Table 2.
Treatment services offered by level assignment.
| Level 1 (low risk) | Level 2 (moderate risk) | Level 3 (high risk) |
|---|---|---|
| • Monthly therapeutic care management contacts1 ∘ Brief risk assessment ∘ Motivational interviewing around accessing/participating in treatment services ∘ Review and use of personal safety plan ∘ Problem-solving support ∘ Facilitating connection with interventionist and health system • Self-directed treatment options (as recommended by care manager) ∘ Internet-based cognitive behavioral therapy (eCBT)2 ∘ Dialectical Behavioral Therapy (DBT) skills videos3 |
• Group DBT sessions4 ∘ 18 total sessions over 3 modules focused on DBT skills training ∘ Modules (6 sessions each): Emotion regulation, interpersonal effectiveness, distress tolerance ∘ 90-minutes each session • + Level 1 treatment services ∘ Care management contact will also include support around use of skills taught in group |
• Individual DBT sessions5 ∘ 10 sessions6 ∘ 60-minutes each session • + Level 2 treatment services |
These contacts will be initiated by phone, with follow up as needed using the participant’s preferred mode of contact (phone or email) to increase success in maintaining connections with participants.
Participants will be offered access to Internet-based Cognitive Behavioral Therapy (eCBT)28 targeting depression, which provides self-directed tutorials on behavior activation and cognitive restructuring, along with the opportunity for participants to monitor and track mood over time.
Participants will be referred to select DBT skills videos on the "Now Matters Now" website.29 Skills taught through these videos emphasize skills taught in DBT and other suicide prevention interventions, such as mindfulness, emotion regulation, distress tolerance, and reducing access to lethal means.
Two DBT groups will be offered: either a multi-family group with youth/parent dyads (for participants < 18 years old) or a young adult group (for participants 18 years and older).
The individual treatment that will be offered in this trial is based on established DBT treatment and uses: regular tracking of patient mood and self-harm urges and behavior; structuring the session agenda based on life-threatening targets first, therapy-threatening targets second, and quality-of-life threatening targets third; chain and solution analyses of any self-harm behavior or significant increase in suicidal urges; integration of DBT skills and strategies; availability of additional CBT modules targeting depression and insomnia; and strategies for enhancing family protection and support.28,30–34 Therapists will also have the freedom to incorporate other CBT treatment strategies, as well as motivational enhancement techniques, to meet the needs of participants.
Additional individual sessions were possible if requested by the care manager and approved by an intervention supervisor.