Practical and Ethical Risk Management Considerations for the Conduct of Remote Research with Youth Who Have Recently Been Hospitalized for a Suicide Attempt: Lessons Learned from the (virtual) Field

Background and Purpose: The COVID-19 pandemic and associated public health precautions necessitated rapid adoption of telehealth services, including assessment and intervention with youth presenting with mental and behavioral health needs. Although provision of mental health services via telehealth has the potential to improve access to care for some populations, it also presents a number of challenges for clinicians and researchers working with patients who are at elevated risk for suicide. In this paper, we describe the lessons learned from conducting virtual qualitative interviews with youth ages 10-18 who had recently been discharged from an inpatient psychiatric facility precipitated by a suicide attempt, their caregivers, and inpatient mental health providers.

Methods: This paper draws upon data collected during the first phase of an intervention development study designed to adapt and test a family-based intervention for suicidal adolescents for use on inpatient psychiatric settings. In the first phase, we conducted 45 qualitative interviews with youth who had been hospitalized within the past six months for a suicide attempt (n=15), their caregivers (n=15), and inpatient mental health providers employed on the unit in which the youth were hospitalized (n=15). Interviews were designed to elicit perspectives of these three key stakeholder groups about care provided on the unit and ultimately informed modifications to the intervention itself. In addition to the conduct of semi-structured interviews, the research team also administered validated measures of suicide risk screening and assessment to all youth participants and employed specific risk management protocols. Specific safety protocols were implemented to prioritize youth participant safety during the conduct of remote interviews. All interviews were conducted via zoom and content was analyzed using reflexive thematic analysis.

Results: Several practical and ethical considerations pertaining to procedures for the conduct of interviews with suicidal youth emerged from this study that can be used to remotely assess and manage suicide risk. These pertain to protocol modifications related to sequencing of interviews (provider, parent, youth), caregiver availability during time of the interviews, qualifications and skillset of research interviewers, and supervision and debriefing protocols. In addition, thematic analysis of interviews with both caregivers and youth revealed that safety planning was an important factor in increasing comfort in virtual participation. Findings from provider interviews underscored the need for addressing barriers to care access and continuity.

Conclusions and Implications: It is highly likely that telehealth service delivery and virtual platforms for research will continue to be utilized even after social distancing measures and other public health precautions are no longer necessary to curb transmission of COVID-19. Thus, there is a need to ensure that both researchers and clinicians are equipped with tools that enable the conduct of research and practice with high risk groups, such as youth who have recently been hospitalized for a suicide attempt, using these modalities. Implications for this study include recommendations for conducting research with suicidal youth using a virtual platform in a manner that ensures safety by primarily prioritizing collaboration with caregivers.