BRITE 2.0: A just-in-time adaptive intervention for suicide safety planning in adolescents

ABSTRACT Despite efforts to prevent suicide, US rates are climbing, and suicide is the second leading cause of death amongst youth. While suicide safety planning interventions can be effective in reducing suicidal behavior, adolescents often face challenges in sustaining their engagement with them. Studies have found that many adolescents do not review their safety plans or attempt to use coping strategies following discharge. Digital tools can provide a powerful means to enhance engagement with these interventions. The overall aim of this SBIR Fast Track proposal is to enhance the effectiveness of safety planning amongst at risk youth by developing and commercializing an augmented version of the BRITE smartphone app that provides enhanced features that will optimize effectiveness by addressing known barriers to user engagement. The BRITE app facilitates self-efficacy by encouraging self-monitoring of emotional distress and utilization of effective coping strategies as well as providing ready access to a safety plan on the adolescent’s smartphone. The BRITE app was developed on evidence-based principles and has undergone rigorous formative development and effectiveness evaluations. However, to optimize its functionality, commercial viability, and scale its implementation, issues related to user engagement need to be addressed. Recent developments in Ecological Momentary Assessment (EMA) and mobile sensing (MS) can provide useful triggers to automatically “push” pertinent safety planning information to individuals during periods of higher risk, which will allow the integration of just-in-time adaptive intervention features within BRITE and should result in more sustained engagement with the plan and increased effectiveness. In Phase I we will develop an augmented version of the BRITE app (BRITE 2.0) that integrates just-in-time automated push notifications for consistent practice of coping skills and for safety planning resources during periods of escalating risk, and will evaluate the usability and acceptability of this product with practitioners and end users. The aim of Phase II is to conduct a micro randomized trial to optimize treatment components, and to conduct an initial RCT to evaluate whether these enhancements increase user engagement.