Q&A with Dr Nicole Hill on aftercare for children and young people

This multisite trial aims to assess the effectiveness of a brief, problem solving intervention, known as the ‘therapeutic intervention’ for young people who present to the emergency department for self-harm and serious suicidal ideation. In addition to a routine psychosocial assessment, the therapeutic intervention involves identifying the thoughts and behaviours associated with suicide and self-harm and working with the young person to identify strategies to prevent or break the cycle of self-harm. The process allows the young person and practitioner, in our case psychiatric liaison nurses, to identify what stressors may lead to self-harm. In doing so will help identify and refer young people to more specific aftercare services, which may meet their needs, following discharge.

The primary outcome is short and long-term engagement in aftercare services. This will be measured one month, six months, and 12 months post-discharge and will be measured using electronic data collected through the public health system, and self-report data. Secondary outcomes include representation to the ED for mental health-related crises (including recurrent self-harm and suicidal ideation). We will also assess factors associated with access to aftercare including the healthcare sector workforce density (relative to the size of the population), opening hours, and days of operation; as well as individual factors such as travel time to services relative to employment and school hours.

This trial involves a collaboration with Geralton Regional Aboriginal Medical Services and Aboriginal researchers from Telethon Kids Institute and the University of Western Australia to develop a culturally safe adaptation of the therapeutic intervention for Aboriginal young people who present to the ED for self-harm. The adaptation will be co-designed with young people and their care takers with lived and living experience of self-harm and suicidal behaviour, as well as clinicians who have worked with Aboriginal young people who have experienced suicidal crisis, through a series of consultations and workshops.

Each trial site will also include an audit of aftercare services in the community using data from the Australian Bureau of Statistics on the mental health workforce density, a desktop based audit of services public, private and non-for-profit services; and survey data. We will also assess individuals access to services according to transport availability and opportunity (e.g., taking into account school/employment hours). These data will indicate whether existing services meet the aftercare needs of young people identified in the therapeutic assessment and identify potential gaps in services. These data will provide key covariates to assess whether these factors impact the likelihood that a person will engage in aftercare services, over and above the expected effectiveness of the therapeutic intervention.

There are multiple and concurrent things that can be done in research, practice, policy, and applied at an individual, community and population level. We are trying to take this approach in the current multisite trial by delivering an evidence-based intervention that is known to improve engagement in aftercare services but adapting it to meet vulnerable Aboriginal young people and controlling for important covariates such as access to services that may mediate the effectiveness of the therapeutic intervention. Suicide prevention is complex, and we need to be addressing it in ways that encourage researchers, decisionmakers, policy makers, clinicians and individuals with lived experience to learn from what works and doesn’t work for effective suicide prevention.

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