Implementation of a trauma-informed suicide prevention intervention for youth presenting to the emergency department in crisis

Given the increasing number of children presenting to the emergency department (ED) in psychiatric crisis, our tertiary children’s hospital ED adopted SAFETY-Acute/Family Intervention for Suicide Prevention (SAFETY-A), an evidence-based practice for suicide prevention. Because of the relationship between trauma and suicide among youth, this study piloted the feasibility of combining SAFETY-A and a standardized approach to the detection and response to trauma in youth, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) within a busy ED setting. Over a three-month period, 30 youth with low to moderate risk for suicide received SAFETY-A+CPM in the ED. 62% of respondents reported trauma exposure, with the majority endorsing moderate or severe traumatic stress symptoms. Twenty-nine of the 30 youth were able to be safely discharged home with follow-up care. Fifteen youth were provided referrals/linkages with new providers, 5 of which were to trauma-focused assessment and treatment as indicated by the CPM-PTS. Overall, crisis workers found that offering SAFETY-A +CPM was “more rewarding” than traditional crisis evaluations and that using trauma-specific data identified with the CPM-PTS was quite helpful. Post-intervention surveys with parents indicated a favorable experience, comfort with maintaining safety, and overall satisfaction with the ED intervention. Clinical and system barriers identified over the course of the pilot are critical to address for sustained delivery. Overall, SAFETY-A was able to be delivered to fidelity and blended with the CPM-PTS.