Running the Clinical Trial?
United States Naval Medical Center, San DiegoLead Sponsor
Naval Health Research CenterCollaborator
Ohio State UniversityCollaborator
References
Crisis management during anaesthesia: recovering from a crisis. [2018]Preventing harm to the patient is the priority during a crisis. After a major incident, and especially when a patient has been harmed, there are a number of matters to be addressed: the ongoing care of the patient; documentation of the incident; investigation of the root causes; completion of reports; interviews with the patient and/or the next of kin, together with apologies and expression of regret; updates and ongoing support for friends and relatives; a word of thanks to the staff involved for their assistance; formal debriefing of staff for quality assurance and possibly ongoing support and a separate debriefing for psychological purposes; ensuring that the recommendations of the root cause analysis are carried out; or, failing that, that the issues are logged on a risk register. The extent and depth of the follow up protocol depends on what, if any, harm may have been done. This may constitute completion of an incident report; notification of an equipment failure to a federal regulatory authority; arranging consultations with a mental health professional to manage psychological sequelae (especially following an awareness episode); follow up during weeks of intensive care treatment; or, when a death has occurred, a full medico-legal and/or coronial set of procedures. A precis is appended in an action card format.
The Joint Crisis Plan: A Powerful Tool to Promote Mental Health. [2021]Purpose: The Joint Crisis Plan (JCP) has received growing interest in clinical and research settings. JCP is a type of psychiatric advance statement that describes how to recognize early signs of crisis and how to manage crises. The purpose of the present study, to our knowledge the first to be conducted on this topic in the French-speaking context and to include inpatients, was to describe the content of JCPs and how they are perceived by patients and the providers. Methods: The study used an exploratory, mixed, sequential method. Existing JCPs were retrospectively collected in several clinical contexts (hospital, community settings, and sheltered accommodation). Based on their analyses, we conducted semi-structured interviews including some rating scales on the perception of the JCPs among patients and providers in these settings. For the qualitative analyses, content analyses were conducted with a hybrid approach using NVivo 12 software. Data were double-coded and discussed with a third researcher until agreement was reached. Results: One hundred eighty-four JCPs were collected retrospectively and 24 semi-structured interviews were conducted with 12 patients and 12 providers. No relatives could be included in the research process. The content of the studied JCPs was relevant and indicated that patients had good knowledge of themselves and their illness. Improvements in the quality of the therapeutic relationship, respect for patients' choices and wishes, and a greater sense of control of their illness were reported. The JCP was perceived as a very useful tool by patients and providers. Concerning JCP limitations, lack of staff training, difficulties with the shared decision-making process, and the poor availability of the JCPs when needed were reported. Conclusion: The study highlights that JCPs may be used with patients suffering from a large variety of psychiatric disorders in different care settings. The JCP is perceived as very useful by both patients and providers. The promising results of this study support the promotion of the wide use of JCPs with patients who have experienced crises. It is important to continue to research JCPs through impact studies that include family members.
Practitioner opinions of crisis plans within early intervention in psychosis services: A mixed methods study. [2021]The efficacy of crisis planning in mental health services is contested. As recovery and self-management are core to Early Intervention in Psychosis (EIP) services and the Care Programme Approach (CPA), the views of EIP practitioners of the most useful aspects of crisis planning can inform this vital aspect of practice. We conducted a mixed methods study using a national cross-sectional survey (n = 70) and semi-structured interviews (n = 12) with EIP practitioners in England in 2019. Data were analysed using non-parametric tests and thematic analysis. A Joint Crisis Plan (JCP) template was used as a benchmark to judge current practice by (Sutherby et al., 1999; Henderson et al., 2004; Thornicroft et al., 2013). The most useful crisis plan themes identified by practitioners included early warning signs, triggers and helpful treatments, although not all elements were considered useful. Additionally, the interviews identified that collaboration with clients, carers and other services; personalisation; and self-management were all considered important in effective crisis planning. The practitioners also identified barriers to effective crisis planning, such as the electronic records system, lack of time and lack of available service provision. The research highlighted the important aspects of EIP and was significant in impacting the service and wider EIP network further. While crisis planning is a significant part of EIP, it does not appear to be consistently applied in practice. Fully implementing collaborative crisis planning in EIP services may require changes to policy, practice and local systems to ensure that crisis planning is as effective as possible.
Ensuring successful implementation of communication-and-resolution programmes. [2021]Communication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients' needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled to achieve the same. However, two Massachusetts hospital systems implementing a CRP demonstrated high fidelity to protocol without raising liability costs.
The Assaulted Staff Action Program (ASAP): common issues in fielding a team. [2019]Thirty-five years of empirical research have continuously documented the potential negative impact of patient assaults on staff. The Assaulted Staff Action Program (ASAP) is a voluntary, peer-help, systems-wide crisis intervention debriefing approach for employee victims of these assaults. ASAP has been associated with providing needed clinical support for victims, declines in violence, and cost-effectiveness in service delivery. A previous paper outlined the basic steps needed to field and ASAP team. This paper continues to address this need by outlining the most commonly encountered ASAP problems and solutions that have evolved in the first eight years of ASAP programs. The implications are discussed.
Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial. [2022]Previous research supports the efficacy of the crisis response plan (CRP) for the reduction of suicidal behaviors as compared to treatment as usual (TAU). Patient perspectives and use of the CRP, and their relationship to later suicidal thoughts, remain unknown.
A randomized, controlled trial of the safety planning intervention: Research design and methods. [2022]Brief interventions for suicide risk among patients treated in acute care settings like the emergency department are needed. The Safety Planning Intervention is a promising approach but has yet to undergo a high quality, individual level randomized controlled trial.
Integrating Safety Plans for Suicidal Patients Into Patient Portals: Challenges and Opportunities. [2019]Safety planning is an emerging evidence-based practice that is effective at decreasing suicidal behaviors. As electronic medical records and patient portals become more prevalent, patients and clinicians have recognized the value of using this technology in the safety planning process. This column describes the experience of one federally qualified health center, the Institute for Family Health, in integrating safety plans into the patient portal. The authors argue that incorporating safety plans into patient portals may unlock a new to way to expand safety planning efforts in health settings-a way that may ultimately save lives.
Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing. [2023]Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan.
Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. [2023]Background. Suicide safety planning (SSP) is a suicide prevention approach that involves developing a collaborative plan between a service provider such as an occupational therapist and a person who is at risk of suicide. Purpose. To synthesize effectiveness studies on SSP. Method. Using the Joanna Briggs Institute methodology, we conducted a systematic review of effectiveness studies including a: (1) title and abstract screening; (2) full-text review; (3) critical appraisal; and (4) narrative synthesis. Findings. We included 22 studies. Critical appraisal scores ranged from 38.5 to 92.3 (m = 63.7). The types of interventions included were: standard and enhanced SSP (n = 11); electronically delivered SSP (n = 5); and SSP integrated with other approaches (n = 6). Only three studies identified meaningful activity as a component of SSP. Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI). While some studies have demonstrated effectiveness for reducing symptoms of mental illness, promoting resilience and service use, the number of studies exploring these outcomes is currently limited. Implications. Occupational therapists support individuals expressing SI, and SSP is a necessary skill for practice.
[SAFETY PLANNING INTERVENTION FOR SUICIDE PREVENTION]. [2022]Safety planning is a short-term therapeutic intervention aimed at enhancing the resources that suicidal individuals harness when dealing with imminent and future suicidal crises. Structured as a six-step action plan, the Safety Planning Intervention (SPI) includes identifying early signs of an emerging suicidal crisis, improving internal coping strategies and the ability to engage relevant social and therapeutic relationships, and removing dangerous means for suicide. The program can be applied in multiple settings, including emergency rooms and outpatient clinics. Studies examining this mode of intervention have demonstrated that it is highly effective in lowering suicidal behavior. Accompanied by a brief case vignette, we will outline key principles underlying safety planning, compare it to other available interventions and discuss remaining questions that warrant future assessment.
Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. [2022]To evaluate the effectiveness of crisis response planning for the prevention of suicide attempts.