Collaborative Safety Planning with Youth during a Suicide-Related Emergency: Developmental and Family Considerations

Suicide is a leading cause of death among youth, yet many risk reduction interventions have been designed for and tested with adults. The Safety Planning Intervention (SPI) is widely used by child-serving clinicians; however, little formal guidance exists about how to conduct the SPI in a developmentally tailored or family centered manner. This study aimed to 1) describe the content of youth safety plans to elucidate the range of strategies that youth find helpful in managing suicide risk, 2) apply operational definitions of SPI fidelity (completeness, personalization, consistency) developed with adults to SPI fidelity measurement with youth, and 3) explore the extent to which quality SPI implementation, including collaboration with parents, was related to parents' perceived readiness and behavioral engagement in supportive behaviors following a psychiatric emergency. A mixed methods approach was used to examine safety plans completed by 54 youth ages 12–17 (79.6% female; 88.9% White) during a psychiatric emergency department visit. Common preferred coping strategies included listening to music, spending time with supportive individuals, creating art/music, and exercise. Youth safety plans were of moderate quality (M = 3.09, SD = 1.34, range = 0–5), with 61% demonstrating evidence of personalization and 35% mostly personalized. Parent ratings of developmentally appropriate and family centered care were associated with both perceived readiness (β = .67, p < .001) and behavioral engagement (β = .51, p = .003) with safety plan recommendations in the days following ED discharge. Implications of these findings for clinical practice are discussed.