BRITE 2.0: A just-in-time adaptive intervention for suicide safety planning in adolescents

ABSTRACT
Despite efforts to prevent suicide, US rates are climbing, and suicide is the second leading cause of death
amongst youth. While suicide safety planning interventions can be effective in reducing suicidal behavior,
adolescents often face challenges in sustaining their engagement with them. Studies have found that many
adolescents do not review their safety plans or attempt to use coping strategies following discharge. Digital
tools can provide a powerful means to enhance engagement with these interventions. The overall aim of this
SBIR Fast Track proposal is to enhance the effectiveness of safety planning amongst at risk youth by
developing and commercializing an augmented version of the BRITE smartphone app that provides enhanced
features that will optimize effectiveness by addressing known barriers to user engagement. The BRITE app
facilitates self-efficacy by encouraging self-monitoring of emotional distress and utilization of effective coping
strategies as well as providing ready access to a safety plan on the adolescent’s smartphone. The BRITE app
was developed on evidence-based principles and has undergone rigorous formative development and
effectiveness evaluations. However, to optimize its functionality, commercial viability, and scale its
implementation, issues related to user engagement need to be addressed. Recent developments in Ecological
Momentary Assessment (EMA) and mobile sensing (MS) can provide useful triggers to automatically “push”
pertinent safety planning information to individuals during periods of higher risk, which will allow the integration
of just-in-time adaptive intervention features within BRITE and should result in more sustained engagement
with the plan and increased effectiveness. In Phase I we will develop an augmented version of the BRITE app
(BRITE 2.0) that integrates just-in-time automated push notifications for consistent practice of coping skills and
for safety planning resources during periods of escalating risk, and will evaluate the usability and acceptability
of this product with practitioners and end users. The aim of Phase II is to conduct a micro randomized trial to
optimize treatment components, and to conduct an initial RCT to evaluate whether these enhancements
increase user engagement.

Grant Number: 5R44MH135605-03
NIH Institute/Center: NIH
Principal Investigator: NICHOLAS ALLEN