18 - Safety Planning Interventions following a Mental Health Crisis: Experiences and Perspectives of Adolescents and Their Caregivers

Publication Number: 3016.18

Alyssa C. Helmling, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Vinisha Velmineti, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Mindy Westlund Schreiner, Nationwide Children's Hospital, Columbus, OH, United States; Ailyn Sierpe, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States; Emma R. Jacobs, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Nikolas G. Hernandez, Geisel School of Medicine at Dartmouth, White River Junction, VT, United States; Hailey M. Cantwell, Children's Hospital at Dartmouth-Hitchcock, Concord, NH, United States; Saskia L. Vanderwiel, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Gwenyth M. Gasper, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Christine Finn, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Alison Kapadia, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Maia Rutman, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Jennifer L.. Hughes, Nationwide Children's Hospital, Columbus, OH, United States; Jacqueline A. Pogue, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States; JoAnna Leyenaar, The Dartmouth Institute of Health Policy & Clinical Practie, Lebanon, NH, United States

Background: Safety planning is a nationally endorsed intervention to reduce suicide risk by identifying warning signs and concrete steps to follow during times of crisis. However, there is limited data about the effectiveness and successful implementation of safety planning in pediatric populations.

Objective: To describe the perspectives and experiences of adolescents and their caregivers regarding safety planning interventions following a youth mental health crisis.

Design/Methods: We interviewed adolescents 12-17 years old and their parents/caregivers who had received care at emergency departments (EDs) in Northern New England for a mental health crisis. We asked about their past experiences with safety planning, views on the effectiveness of any safety planning they had participated in, and feedback about the process. Interviews were audio recorded, transcribed, and analyzed to identify emergent themes.

Results: We interviewed 27 adolescents and 27 parents/caregivers (Table 1). Major themes emerging from the analysis related to (i) the usefulness of safety plan content, (ii) accessibility of the safety plan following the mental health crisis, (iii) factors influencing buy-in, (iv) factors influencing follow through with plan execution, (iv) missed opportunities for safety plan implementation, and (v) potential process improvements (Table 2). As shown in Figure 1, these themes were conceptually interconnected. Youth and caregivers newer to safety planning found it helpful for identifying coping strategies and supports, while others described it as impersonal and repetitive. Participants noted the limited utility of paper-based safety plans following their initial development given the relative inaccessibility of the paper copy, and reported varying levels of buy-in and perceived effectiveness of the safety planning process. Participants' ability to execute their safety plan was influenced by several factors, including accessibility of outpatient mental health resources, financial barriers to lethal means restriction, parental involvement, and reinforcement of the plan following the crisis.

Conclusion(s): Adolescents and their caregivers identified several themes relevant to the implementation and sustained value of pediatric safety planning interventions. These findings may be used to inform process improvements to ultimately increase the effectiveness of safety planning for youth experiencing mental health crises.

Table 1. Adolescent and caregiver demographics
This table is missing the demographic information of one of the parent/guardians interviewed.

Figure 1. Conceptual model showing the intersectionality of major themes regarding experiences with safety planning interventions


Table 2. Supporting quotes for thematic concepts