Stepped-Care for Suicidal Youth and Children

NCT ID: NCT07321171

Last Updated: 2026-01-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

350 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-07

Study Completion Date

2027-12-31

Brief Summary

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The goal of this RCT study is to test the efficacy of a stratified stepped-care (SSC) model in reducing suicidal thoughts and behaviors (STB) in children and adolescents. The main questions it aims to answer are:

1. Does the SSC model effectively reduce STB and mental health symptoms?
2. Can the SSC model improve access to treatment and be cost-effective?

Researchers will compare the SSC model to Care as Usual (CAU). The SSC model includes low-intensity counseling delivered by non-specialists for mild STB and professional-delivered therapy for more severe cases. The CAU group will receive standard clinic treatment, which consists of a waitlist for brief therapy and follow-up.

Participants will be recruited from a clinic at Schneider Children's Medical Center, randomly assigned to either the SSC group or the CAU group, and Complete assessments at the start of the study and at 1, 3, and 6 months.

Detailed Description

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Detailed Study Description This study is aimed at improving the care provided to children and adolescents experiencing suicidal thoughts and behaviors (STB). It addresses the significant public health challenge of rising suicide rates among youth and the systemic issues within mental health services, such as long waiting times and a shortage of professional staff. The research aims to develop a new, effective model of care that can be integrated into existing health systems.

The investigators will conduct a randomized controlled trial (RCT) comparing a new SSC model to the current standard of care, Care as Usual (CAU). The goal is to determine if the SSC model is more effective in reducing suicidal symptoms and improving mental health outcomes.

1. Provider Training:

A key component of this model is the use of non-specialist mental health providers. The investigators will train a group of individuals, primarily psychology and community mental health graduate students with relevant experience, to deliver a low-intensity, evidence-based intervention. This intervention, Interpersonal Counseling for Suicidal Crisis Intervention (IPC-A-SCI), is a manualized protocol adapted for this study. The training will be conducted in a hybrid format (in-person and online), and the investigators will include weekly group supervision by a senior clinical psychologist. This training emphasizes the ethical and safety considerations necessary when working with this vulnerable population.
2. Participant Treatment and Data Collection:

Upon entering the study, senior clinicians will conduct a baseline assessment of each participant, including a diagnostic interview and a suicide risk evaluation. Participants will then be randomly assigned to one of two groups:

Intervention Group (SSC): Participants in this group will receive care based on their initial clinical assessment. Those with mild-to-moderate STB will receive the low-intensity IPC-A-SCI intervention from the newly trained non-specialist providers. If a patient's condition worsens, they can "step up" to a higher level of care, receiving brief IPT-A-SCI (Interpersonal Psychotherapy for Adolescents) from a professional therapist.

Control Group (CAU): Participants in this group will receive the standard treatment currently provided at the clinic. This typically involves an initial psychiatric assessment followed by placement on a waitlist for brief therapy.

Assessments to measure outcomes, including STB, depression, anxiety, and trauma, will be conducted at the beginning of the study and again at one, three, and six months. The investigators will analyze this data to compare the effectiveness of the two care models.

Conditions

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Suicidal Ideation and Behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study uses a parallel-group, randomized controlled trial (RCT) design. This means that after a baseline assessment, participants will be randomly assigned to one of two distinct, independent groups. Each group will receive a different intervention for the duration of the study, and their outcomes will be compared.

The core of this model is the comparison between a novel, multi-layered treatment approach (Stratified Stepped-Care - SSC) and the existing standard of care (Care as Usual - CAU). The two groups are completely separate, with no participants switching between them. This design is robust for evaluating the effectiveness of a new intervention against an established one, as it minimizes bias and allows for a direct comparison of outcomes.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Although the therapists are aware of the type of treatment they are providing, the participants themselves are not aware of which research arm they belong to (the SSC group or the CAU group) at the time of allocation. They know that they are participating in a study to compare treatment methods, but the identity of the specific treatment they receive is only revealed to them upon the start of the treatment. This makes them "masked" for a certain period to prevent bias.

Study Groups

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Intervention Arm: Stratified Stepped Care (SSC)

The role of this arm is to test the efficacy of a new, tiered model for treating suicidal thoughts and behaviors (STB) in youth. Participants in this group will receive an intervention that is tailored to their specific needs and level of risk, as determined by an initial clinical assessment.

Low-Intensity Treatment: Participants with mild-to-moderate STB will receive an adapted form of Interpersonal Counseling (IPC-A-SCI) delivered by a trained non-specialist. This intervention focuses on safety planning and improving interpersonal skills.

High-Intensity Treatment: Participants with more severe STB, or those whose condition worsens, will receive Interpersonal Psychotherapy (IPT-A-SCI) from a professional therapist. This provides a clear "step-up" pathway to a more intensive level of care.

Group Type EXPERIMENTAL

IPC-A-SCI (Interpersonal Counseling for Suicide Crisis Intervention)

Intervention Type BEHAVIORAL

The IPC-A-SCI is a manualized, low-intensity intervention adapted for adolescents experiencing suicidal thoughts and behaviors. It is based on Interpersonal Psychotherapy (IPT) principles but is designed to be delivered in a limited number of sessions by trained non-specialists. The protocol focuses on identifying and addressing interpersonal problems that may trigger or maintain suicidal behaviors. It includes core components such as safety planning, building interpersonal skills, and emotional processing, with a specific emphasis on involving parents in the treatment process. The intervention is a key component of the overall stratified stepped-care (SSC) model, which aims to provide targeted, effective, and accessible care in a public health setting.

IPT-A-SCI (Interpersonal Psychotherapy for Adolescents with Suicidal Crisis Intervention)

Intervention Type BEHAVIORAL

The IPT-A-SCI is a crisis-focused psychotherapeutic intervention developed for adolescents with suicidal thoughts and behaviors. It is based on the principles of Interpersonal Psychotherapy (IPT).

Control Arm: Care as Usual (CAU)

The role of this arm is to serve as a comparison group to the SSC model. It represents the standard of care currently available in a public outpatient clinic in Israel.

Standard Treatment: Participants in this arm will receive an initial psychiatric assessment. They will then be placed on a waitlist for a brief IPT intervention. Follow-up assessments will be conducted every three months. After completing the brief IPT, some participants may be referred to community services, and a small percentage may receive longer-term psychotherapy.

Group Type ACTIVE_COMPARATOR

IPT-A-SCI (Interpersonal Psychotherapy for Adolescents with Suicidal Crisis Intervention)

Intervention Type BEHAVIORAL

The IPT-A-SCI is a crisis-focused psychotherapeutic intervention developed for adolescents with suicidal thoughts and behaviors. It is based on the principles of Interpersonal Psychotherapy (IPT).

Interventions

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IPC-A-SCI (Interpersonal Counseling for Suicide Crisis Intervention)

The IPC-A-SCI is a manualized, low-intensity intervention adapted for adolescents experiencing suicidal thoughts and behaviors. It is based on Interpersonal Psychotherapy (IPT) principles but is designed to be delivered in a limited number of sessions by trained non-specialists. The protocol focuses on identifying and addressing interpersonal problems that may trigger or maintain suicidal behaviors. It includes core components such as safety planning, building interpersonal skills, and emotional processing, with a specific emphasis on involving parents in the treatment process. The intervention is a key component of the overall stratified stepped-care (SSC) model, which aims to provide targeted, effective, and accessible care in a public health setting.

Intervention Type BEHAVIORAL

IPT-A-SCI (Interpersonal Psychotherapy for Adolescents with Suicidal Crisis Intervention)

The IPT-A-SCI is a crisis-focused psychotherapeutic intervention developed for adolescents with suicidal thoughts and behaviors. It is based on the principles of Interpersonal Psychotherapy (IPT).

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Participants must be between 6 and 18 years old, inclusive.
* Participants currently exhibit various forms of STB, including suicidal thoughts, gestures, behaviors, or attempted suicide.

Exclusion Criteria

* Acute medical conditions.
* Current psychotic disorders.
* Non-fluency in Hebrew (language of intervention and assessment).
* Diagnosed intellectual disability.
* Diagnosed neurodevelopmental disorders (other than those that commonly co-occur with STB and are deemed manageable by the study team).
* Inability to provide informed consent (participant) or parental permission (parent/guardian).
Minimum Eligible Age

6 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Schneider Children's Medical Center, Israel

OTHER

Sponsor Role collaborator

Shira Barzilay

OTHER

Sponsor Role lead

Responsible Party

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Shira Barzilay

Principal Investigator Dr Shira Barzilay

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Shneider children's Medical Center

Petah Tikva, , Israel

Site Status RECRUITING

Countries

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Israel

Central Contacts

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Shira Barzilay, Principal Investigator, Phd

Role: CONTACT

972-54-5309759

Facility Contacts

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Alan S Apter, Prof

Role: primary

972-3-9253582

Noa Ben Aroya milshtein, MD

Role: backup

972-3-9253582

Other Identifiers

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2023/333

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

0021-24-RMC

Identifier Type: -

Identifier Source: org_study_id

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