Motivational interviewing-enhanced safety planning for adolescents at high suicide risk: A pilot randomized controlled trial
Abstract
This pilot randomized controlled trial examined the feasibility and acceptability of a motivational interview (MI)-enhanced safety planning intervention (MI-SafeCope) for teens hospitalized due to suicide risk and explored proximal outcomes (possible mechanisms of change). Participants were 36 hospitalized adolescents (ages 13-17; 78.8% female) with last-week suicidal ideation and/or past-month suicide attempts. Adolescents were randomized to MI-SafeCope, a three-component intervention (individual and family sessions, postdischarge call), or to treatment as usual. Primary outcomes were feasibility and acceptability. We also explored differences in proximal outcomes assessed at 2 weeks, 1 month, and 3 months (family connectedness, motivation for safety plan use, parental motivation to encourage safety plan use), as well as daily for 4 weeks (self-efficacy, coping behavior, safety plan use). Participation and retention rates and intervention satisfaction ratings indicate feasibility and acceptability. Mixed-effects models of daily assessments indicated, for the MI-SafeCope group, significantly higher self-efficacy to refrain from suicidal action (B = 1.15, p = .030), greater reliance on self to cope with suicidal ideation (B = 1.56, p = .042), and higher likelihood of safety plan use to manage suicidal thoughts (B = 0.25, p = .004). Parents in the MI-SafeCope group reported higher motivation to encourage safety plan use (B = 1.04, p = .031). Safety planning incorporating MI is feasible and acceptable with hospitalized teens. Preliminary findings suggest that MI strategies may be promising in maintaining adherence to safety plans, increasing self-efficacy and coping, and in fostering parents' motivation to encourage safety plan use. Our study also highlights the benefit of daily-level assessment of individuals' response to suicide-specific interventions.
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Re-presentation to acute care settings was designated as the primary outcome in zero studies and a secondary outcome in 2 studies.
“Re-presentation to acute care settings was designated as the primary outcome in zero studies and a secondary outcome in 2 studies.38,44”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [38]
Suicide-related behavior was designated as a primary outcome in 1 study and a secondary outcome in 2 studies.
“SRB was designated as a primary outcome in 1 study44 and a secondary outcome in 2 studies.35,38”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents (2025) · cites this paper as [38]
Motivational interviewing strategies may enhance adherence to youth safety plan use and parents' motivation to encourage safety plan use.
“Motivational interviewing strategies, which are often used to address health behavior change in pediatric primary care, may enhance adherence to youth safety plan use and parents’ motivation to encourage safety plan use.57,58”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [57]
Safety plans increase self-efficacy and coping.
“Safety plans do increase self-efficacy and coping.57,58”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [57]
Only one of the reviewed studies employed EMA to assess the effectiveness of an intervention.
“only one of the reviewed studies employed EMA to assess the effectiveness of an intervention (53)”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [53]
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- Authors
- Czyz, E. K., King, C. A., & Biermann, B. J.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Czyz, E. K.
- Venue
- Journal of Clinical Child & Adolescent Psychology
- Publisher
- Informa UK Limited
- Published
- 2018-08-24
- Volume
- 48
- Issue
- 2
- Pages
- 250-262
- ISSN
- 1537-4416 (ISSN-L)
- 1537-4424
- OpenAlex
- W2888450918
- Cited by
- 105
- References
- 72
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 14 · 2023: 17 · 2022: 17 · 2021: 19 · 2020: 10 · 2019: 4 · 2018: 2 · 2013: 1
- FWCI
- 10.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Child & Adolescent Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Foundation for Suicide Prevention (PDF-0-028-14)
- Michigan Institute for Clinical and Health Research (Postdoctoral Translational Scholar Program)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- motivational interviewing, safety planning, adolescents, suicide risk, suicidal ideation, suicide attempts, hospitalized adolescents, self-efficacy, coping styles, family involvement, parental motivation, intervention feasibility and acceptability
- MeSH terms
- Adolescent, Female, Humans, Male, Pilot Projects, Suicide, Attempted, Motivational Interviewing
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