Development of Britepath: A Suite of Digital Tools for Suicide Prevention within Pediatric Primary Care Settings

Background: Efforts within primary care settings to prevent adolescent suicide, the second leading cause of death among youth, is a critical public health concern of high relevance to social workers. Clinical social workers predominate behavioral health services embedded within primary care and frequently manage youth who are depressed and at suicidal risk. As many as 14% of adolescents in primary care report they are suicidal, and the majority of suicide decedents have their last clinical contact in primary care. The use of digital tools to augment clinical practice within pediatric primary care is promising, given the high rate of smartphone use among adolescents (95%). BritePath is a suite of digital tools developed as part of a NIMH-funded ALACRITY Center to support management of suicidal risk within pediatric primary care settings through the use of novel digital tools. BritePath includes three components: (1) Brite, a safety planning and emotion regulation smartphone app for adolescents; (2) Guide2Brite, a guide for clinicians to help adolescents load the content of their digital safety plans and personalize emotion regulation techniques to their Brite app; and (3) BriteBoard, an online portal for clinicians to track adolescents’ app use, distress ratings, and treatment progress. This study aimed to gather stakeholder perspectives from adolescents, parents, and clinicians within pediatric primary care settings to inform the design and development of BritePath.

Methods: Qualitative interviews were conducted with adolescents (n=9) who were treated for depression and/or suicidality and their parents (n=10). Focus groups were conducted with pediatric primary care providers and embedded behavioral health staff (n=17). Data collection focused on stakeholders’ perspectives toward the acceptance of BritePath to support clinical management of suicidal risk within primary care settings. Additionally, paper-based prototypes of the digital products were reviewed with stakeholders to explore the acceptability of the function and usability of BritePath components. Interviews and focus groups were recorded, transcribed, and analyzed using thematic analysis. Features of functionality and usability were identified by stakeholders to guide the design and development of BritePath.

Results: Overall, adolescents, parents, and clinicians reported acceptance of BritePath components for use within pediatric primary care settings. Stakeholders appreciated the youth-friendly design of the Brite app and the capacity for adolescents to have constant access to their safety plan and coping skills. However, parents requested additional information on how to support their child in using the skills present on the Brite app. Additionally, clinicians reported a need for technical assistance to assure competence with the intervention and in management of potential liability associated with having constant access to app ratings of distress.

Conclusions and Implications: BritePath shows promise in supporting management of suicidal risk in pediatric primary care, a critical topic for social work practice, by augmenting current interventions with novel digital tools. Consideration of adolescents’, parents’, and clinicians’ preferences toward the usability and function of the suite of tools is essential to its acceptability.