JMIR Publications

ABSTRACT

Background:

Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in the ED, as well as a comparison of these measures across three potential delivery modalities.

Objective:

Our aim was to test the effectiveness of the ReachCare intervention in its entirety through conducting a feasibility study with patients presenting with suicidality to the ED. We tested three different ways of receiving the ED-based components of ReachCare: (1) self-administered on the tablet application using a chatbot interface; (2) administered by an in-person clinician; or (3) administered by a telehealth clinician.

Methods:

47 ED patients who screened positive for suicide risk were randomly allocated to receive one of three delivery modalities of ReachCare in the ED: (1) self-administered on the patient-facing tablet application with a chatbot interface; (2) delivered by an in-person clinician or (3) delivered by a telehealth clinician, with the latter two utilizing a clinician-facing web application. We measured demographic and clinical characteristics, acceptability and appropriateness of the intervention, and quality and completeness of the resulting safety plans.

Results:

Patients gave high ratings for the acceptability (m=4.16/5, SD = 0.53) and appropriateness (mean=4.15/5, SD= 0.48) of ReachCare’s ED components, and there were no substantial differences across the three delivery modalities [F(acceptability)=0.84, p=0.25; F(appropriateness)=0.84, p=0.44]. The self-administered modality took significantly less time than the two clinician modalities (F=37.22, p<0.001), and the usability of the self-administered version was in the “very high” range (m=88.3/100, SD=12.3). The safety plans created across all three modalities were high-quality (m=28.8/38, SD= 5.17; F= 0.35, p=0.71).

Conclusions:

Patients rated ReachCare in the ED as highly acceptable and appropriate regardless of modality. Self-administration may be a feasible way to ensure patients with suicide risk receive an intervention in resource constrained EDs. Further research will examine the clinical outcomes of patients receiving both the in-ED and post-ED components of ReachCare. Clinical Trial: Clinicaltrials.goc: NCT04720911; https://clinicaltrials.gov/ct2/show/NCT04720911