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A UMass Medical School researcher in emergency medicine recently received a grant from the National Institute of Mental Health to develop telehealth and mobile app programs to reduce suicide among patients seen in emergency departments.
Celine Larkin, PhD, assistant professor of emergency medicine, is co-investigator with Bengisu Tulu, PhD, associate professor at Worcester Polytechnic Institute, on the $727,201 two-year grant.
The mobile tech-based program, called Technology-Assisted Systems Change for Suicide Prevention (TASCS) follows a multiyear NIMH-funded initiative, Emergency Department Safety Assessment and Follow-up Evaluation, or ED-SAFE. That prior clinical trial, conducted at eight hospitals, was co-led by Edwin Boudreaux, PhD, vice chair and professor of emergency medicine and professor of psychiatry and quantitative health sciences at UMMS.
The ED-SAFE intervention reduced the number of suicide attempts by 30 percent, compared with patients who received treatment as usual, and was as cost-effective as medical treatments widely in use, according to study authors. Interventions included providing resources to outpatient suicide prevention; intensive post-visit, telephone-based coaching incorporating motivational interviewing; case management and family systems therapeutic principles.
“That was a landmark study within the suicidology field,” said Dr. Larkin, who joined the team in 2016. “But we saw a lot of implementation barriers within the emergency department, for various reasons.”
The current TASCS study attempts to address a key challenge: availability of behavioral health clinicians to intervene with people in crisis.
“We started to brainstorm, and one solution was to use technology to bridge that gap,” Larkin said.
The research team will spend the first part of the study developing TASCS, which will be a platform to improve the reach and quality of interventions such as safety planning and follow-up counseling calls. The platform will be designed to work in a typical emergency department for patients, their families, clinicians and payers.
The TASCS ED app will facilitate three delivery modalities. When on-site clinicians are available, it will guide them through the intervention components, including personalized safety planning, using semi-structured templates on a tablet. When on-site clinicians are not available, a telehealth counselor will use the app to perform these tasks via standard two-way video in the emergency department, similar to existing tele-psychiatry evaluation models. When clinically appropriate, the ED-based intervention components can be self-administered with nonspecialist guidance, using a highly intuitive interface.
The remaining components will take place after the visit through a combination of telephone conversations with a telehealth counselor, facilitated by the post-ED clinician app, and access to the post-ED patient and family app.
Larkin said, “I think it’s timely as well now because there’s so much more acceptance of telehealth.”
The TASCS test app will be fine-tuned through feedback and iterative process improvements evaluated by small numbers of clinicians and patients and their family members. It will also be refined to be compatible with electronic health records through Epic Systems.
The feasibility of TASCS will be evaluated using a pilot experiment, in which patients with thoughts of suicide in the past two weeks or an attempt in the past six months will be randomly assigned to receive the TASCS ED app either with an on-site clinician, entirely by telehealth or guided self-administration. All patients will receive coaching calls for three months after their emergency visit, facilitated by the post-ED clinician app and access to the post-ED patient and family app.
“I think one of the most important things an emergency department or health system can do is to help people in crisis feel connected. And I think that telehealth doesn’t preclude that,” Larkin said.
She added that if the quality of the telehealth intervention is better because of TASCS’ supportive design, in addition to being available promptly, “then that’s a win, win.”
“If the clinician doing the telehealth evaluation has access to resources on their end, as we’re hoping to develop with TASCS, that can actually help to make the intervention better, by giving them that structure in a way they wouldn’t necessarily have if they’re face-to-face with the person,” Larkin said.
