Jennifer Hoffmann, MD, MS

Caring Contacts by Text Message to Prevent Youth Suicide after an Emergency Department Visit

Emergency department (ED) visits and hospitalizations for suicidal thoughts and behaviors are increasing among youth. The ED represents a critical setting to identify youth at risk and deliver scalable suicide prevention interventions. Caring Contacts—brief, non-demanding messages expressing care and concern—have demonstrated effectiveness in reducing suicidal thoughts and behaviors among adults, including when delivered by text message. However, they have been minimally studied in adolescents, despite the potential for text messaging to provide a low-burden, scalable intervention well suited to the ED setting.

This study will adapt and evaluate a text message-based Caring Contacts intervention following ED visits by adolescents with elevated suicide risk. A multidisciplinary team will first interview adolescents with lived experience to refine message content, timing, and delivery based on youth preferences. Next, the adapted intervention will be piloted to assess feasibility, preliminary effectiveness, and potential mechanisms of action. Finally, barriers and facilitators to implementation in pediatric EDs will be identified to inform future large-scale implementation.

Optimizing Digital Single-Session Interventions for Youth with Suicidal Thoughts and Behaviors in the Emergency Department

Although more youth with suicidal thoughts and behaviors are being seen in the emergency department (ED), many are discharged without receiving evidence-based interventions, contributing to recurrent crises and repeat ED visits. Single-session interventions (SSIs) have been shown to reduce depression and anxiety, and SSIs delivered by clinicians in the ED can reduce suicidal behaviors and improve linkage to outpatient care. However, the feasibility and effectiveness of self-guided digital SSIs in the ED is unknown. Navi is a web-based platform that delivers evidence-based digital SSIs, including safety planning, and supports personalized post-discharge care, but has not yet been evaluated in pediatric EDs.

This project will adapt and pilot Navi for youth presenting to the ED with suicide risk. First, we will use human-centered design with youth, caregivers, and ED staff to refine Navi and its embedded SSIs for the ED setting. Next, we will conduct an open pilot trial with youth in the ED to evaluate the feasibility, acceptability, and short-term impact of Navi on mechanisms of action (e.g., hopelessness, agency) and clinical outcomes, while describing patterns of use. Finally, we will conduct qualitative interviews with participating youth and ED staff to further refine Navi and identify barriers and facilitators to implementation, informing future larger-scale testing and integration into routine ED care.

Perceptions and Use of the 988 Lifeline among Youth at Risk of Suicide and Their Caregivers in the Emergency Department

Suicide is a leading cause of death among U.S. adolescents, with rates rising substantially over the past decade. Since its launch in 2022, the 988 Suicide & Crisis Lifeline has become the nation's entry point for crisis care, handling more than 14 million calls, texts, and chats. Crisis lines reduce distress and suicide risk, yet little is known about how adolescents with suicide risk and their caregivers perceive or use 988. This knowledge gap is important because emergency departments (EDs) are often the primary point of care for youth with suicidal thoughts and behaviors, many of whom do not receive timely outpatient follow-up and remain at high risk for recurrent crises. Given its broad national availability, 988 is a scalable resource that could improve support during this vulnerable transition.

The objective of this study is to evaluate awareness, use, and perceptions of the 988 Lifeline among adolescents with suicide risk who present to the ED and their caregivers. First, we will survey adolescents with elevated suicide risk and their caregivers at two EDs to assess awareness and prior use of 988 and identify factors associated with utilization. Then, we will conduct interviews with adolescents and their caregivers to explore attitudes, barriers, and facilitators to using 988. Findings will inform the development of a future ED-based intervention designed to increase awareness and use of 988 among adolescents with suicide risk, with the long-term goal of improving community support, reducing ED utilization, and preventing youth suicide.