Development of a Recovery-Oriented Suicide Prevention Intervention with Peers for Clinical High Risk for Psychosis

About This Grant

PROJECT SUMMARY/ABSTRACT This application responds to PAR-25-178 (Pilot Hybrid Effectiveness-Implementation Trials for Mental Health Interventions, R01). The goal of the project is to refine and evaluate preliminary effectiveness of a novel peer- supported suicide prevention in routine care for clinical high risk for psychosis (CHR). Although individuals with CHR are at particularly high risk for suicide, there does not appear to be a standard approach for suicide prevention for this population. The present study aims to evaluate a new suicide prevention intervention, Recovery Integrated Safety and Engagement (RISE), which adapts an existing evidence-informed peer-led intervention developed by our group to the CHR population. RISE targets personal recovery and suicide prevention strategy recall to decrease suicide ideation and improve care engagement. RISE is a therapist and peer co-facilitated group intervention with four recovery-oriented modules (reasons for living, hope, recovery goals, social connection) that are dovetailed with compensatory cognitive strategies to increase recall of intervention material and a caregiver session focused on means restriction. We propose a 3-year two site hybrid type 1 pilot study that follows the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. First, in Aim 1 we will refine the protocol and intervention through qualitative interviews and community advisory board input. We will then conduct an open trial to evaluate fidelity and needs for further adaptations based on participant feedback. In Aim 2, we will conduct a pilot effectiveness randomized controlled trial (RCT) to collect preliminary effectiveness compared to treatment as usual (TAU), evaluating impact on targets and suicide ideation. In Aim 3, we will administer qualitative interviews with RCT participants and administrators/clinicians focused on implementation determinants resulting in an implementation tool kit for future sustainment. We will evaluate whether RISE leads to significant increases in personal recovery and suicide prevention strategy recall at follow- up and whether participants experience sustained reduction in suicide ideation severity as compared to TAU. This project responds directly to NIMH Strategic Objective 2.2 by determining novel intervention targets (e.g., personal recovery) in risk and protective factors for suicide in CHR and Objective 3.3 by testing a deployment- focused suicide prevention intervention for effectiveness and implementation in two early psychosis programs with input from patients, caregivers, and administrators/clinicians. Pending success of this pilot hybrid trial, RISE could fill important gaps in suicide prevention in routine early psychosis care.