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An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment
Open accessAbstract
OBJECTIVE: Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared. METHODS: In a randomized controlled trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge. RESULTS: Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes. CONCLUSIONS: Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments.
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“SI was designated as a primary outcome in zero studies and designated as a secondary outcome in 3 studies.35,38,40”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In controlled trials with children and adolescents,35,38,39,40,42,43,44 control conditions were often vaguely defined and sometimes involved elements of safety planning to varying degrees, although results were consistent whether these studies were removed (Figure 2) or included (eFigure in Supplement 1).”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Based on study-level results, adolescents who received interventions that were family-based had lower rates of re-presentation44 and were more likely to be linked to outpatient mental health services after discharge35 compared with adolescents who received treatment as usual.”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
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“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: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
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In the citing paper
“SA was designated as a primary outcome in 1 study40 and a secondary outcome in 1 study.35”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
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“Only 3 studies35,42,44 had adequate-sized samples to compare treatment effects across groups; 2 of these studies35,44 used true randomization, and neither found significant between-group differences in suicide-related outcomes.”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
In the citing paper
“Asarnow and colleagues53 demonstrated that a brief family-based ED intervention, the Family Intervention for Suicide Prevention (FISP), could effectively link youth and parents to care and this intervention was effectively delivered in the ED setting in 80.9% of patients54.”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“FISP was tested in a randomized controlled trial in which suicidal youths at two EDs (N=181; aged 10-18) were individually randomized to 1) Usual ED Care enhanced by provider education (UC); or 2) FISP, supplemented by care linkage telephone contacts after discharge. Intervention patients were significantly more likely to attend outpatient treatment compared to UC patients (92.1% vs 76.2%, p=0.004”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“The intervention group also had a significantly higher rate of psychotherapy, combined psychotherapy/medication, and more psychotherapy visits”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“FISP, also included as an evidence-based intervention by SPRC/AFSP , is an enhanced mental health intervention involving a family-based CBT session in the ED designed to increase motivation for follow-up treatment, support, coping, and safety.53”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“but no significant effects on suicidality or other clinical/functioning outcomes (exploratory analyses).53”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
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InfluentialLes soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide
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“Though safety planning has been integrated into broader suicide-specific interventions for youth such as the Family Intervention for Suicide Prevention (FISP) (Asarnow et al., 2011) and MI-SafeCope (Czyz et al., 2019), studies examining the SPI as a standalone intervention with youth at risk for suicide are lacking as…”
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“…studies have documented the critical role of families in facilitating treatment access, engagement, and outcomes for youth at risk for suicide (Asarnow et al., 2011; Ougrin, Tranah, Stahl, Moran, & Asarnow, 2015), yet parental psychopathology is a risk factor for poor treatment outcomes…”
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InfluentialSelf-citationDo suicidal thoughts and behavior persist following juvenile justice involvement?
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“In particular, in emergency department settings, it is not uncommon for youth with mental health issues to not be seen by a mental health professional (Kalb et al., 2019), or for suicidal youth to not receive therapy following their discharge (Asarnow et al., 2011).”
BackgroundSelf-citationNot a fad: Nonsuicidal self-injury and suicide attempts
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“The FISP has demonstrated significant improvements in getting child and adolescent patients linked to outpatient treatment upon discharge from the ED, but it has not shown significant improvements in functioning or clinical outcomes (Asarnow et al., 2011).”
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“Several interventions have been used to support youth in the ED and promote positive mental health outcomes (Asarnow et al. 2011; Donaldson et al. 1997; Kodish et al. 2023; Rengasamy and Sparks 2019; Ryan et al. 2022).”
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Quantifying the Representation of Black Adolescents in Suicide Intervention Research
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Hughes, J. L., & Asarnow, J. R. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.06.009 · Cited by 5
Self-citationShi, T., Merai, R., Lowry, N. J., Ruch, D. A., Bridge, J. A., Pao, M., & Horowitz, L. M. (2025) · JAACAP Open · doi:10.1016/j.jaacop.2025.01.001 · Cited by 5
“Interventions in various clinical settings that improve family support and education have been shown to increase outpatient treatment adherence 41 and decrease inpatient hospitalization rates, 42 respectively, compared with treatment-as-usual conditions.”
Future Directions: Targeting Social Contribution in Youth Suicide Prevention
Edenbaum, E. R., & Buitron, V. (2025) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2025.2521852 · Cited by 6
“…and coordinated efforts to reduce psychiatric symptoms, transition youth to lower levels of care and back into activities of daily life, and prevent the recurrence of self-injurious thoughts and behavior (Asarnow et al., 2011; Czyz et al., 2021; B. Kennard et al., 2019; B. D. Kennard et al., 2015).”
Reasons Why Suicidal Adolescents Want to Live: A Corpus-Driven Language Analysis
Ugueto, A. M., O’Hagan, L. A., & Lucassen, M. F. G. (2025) · Psychiatric Services · doi:10.1176/appi.ps.20240332 · Cited by 6
Parast, L., Burkhart, Q., Bardach, N. S., Thombley, R., Basco, W., Barabell, G., Williams, D. J., Mitchel, E., Machado, E., Raghavan, P., et al. (2022) · Academic pediatrics · doi:10.1016/j.acap.2021.03.005 · Cited by 4
Feng, Y. R., Valuri, G. M., Morgan, V. A., Preen, D. B., O’Leary, C., Crampin, E. F., & Waterreus, A. J. (2023) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674231172116 · Cited by 5
Berk, M. S., Starace, N., & Glasser, C. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1941429 · Cited by 5
“As in the FISP/SAFETY-A intervention (Asarnow et al., 2008, 2009, 2011; Asarnow, Goldston et al., 2020), in the Crisis Clinic, we use a feelings thermometer to help the teen identify early warning signs that they may be escalating to the point of crisis, so they can use coping skills or ask for…”
BackgroundMethodInfluentialSelf-citationA Community Call to Action: Use of Quality Improvement Strategies to Address Youth Suicides
Esposito-Smythers, C. L., Defayette, A. B., Whitmyre, E. D., Steinberg, P., Goldston, D. B., & Asarnow, J. R. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1917020 · Cited by 5
“An overview of training provided in the SAFETY-Acute/Family Intervention for Suicide Prevention (SAFETY-A/FISP; Asarnow et al., 2009, 2011) is offered as an example of the work conducted by the consortium.”
BackgroundMethodInfluentialSelf-citationAhmadi, N., Pynoos, R. S., Leuchter, A. F., & Kopelowicz, A. J. (2022) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20200061 · Cited by 7
Sheppler, C. R., Edelmann, A. C., Firemark, A. J., Sugar, C. A., Lynch, F. L., Dickerson, J. F., Miranda, J. M., Clarke, G. N., & Asarnow, J. R. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106959 · Cited by 6
Self-citationAsarnow, J. R., & Mehlum, L. I. (2023) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.23021005 · Cited by 6
Self-citationAnnual Research Review: Self‐harm in young people
Ougrin, D., & Kaess, M. (2026) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.70112 · Cited by 5
Yurtseven, A., Turan, C., ORT, D. M., ISLAM, M., Köse, S., Saz, E. U., & HENNES, H. M. (2023) · TURKISH JOURNAL OF MEDICAL SCIENCES · doi:10.55730/1300-0144.5757 · Cited by 4
Developing and Piloting Suicide Prevention Training in Pediatric Primary Care
Parkhurst, J. T., Hilliard, M., Hubbell, D. E., Spencer, A. E., Hoffmann, J. A., Martinez‐Charleston, E., Loughead, J. L., & Janssen, A. C. (2024) · JAACAP Open · doi:10.1016/j.jaacop.2024.12.001 · Cited by 4
Safety Planning and Lethal Means Counseling with Youth
Monahan, M. F., & Stanley, B. (2022) · SpringerBriefs in psychology · doi:10.1007/978-3-031-06127-1_9 · Cited by 4
Treatment Approaches with Suicidal Adolescents
Spirito, A., Webb, M. A., Wolff, J. C., & Esposito-Smythers, C. L. (2022) · Springer eBooks · doi:10.1007/978-3-030-42003-1_21 · Cited by 4
Madsen, T., Erlangsen, A., Egilsdóttir, E., Andersen, P. K., & Nordentoft, M. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02585-y · Cited by 4
Brief Interventions for Suicidal Youths in Medical Settings: A Meta-Analysis
Pitts, B. H., Doyle, R., Wood, L., Dar, R., Ayala, S. D. J., Sharma, T., Pierre, M. S., & Anthony, B. J. (2024) · PEDIATRICS · doi:10.1542/peds.2023-061881 · Cited by 4
“15,16,20,21 The mean effect size for SI measures was 0.053 with a 95% CI of (cid:1) 0.160 to 0.255.”
InfluentialUsing Equipercentile Equating to Link Scores of the CBCL and SDQ in Residential Youth
Stevens, A. L., Ho, K. Y., Mason, W. A., & Chmelka, M. B. (2019) · Residential Treatment for Children & Youth · doi:10.1080/0886571x.2019.1704670 · Cited by 7
Investing in Suicide Prevention: Zero Suicide in a Pediatric System of Care
Thomas, G. V., Chapman, M. R., & Grumet, J. G. (2022) · SpringerBriefs in psychology · doi:10.1007/978-3-031-06127-1_15 · Cited by 4
Do all children with suicidal ideation receive a significant psychiatric intervention?
Waseem, M., Diaz‐Guerrero, R. J., Cosme, R. M., Ain, Y., Leber, M. J., & Gerber, L. M. (2014) · Pediatrics International · doi:10.1111/ped.12527 · Cited by 4
Effectiveness of Nursing Preventive Interventions in Suicide re- Attempts
Ghanbari, B., Malakouti, S., Nojomi, M., Alavi, K., Khaleghparast, S., & Sohrabzadeh, A. (2016) · Iran Journal of Nursing · doi:10.29252/ijn.29.99.100.34 · Cited by 4
Kreuze, E. J., & Ruggiero, K. J. (2017) · Adolescent Research Review · doi:10.1007/s40894-017-0060-5 · Cited by 4
Pinciotti, C. M., Buckland, E. K., Mayes, T. L., Cooley, J. L., Mitchell, S. M., Zullo, L., Hughes, J. L., Patel, P., Neal, C., DeFilippis, M., et al. (2025) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2025.2522068 · Cited by 3
“This intervention was originally developed for use in emergency departments to improve linkage to outpatient mental healthcare and reduce the need for inpatient admission (Asarnow et al., 2011).”
Self-citationBrousseau‐Paradis, C., Genest, C., Maltais, N., Séguin, M., & Rassy, J. (2024) · Community Mental Health Journal · doi:10.1007/s10597-024-01394-0 · Cited by 6
“Safety plans have proven to be effective as they can significantly reduce suicidal behaviors (Ferguson et al., 2022; Nuij et al., 2021; Stanley et al., 2018) and help promote outpatient follow-up (Asarnow et al., 2011; Ferguson et al., 2022; Nuij et al., 2021; Stanley et al., 2018).”
Szlyk, H. S., Tan, J., & Lengnick‐Hall, R. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.657303 · Cited by 3
“, 2014); the Family Intervention for Suicide Prevention (FISP; Rosenbaum et al., 2011), an adaptation of an emergency room intervention; Sources of Strength (Wyman et al.”
BackgroundKennard, B. D., Gupta, M., Hensley, J. K., Heerschap, J. K., Moorehead, A., Wildman, R., & Nakonezny, P. A. (2024) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02761-3 · Cited by 3
“Treatments with demonstrated ef fi cacy include family-integrated cognitive-behavior therapy (Esposito-Smythers et al., 2019; Asarnow et al., 2011), attachment-based family therapy (Diamond et al., 2016), dialectical behavior therapy (DBT; Mehlum et al., 2014; McCauley et al., 2018), and…”
Suicide Prevention and Telehealth in Children's Hospital Emergency Departments
Doupnik, S. K., Bowden, C. F., Worsley, D., Keating, C., Cassidy, K., Foster, A. A., Quarshie, W. O., Min, J., Meisel, Z. F., & Marcus, S. C. (2024) · Pediatric Emergency Care · doi:10.1097/pec.0000000000003304 · Cited by 3
The role of culture in suicide prevention in adolescents.
Molock, S. D., Smith, A. P., Jeffries, D., & Jean, D. (2014) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0101632 · Cited by 5
Notfallplaninterventionen zur Behandlung suizidaler Patient:innen: eine narrative Literaturübersicht
Teismann, T., Brieger, P., Spießl, H., Hensel, L. M., & Hamann, J. (2024) · Der Nervenarzt · doi:10.1007/s00115-024-01763-w · Cited by 3
“…dass der Notfallplan nicht ausschließlich mit den Betroffenen selbst, sondern auch mit deren Bezugspersonen besprochen und verfeinert werden muss [11]; die Safety-Plan-Intervention wird daher zumeist in ein mehrere Sitzungen umfassendes Kri-senbehandlungsprogramm eingebunden (u. a. [41–43]).”
Safety Planning for Youth in the Emergency Department Who Have Suicide Risk
Foster, A. A., Hoffmann, J. A., Berg, K. T., Cheng, T. A., Claudius, I. A., Dietrich, A. M., Hooley, G., Lam, S. H. F., Li, J., Lin, S., et al. (2025) · Journal of the American College of Emergency Physicians Open · doi:10.1016/j.acepjo.2025.100275 · Cited by 5
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After Screening: A Developmentally Informed Approach to Safety Planning and Stabilization
Zullo, L., Kodish, T., & Asarnow, J. R. (2022) · SpringerBriefs in psychology · doi:10.1007/978-3-031-06127-1_8 · Cited by 2
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Benjamin, L. S., & Carney, M. M. (2018) · Clinical Pediatric Emergency Medicine · doi:10.1016/j.cpem.2018.08.002 · Cited by 2
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Rosic, T., Cloutier, P., Myran, D. T., Imsirovic, H., Kurdyak, P. A., & Gardner, W. P. (2024) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2024.06.019 · Cited by 1
Emergency department care experiences among youth with mental health concerns
Wells, L. K., Bartels, S. A., Nicholls, T., & Walker, M. (2024) · PLOS mental health. · doi:10.1371/journal.pmen.0000200 · Cited by 1
Fontanella, C. A., Hughes, J. L., Brock, G. N., Ruch, D. A., Kemper, A. R., Bunger, A. C., Walker, D. M., McAlearney, A. S., Maa, T., Miller, M., et al. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108208 · Cited by 1
Metadata
- Authors
- Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., Piacentini, J. C., Rotheram-Borus, M. J., Cohen, D., & Tang, L.
- Affiliations
- University of California, Los Angeles (US)
- Harbor–UCLA Medical Center (US)
- Santa Monica College (US)
- Dr. Suddath, Dr. Piacentini, Dr. Rotheram-Borus, and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, UCLA.
- Johns Hopkins University (US)
- Venue
- Psychiatric Services
- Published
- 2011-11
- Volume
- 62
- Issue
- 11
- Pages
- 1303-1309
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- PMC
- PMC3251923
- OpenAlex
- W2170748745
- Cited by
- 251
- References
- 41
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 18 · 2023: 24 · 2022: 16 · 2021: 28 · 2020: 19 · 2019: 20 · 2018: 11 · 2017: 15 · 2016: 21 · 2015: 9 · 2014: 19 · 2013: 12 · 2012: 4
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (CCR921708)
- National Institute of Mental Health (R34MH078082, P30MH082760, R01MH082856)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- adolescent suicide, suicide prevention, emergency department care, provider education, suicide attempts
- MeSH terms
- Suicide Prevention, Adolescent, Ambulatory Care, Child, Community Mental Health Services, Depressive Disorder, Emergency Service, Hospital, Family Therapy, Female, Humans, Male, Patient Acceptance of Health Care, Patient Discharge, Pilot Projects, Regression Analysis, Stress Disorders, Post-Traumatic, Suicide, Suicide, Attempted, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Suicidal Ideation
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