Duke psychologists are employing the “SAFETY-Acute” intervention for adolescents and young adults who are experiencing suicidal thoughts and behaviors to help them cope with their feelings and stay safe when they are in distress. The result of the intervention is a family safety plan that details warning signs, coping skills, ways to ensure safety, and support resources. Another important aspect of the SAFETY-Acute Intervention is connection to appropriate longer-term care, where youth can continue important mental health services.

“When adolescents and young adults have suicidal thoughts, we use a cognitive behavioral approach that builds on youth and family strengths to help young people remain safe and get them to a better place,” says David B. Goldston, PhD, a child and family clinical psychologist who works primarily with patients who struggle with anxiety, depression, substance use, and suicidal thoughts.

Youth who have been exposed to traumatic experiences are at higher risk for suicidal behavior, and this approach was developed with special sensitivity to the needs of those youth.

A collaborative process between clinicians, patients, and families, the SAFETY-Acute intervention may begin when a young person presents in the ED with suicidal thoughts or behaviors, as an outpatient in a mental health clinic, a school-based health clinic or integrated care setting, or when they are referred from another provider.

Goldston says the steps are adapted for an individual’s and family’s immediate needs but usually involve the following:

• promoting a psychologically safe environment for youth and families in distress
• listening intently to fully understand a patient’s distress
• stabilizing the immediate situation
• fostering hope and resiliency, helping patients identify their strengths and interests
• finding ways to keep the home environment safe so patients are less likely to act on their impulses when they are feeling vulnerable
• teaching patients to label their emotions and the physical reactions associated with them so they recognize triggering events or warning signs
• showing patients how to self-soothe and tolerate moments of distress through distracting behaviors, such as listening to music
• identifying resources patients and families can contact when they feel unsure about their safety
• linking patients with providers for follow-up care

“Essentially, what we’re doing is trying to help a patient step back from that place of acute suicidality, when they’re experiencing unbearable psychological pain, so they are better able to see a future beyond the current moment, have hope, and use coping strategies to get through this time, ” says Goldston.

Parents, caregivers, and other family members are brought together to discuss the shared safety plan, strengths, areas of need, and the importance of follow-up care.   Therapists also discuss the effects of alcohol and drugs on anxiety and depression, discouraging the use of substances when people are feeling vulnerable.

Goldston stresses that the first step in the intervention—listening to the patient—is one of the most important, noting that the majority of people experiencing suicidal behaviors have had some kind of contact with a medical professional during the time leading up to the behavior.

“We’ve talked with young adults who were suicidal when they were younger,” he says. “Many of them said their providers focused on how to manage them rather than expressing interest in what they were dealing with and trying to understand why they felt the way they did. A sense of collaboration and hope comes through a relationship with someone who tries to understand a patient’s own story and helps get them to a better place.”

There are many different paths that lead to suicidal thoughts and behaviors, Goldston notes, and it’s sometimes difficult for people to come out of that place and think beyond their current pain. “A lot of our work is helping people step back from feeling their worst and actually be able to envision a life worth living,” he says.

For more information about the National Child Traumatic Stress Network Center supporting this work, see https://www.asapnctsn.org/