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Rose McCabe and co-applicants Stefan Priebe, Sally O’Keeffe and Yan Feng are currently conducting a similar project with adults presenting to Emergency Departments with self-harm, the ASsuRED study.
“We are very excited to extend this work to include mental health practitioners working with adolescents in Emergency Departments, thanks to this generous grant from Kavli Trust,” said Sally O’Keeffe.
“Kavli Trust is excited about funding this research project. The purpose and the plans for the project is truly important, and it will provide new knowledge about the effect of an individualized treatment to reduce self-harm and suicide-related behavior in adolescents. We hope it will lead to new hope for young patients and their families,” said general manager at Kavli Trust, Inger Elise Iversen.
Second-leading cause of death
Suicide is the second-leading cause of death in young people worldwide (World Health Organization, 2014) and the strongest predictor of suicide is self-harm (Hawton et al., 2015) – defined as self-injury and self-poisoning. It does not necessarily include an intention of suicide.
Visits to the Emergency Department by adolescents for self-harm in the UK are related to repeat self-harm and suicide. The period immediately following discharge from hospital is associated with the highest risk, demonstrating a need for rapid intervention.
Research gap identified
The Kavli Trust Programme on Health Research has identified a gap in current evidence on effective interventions to reduce suicide-related behaviour in adolescents.
This project aims to address this gap, by running a cluster randomised controlled trial to investigate the effectiveness of a brief psychological intervention, developed for young people who come to the Emergency Department to be treated for self-harm.
The intervention involves providing a therapeutic assessment soon after the adolescent presents to the Emergency Department, followed up by a series of solution-focused therapy sessions.
A novel approach
Therapeutic assessment was developed by co-applicant Dr Dennis Ougrin and is an approach specifically designed for adolescents in a self-harm crisis.
“It is a novel approach to working with adolescents and families, and focuses on solutions. It has been found to dramatically increase young people’s engagement with follow-up care which is key to reducing future self-harm in the future”, said Sally O’Keeffe.
The intervention will include three sessions.
In their preliminary work, the researchers have interviewed young people with experience of attending the Emergency Department due to self-harm.
“Young people described a feeling that healthcare professionals focus on assessing risk to ‘fill in a box on a piece of paper’ rather than having a conversation to understand them”, said O’Keeffe.
“They want to feel understood and be treated with compassion rather than procedural assessments. After leaving the Emergency Department, they want continued care by being offered follow-up with the same practitioner, so that they don’t need to repeat their story to someone new. Finally, they want personalised solutions based on their concerns rather than generic advice such as calling a helpline or crisis number.”
Based on lived experience
This feedback has shaped the proposed intervention, which will be further adapted in collaboration with a lived experience advisory panel of young people. The panel will provide advice and expertise at all stages of the research project.
The researchers will recruit 144 participants aged 12-19 into the trial: half of whom will receive the new intervention and half of whom will receive treatment as usual.
Participants will be followed up for six months, and they will assess the clinical effectiveness and the cost-effectiveness of the intervention.
“We will measure repeat self-harm using Ecological Momentary Assessment (EMA), whereby participants will be asked to provide real-time updates on recent self-harm behaviour on their smartphone. This innovative method aims to capture a more continuous picture of self-harm, compared with more traditional measures of self-harm,” said Sally O’Keeffe.
“The proposed project is well-planned and has the potential to make a great impact in helping to treat adolescent self-harm and suicide risk. According to the reviewers the intervention is novel, particularly in terms of youth involvement in design, and will move the field forward,” said Ida Svege, senior adviser at The Kavli Trust Programme for Health Research.
- The project will begin in May 2022.
- It will be hosted by the School of Health Sciences at City, University of London, in close collaboration with partners at University College London, Queen Mary University of London and the McPin Foundation.
- The McPin Foundation champion the involvement of people with lived experience in mental health research and will lead the young people’s advisory group.