Crisis Care is a smartphone application (app) intervention for suicidal adolescents. It is designed specifically for adolescents and their parents/guardians to use following discharge from an inpatient psychiatric hospital or emergency room (ED) where they were seen for suicidal ideation or a suicide attempt. The app aims to decrease suicide risk by providing adolescents and parents/guardians with immediate access to 1) a set of coping skills they have identified as being helpful when feeling suicidal, 2) critical skills in listening and safety planning for parents/guardians to implement with their suicidal adolescents, 3) a means of connection and support between the adolescent and parents/guardians during a suicidal crisis, and 4) immediate help from outside professionals or emergency services when there is concern the adolescent is at imminent risk for suicide. This award would be used to fund the development of the web-based app prototype into fully functioning iPhone and Android apps. Once developed, the goal of the project is to test the feasibility, acceptability, and usability of Crisis Care with suicidal adolescents and their parents/guardians following discharge from an ED or inpatient psychiatric hospitalization. This stage of the project will be funded internally by Boston Children's Hospital.
An increasing number of apps are being developed for suicide prevention; however, few are being tested for usability and acceptability, and fewer are developed as a component of a manualized safety planning intervention. Crisis Care is innovative because to our knowledge it is the only app developed specifically for adolescents and parents/guardians to use together. Crisis Care has two distinct modes, one for the adolescent and one for the parents/guardians, to be used in tandem. Also novel is that Crisis Care is 1) uniquely personalizable for each adolescent and parent/guardian, 2) specifically developed for use after discharge from inpatient hospitals or EDs when the risk for suicide is greatest, 3) created for use during a suicidal crisis when the risk for suicide is greatest, and 4) designed as an adjunct intervention to current safety planning practices that are conducted together with the adolescent, mental health clinician, and parents/guardians.
After establishing the feasibility, acceptability, and usability of Crisis Care with suicidal adolescents and their parents/guardians following discharge from an ED or inpatient psychiatric hospitalization, the leaders of the project plan to disseminate the app to other area hospitals and psychiatric units for use with their patients. The leaders of the project work in close collaboration with the Massachusetts Department of Public Health who would assist with this dissemination. To disseminate the app nationally, the leaders of the project would combine efforts with other collaborators at the national level, including the American Foundation for Suicide Prevention and the Injury Control and Research Center for Suicide, to maximize access to this innovation across the United States.
Gary Pihl and Barry Belotti developed the web-based prototype of the Crisis Care app and are scheduled to develop the fully functioning apps pending funding. The developers estimate that fully functioning iPhone and Android apps will cost $25,000 to develop. The leaders of the innovation are employed by Boston Children's Hospital, where they will be testing the app for feasibility, acceptability, and usability. Boston Children's Hospital has a vested interest in seeing this project to completion, as they internally funded the development and pilot testing of the web-based prototype of the app. Boston Children's Hospital is also committed to the dissemination of Crisis Care across multiple services because of the implications of the app for improved patient safety and quality.
The app developers will create code for the app that can be easily duplicated and is easily transferrable. Once the app has been developed and tested, its design could easily be adapted by other hospitals and programs that provide similar crisis services. We plan to develop a manual for clinicians to use when assisting with the uploading of the app to the smartphones of the adolescents and parents/guardians. The ultimate goal is for this app to be available to any adolescent and family in the United States at no cost. We anticipate starting dissemination at the hospital level, continuing at the state level, and finishing at the national/international level.
We will administer the System Usability Scale (SUS), a 9 item questionnaire about the smartphone app that will be administered to the adolescent and parent/guardian, at 6 week follow-up. The first 7 questions ask about the acceptability and usability of the app, and questions 8 and 9 ask for written answers to “what did you like most about the app” and “what would you change about the app.” Usability and acceptability will be evaluated by calculating means, medians, range, and margin of error for questions 1-7. Questions 8 and 9 will be qualitatively analyzed for emerging themes. For an additional test of feasibility, acceptability, and usability, patterns of app use (i.e., time of day, amount of use) will be examined. We will also administer a battery of suicide measures at baseline and 6 weeks to begin to explore the initial efficacy of the app in decreasing suicide-related thoughts and behaviors.