Adapting SAFETY-A to Support Students Returning to School After Mental Health Emergency Department Visits

About This Grant

Abstract The objective of this K23 proposal is to enhance the supports available to students returning to school after mental health related Emergency Department (ED) visits. Many youth are referred to the ED because school personnel feel unprepared to meet their needs, yet ED clinicians deem that the youth do not require hospitalization thus facilitating their prompt return to school. There is a growing literature base on supports for students after psychiatric hospitalization, but the number of students returning directly to school after an ED visit is much higher than the number of students who are actually hospitalized. Therefore, the focus of this proposal is on adapting Safe Alternatives for Teens and Youths–Acute (SAFETY-A), a cognitive behavioral therapy- informed intervention that has been delivered in the ED, for students returning to school. Further, completing the proposed study and meeting the identified career development goals will establish Dr. Lora Henderson Smith as an implementation scientist and mixed-methodologist with an expertise in ED to school transitions. This project is unique in that it is the first to propose an intervention to specifically meet the needs of the growing number of youth with significant mental health concerns who require an ED visit, but do not meet criteria for hospitalization. Adapting SAFETY-A will provide schools with a tool to better support these youth. There is often minimal communication between the ED and schools; however, cross-system communication can facilitate optimal care for youth. As such, Aim 1 includes the examination of discharge summaries to identify what recommendations ED clinicians are making for schools to support youth. It is hypothesized that there will be few recommendations made for how schools can best support youth returning directly to school. Improving discharge summaries can help facilitate care for youth. We will use data from Aim 1 and principles of user-centered design to adapt SAFETY-A for students returning to school after an ED visit. The adaptation will be informed by interviews with key informants including families, school leaders, school mental health professionals (SMHPs), and ED clinicians. In Aim 3, a cluster randomized controlled trial will be conducted. We expect to enroll 4 schools and randomly assign 2 to the SAFETY-A condition. We will assess SMHP knowledge and skills pre- and post- training and implementation as well as SMHP adherence to the adapted SAFETY-A protocol. A small number of SMHPs will be interviewed about their experiences implementing SAFETY-A. We will also test the feasibility of methods to assess youth clinical outcomes. The proposed study, aligns with Objective 3.2 of strategic plan NIMH’s strategic plan (i.e., develop strategies for tailoring existing interventions to optimize outcomes) and other priorities related to youth suicide and school mental health and will significantly improve SMHP capacity to support students after mental health ED visits.