Adapting the SAFETY-Acute Intervention to Improve Quality of Care for Suicidal Youth in Emergency Rooms and Medical Floors

Hospitals and emergency departments (ED) are experiencing an increased number of youths with suicidality. Safety interventions used in the ED and on medical floors have not been systematically examined. In this paper, we present the implementation and feasibility of the brief SAFETY-Acute intervention (SAFETY-A), adapted for use by our consultation–liaison psychiatry service. SAFETY-A is a cognitive-behavioral therapy (CBT) family intervention for youth, developed for an ED setting. We implemented SAFETY-A in the ED and on medical floors to determine disposition of a patient to an inpatient hospital versus a lower level of care. We adapted SAFETY-A to use clinically with youths in the ED and medical floors at the Children’s Medical Center in Dallas, Texas. In this report we analyze clinical outcomes of SAFETY-A with patients 10–17 years old (N = 333), who presented to the ED and medical floors with suicide ideations (SI) or suicide attempts (SA). SAFETY-A proved to be feasible and acceptable based on clinicians’ reporting. Safety planning and home safety education were reported as the most effective components of the intervention. Patients who completed SAFETY-A were more likely to be recommended to lower levels of care than patients who did not complete all components of SAFETY-A. SAFETY-A implemented in our consultation-liaison service was associated with reduced inpatient referrals and disposition to a lower level of care. SAFETY-A shows positive outcomes as an acceptable and feasible intervention in a pediatric hospital consultation-liaison program.