Optimizing Suicide Prevention Strategies for Pediatric Primary Care (HEART+ Study)
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Dates: 6/19/2023-4/30/2026
This proposal aimed to help address the youth suicide crisis by improving how suicide‑prevention support could be delivered in pediatric primary care (PPC). Even though PPC providers often identified teens who were at risk, there had not been an intervention they could use right away during an office visit. In earlier work, our team created and tested an intervention called iCHART (Integrated Care to Help At‑Risk Teens) in a specialized clinic that had behavioral health providers. iCHART included three tools:
- The Screening Wizard, which helped providers make treatment decisions
- BRITE, an app that helped teens create a personalized safety plan on their phones; and
- Text2Connect, which sent supportive text messages to encourage teens to follow treatment recommendations.
These tools were shown to be helpful, easy to use, and acceptable to teens, parents, and providers, and they showed early signs of improving mental health outcomes.However, many pediatricians did not have access to behavioral health staff, making it hard to deliver parts of iCHART in regular primary care settings. To solve this problem, the project proposed creating a computerized version of the As Safe As Possible program, called cASAP, to replace the parts of iCHART that required behavioral health support. This computerized tool would teach safety‑planning information, coping skills, and ways for parents and teens to communicate about mental health. Working with the American Academy of Pediatrics and its national research network, we planned to build and test a new version of iCHART—called iCHART‑cASAP—that could be used in PPC offices without on‑site behavioral health providers.
The study included a pilot trial with 60 teens ages 12–17 who were at risk for suicide, comparing iCHART‑cASAP to usual care and tracking changes in depression and suicide risk over six months. After that, we gathered feedback from PPC providers to develop a plan for real‑world implementation. These results guided a larger future study to test how well iCHART‑cASAP improved identification of at‑risk youth, treatment follow‑through, safety planning, and overall protection against suicidal behavior.