A Comparison of Two Brief Suicide Prevention Interventions Tailored for Youth on the Autism Spectrum

A Comparison of Two Brief Suicide Prevention Interventions Tailored for Youth on the Autism Spectrum

Rates of suicide have increased significantly over the past two decades, particularly among youth. Compared to the general population, autistic people are significantly more likely to think about suicide, attempt suicide, and die by suicide. Autistic individuals have identified suicide prevention as a top research priority; however, little is known about how to best help autistic youth at risk for suicide. The purpose of this study is to compare the effectiveness, feasibility, and acceptability of two suicide prevention strategies tailored for autistic individuals: the Safety Planning Intervention tailored for Autistic individuals (SPI-A) and SPI-A plus structured follow-up contacts (SPI-A+).

**Participants**

Participants are from three distinct groups: health systems leaders, clinicians, and autistic youth (patients). The autistic youth participant pool is comprised of three subgroups, described below.

1. "Basic EHR-Only" Arm:

   Population: All individuals 12-24yo scheduled for a clinical visit with a consented clinician during the study recruitment period qualify for this arm. The total number of subjects for this subgroup is expected to exceed 15k individuals.

   Participation is limited to Electronic Health Record (EHR) review only. Participants will not have contact with the study team.

2. "Enhanced EHR-Only" Arm: Population: Individuals meeting the above criteria who also receive one of the interventions of interest (SPI-A or SPI-A+) during routine clinical care. Approximately 250-400 individuals are expected to qualify for this arm.

   Participation is limited to EHR review and abstraction to evaluate outcomes related to the SPI-A and SPI-A+ interventions. Participants will not have contact with the study team.

3. "Active Patient-Reported Outcomes (PRO)" Arm: Population: Individuals meeting the criteria for the "Enhanced EHR-Only" arm who are referred by a participating clinician to the study team and provide informed con/assent to participate in survey and interview data collection constitute this arm.

Participation consists of medical records review and abstraction, as well as survey and interview data collection. Please note that enrollment into this arm concluded 9/1/2025.

**Aims**

This study includes three aims:

Aim 1: Among autistic youth (age 12-24) at risk for suicide, compare the effectiveness of SPI-A vs. SPI-A+. The primary outcomes of interest are suicidal ideation (SI) and suicidal behavior (SB), as derived from electronic health records (EHR) and patient reported outcomes (PRO) data. Secondary patient-centered outcomes are mental health treatment initiation and engagement (EHR and PRO), use of acute care services for suicidality (EHR and PRO), quality of life (PRO), well-being (PRO), skills to manage SI (PRO), access to lethal means (PRO), and safety plan use (PRO).

Aim 2: Compare implementation outcomes of acceptability and feasibility for the two interventions from the perspectives of patients, clinicians, and health system administrators.

Aim 3: Explore patient characteristics that may moderate the relationship between intervention and SI and SB.

(A) Patient Participants

Please note that that eligibility criteria differ for each distinct patient subgroup as defined below.

A.1 - Basic EHR-Only Arm

Inclusion criteria:

• 12-24 years old
• Scheduled for a clinical visit with a consented clinician Exclusion criteria: None

A.2 - Enhanced EHR-Only Arm:

Inclusion criteria:

• Meets inclusion criteria for the Basic EHR-Only arm
• Receives one of the interventions being studied (SPI-A or SPI-A+) as part of routine clinical care

Exclusion criteria: Presence of documentation that the patient declines all research participation

A.3 - Active PRO Arm:

Inclusion Criteria:

• Meets inclusion criteria for the Enhanced EHR-Only arm
• Referred to the study team by a consented clinician
• Able and willing to provide informed consent (age 18+) or assent and parental/guardian consent (age < 18)
• Able to speak English (and, if applicable, at least one guardian also able to speak English)

Exclusion Criteria: Altered mental status that precludes ability to provide informed assent or consent (acute psychosis, intoxication, or mania)

(B) Clinician Participants

Inclusion Criteria:

• Employment as a provider serving autistic patients at one of the study sites
• Employment in a role that involves suicide risk intervention with youth patients at a participating clinic
• Able to read and speak English
• Able and willing to provide informed consent

Exclusion Criteria: None

(C) Health System Leader Participants

Inclusion Criteria:

• Health system or clinic leader at one of the study sites
• Employed in a role that provides administrative oversight to clinicians conducting safety plans with patients
• Able to read and speak English
• Able and willing to provide informed consent

Exclusion Criteria: None