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| Name | Class |
|---|---|
| Brown University | OTHER |
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The four year SPIRIT Trial, or Suicide Prevention Intervention for at-Risk Individuals in Transition, will recruit 800 pretrial jail detainees at risk for suicide. Each participant will be randomly assigned to today's standard care or to Safety Planning Intervention (SPI) method and then followed for one year after release. Outcomes include suicide events, suicide attempts and ideation, psychiatric symptoms, functioning, treatment utilization, problem-solving, belongingness, and cost-effectiveness.
There were nearly 12 million admissions to US jails in 2012. Jailed individuals face a disproportionate risk for suicide. The time of arrest and jail detention represents an acute stressor that further exacerbates this risk. The epidemic of suicide during jail detention has been recognized. However, less attention has been paid to the high suicide risk and mortality in the months following jail release, as individuals re-enter their communities, are faced with financial, legal, and social stressors, and have increased access to lethal means (e.g., drugs, cars, firearms). Given that roughly 10% of all suicides in the U.S. with known circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide risk in the year after jail detention could have a noticeable impact on national suicide rates. Unlike prison, where individuals have already been sentenced and typically stay from months to years, most pretrial jail detainees are released within days. Therefore, brief interventions are required. Stanley and Brown's Safety Planning Intervention (SPI) is a brief, adjunctive suicide risk reduction intervention developed for suicidal patients presenting to urgent care settings. SPI incorporates evidence-based suicide risk reduction strategies in a low intensity, low cost intervention that can be delivered by a broad range of clinicians, making it scalable in the mental health resource-poor justice system. SPI reduces subsequent suicidal ideation and attempts among at-risk individuals in emergency rooms. However, there is no previous test of this intervention (or any other) for reducing suicidality following jail release. This RCT evaluates the effectiveness and cost-effectiveness of SPI for reducing suicide events (attempts, suicide behaviors, and suicide-related hospitalizations and emergency department visits) and attempts among 800 suicidal pretrial jail detainees from two jails in the year following jail release. It assesses critical mechanisms of suicide reduction in our target population: treatment utilization, suicide-related problem-solving, and belongingness. SPI will consist of safety planning during jail detention and follow-up phone sessions after jail release. Research with previously incarcerated individuals and with suicidal individuals in the community has shown that telephone follow-up intervention is feasible and powerful in building trust and reducing risk among these disenfranchised, isolated populations. This study will be the first randomized evaluation of a suicide prevention intervention in the vulnerable year after jail release. Beyond the human suffering and costs at an individual level, suicidal behavior incurs high economic costs in terms of health care costs and lost productivity. Jails are a catchment area for at-risk individuals at a time of high life stress and high suicide risk, providing an important opportunity for suicide prevention intervention, one that is currently being missed. This study will provide the data on costs and cost-adjusted outcomes that systems need to make informed decisions about adoption, speeding implementation. Thus, this study will contribute to knowledge about both mechanisms of action and system-level intervention effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Safety Planning Intervention | Experimental | Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. |
|
| Standard Care | No Intervention | Standard Care for pretrial jail detainees is assessment of risk and stabilization to the extent possible during their jail detention. No post-release community follow-up is typically provided. This study will augment standard care with regular assessment and emergency referral post-release, as well as provision of a list of community resources. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Safety Planning Intervention | Behavioral | Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. |
| Measure | Description | Time Frame |
|---|---|---|
| Suicide Events | Number of suicide events (a composite of attempts, behaviors, suicide-related hospitalizations, and suicide deaths) in the year following jail release. Events are identified through self-report, hospital records, and death records. | One year after jail release |
| Measure | Description | Time Frame |
|---|---|---|
| Suicide Attempts | Number of suicide attempts using the Columbia (C-SSRS) criteria. | One year after release from jail |
| Weeks of Active Suicide Ideation | Operationalized using the Longitudinal Interval Follow-Up Evaluation (LIFE) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jennifer Johnson, PhD | Michigan State University | Principal Investigator |
| Lauren Weinstock, PhD | Brown University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Genesee County Jail | Flint | Michigan | 48502 | United States | ||
| Rhode Island Department of Corrections |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42048567 | Derived | Arias SA, Weinstock LM, Cinader MK, Schall G, Pawlaczyk A, Chukwuorji JC, Johnson JE. Highest Columbia-Suicide Severity Rating Scale (C-SSRS) Screener Item Endorsed by Individuals Who Attempted Suicide Within 30 Days of Pretrial Detention. J Clin Psychol. 2026 Apr 28. doi: 10.1002/jclp.70147. Online ahead of print. | |
| 41212557 | Derived | Weinstock LM, Jones RN, Miller TR, Brown GK, Arias SA, Graves HR, Miller IW, Cerbo L, Rexroth J, Fitting H, Russell D, Kubiak S, Stein MD, Matkovic C, Yen S, Gaudiano BA, Johnson JE. Safety Planning vs Standard Care for Suicide Prevention After Pretrial Jail Detention: A Randomized Clinical Trial. JAMA Netw Open. 2025 Nov 3;8(11):e2543156. doi: 10.1001/jamanetworkopen.2025.43156. |
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De-identified data will be made available through relevant NIH and NIJ repositories after the trial has ended.
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| ID | Title | Description |
|---|---|---|
| FG000 | Safety Planning Intervention | Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. Safety Planning Intervention: Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. |
| FG001 | Standard Care | Standard Care for pretrial jail detainees is assessment of risk and stabilization to the extent possible during their jail detention. No post-release community follow-up is typically provided. This study will augment standard care with regular assessment and emergency referral post-release, as well as provision of a list of community resources. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Safety Planning Intervention | Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. Safety Planning Intervention: Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Suicide Events | Number of suicide events (a composite of attempts, behaviors, suicide-related hospitalizations, and suicide deaths) in the year following jail release. Events are identified through self-report, hospital records, and death records. | Posted | Mean | Standard Deviation | number of events | One year after jail release |
|
Assessed from consent through 1 year after release from jail, up to 27 months.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Safety Planning Intervention | Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. Safety Planning Intervention: Brown and Stanley's Safety Planning Intervention (SPI) is a brief, adjunctive intervention designed to reduce subsequent suicidal behavior in high-risk populations. The core element of SPI is the collaborative development of the Safety Plan, which is a prioritized written list of coping strategies and supports that individuals can use during or preceding suicidal crises. In this study, safety planning will occur during pretrial jail detention, with telephone follow-up in the community to conduct risk assessment, review the Safety Plan, problem-solve obstacles to treatment, and assist with linkage to services. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Suicide attempt | Psychiatric disorders | Systematic Assessment | Non-fatal suicide attempt |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Non-suicidal self-injurious behavior | Psychiatric disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Jennifer Johnson | Michigan State University | 810-730-6121 | jjohns@msu.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 23, 2020 | Sep 22, 2025 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D013405 | Suicide |
| D000092864 | Suicide Prevention |
| ID | Term |
|---|---|
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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|
|
| One year after release from jail |
| Severity of Suicide Ideation | Columbia Suicide Severity Rating Scale (C-SSRS) Suicide Intensity Subscale score. Subscale scores range from 2 to 25, higher scores indicating more intense suicidal ideation. | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
| Time to First Suicide Event | One year after release from jail |
| Psychiatric Symptoms | NIH's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Cross-Cutting Measure total score. Scores range from 0 to 92, higher scores reflecting greater severity of psychiatric symptoms. | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
| Functioning | Veterans RAND 12-Item Health Survey (VR-12) total score. Scores range from 0 to 100, higher scores indicating greater functioning. | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
| Treatment Utilization | Number of outpatient mental health and substance use visits attended | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
| Suicide-related Problem-solving | Suicide-Related Coping Scale total score. Scores range from 0-68, higher scores indicating better suicide related coping. | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
| Belongingness | Interpersonal Needs Questionnaire-12 (INQ-12) belongingness subscale score. Scores range from 0-54, higher scores indicating higher levels of thwarted belongingness. | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
| Cranston |
| Rhode Island |
| 02879 |
| United States |
| BG001 | Standard Care | Standard Care for pretrial jail detainees is assessment of risk and stabilization to the extent possible during their jail detention. No post-release community follow-up is typically provided. This study will augment standard care with regular assessment and emergency referral post-release, as well as provision of a list of community resources. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| OG001 | Standard Care | Standard Care for pretrial jail detainees is assessment of risk and stabilization to the extent possible during their jail detention. No post-release community follow-up is typically provided. This study will augment standard care with regular assessment and emergency referral post-release, as well as provision of a list of community resources. |
|
|
| Secondary | Suicide Attempts | Number of suicide attempts using the Columbia (C-SSRS) criteria. | Posted | Mean | Standard Deviation | Number of attempts | One year after release from jail |
|
|
|
| Secondary | Weeks of Active Suicide Ideation | Operationalized using the Longitudinal Interval Follow-Up Evaluation (LIFE) | Posted | Mean | Standard Deviation | weeks | One year after release from jail |
|
|
|
| Secondary | Severity of Suicide Ideation | Columbia Suicide Severity Rating Scale (C-SSRS) Suicide Intensity Subscale score. Subscale scores range from 2 to 25, higher scores indicating more intense suicidal ideation. | Posted | Mean | Standard Deviation | score on a subscale | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
|
|
|
| Secondary | Time to First Suicide Event | Posted | Mean | Standard Deviation | weeks | One year after release from jail |
|
|
|
| Secondary | Psychiatric Symptoms | NIH's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Cross-Cutting Measure total score. Scores range from 0 to 92, higher scores reflecting greater severity of psychiatric symptoms. | Posted | Mean | Standard Deviation | score on a scale | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
|
|
|
| Secondary | Functioning | Veterans RAND 12-Item Health Survey (VR-12) total score. Scores range from 0 to 100, higher scores indicating greater functioning. | Posted | Mean | Standard Deviation | score on a scale | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
|
|
|
| Secondary | Treatment Utilization | Number of outpatient mental health and substance use visits attended | Posted | Mean | Standard Error | number of visits | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
|
|
|
| Secondary | Suicide-related Problem-solving | Suicide-Related Coping Scale total score. Scores range from 0-68, higher scores indicating better suicide related coping. | Posted | Mean | Standard Error | score on a scale | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
|
|
|
| Secondary | Belongingness | Interpersonal Needs Questionnaire-12 (INQ-12) belongingness subscale score. Scores range from 0-54, higher scores indicating higher levels of thwarted belongingness. | Posted | Mean | Standard Error | score on a subscale | Assessed 1, 4, 8, and 12 months after release from jail, 12 months reported. |
|
|
|
| 12 |
| 342 |
| 177 |
| 342 |
| 70 |
| 342 |
| EG001 | Standard Care | Standard Care for pretrial jail detainees is assessment of risk and stabilization to the extent possible during their jail detention. No post-release community follow-up is typically provided. This study will augment standard care with regular assessment and emergency referral post-release, as well as provision of a list of community resources. | 4 | 313 | 159 | 313 | 69 | 313 |
|
| Inpatient hospitalization | Psychiatric disorders | Systematic Assessment | Suicide or potentially suicide related inpatient hospitalization |
|
| Death | Psychiatric disorders | Systematic Assessment |
|
| Distress during the assessment | General disorders | Systematic Assessment |
|
| Access of confidential information by non-authorized person | Social circumstances | Systematic Assessment |
|
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