A Pilot Study of Collaborative Assessment and Management of Suicidality With Suicidal Children (“CAMS-4Kids”)

Overview

The purpose of the study is to assess the feasibility and acceptability of CAMS-4Kids for children with suicidal ideation and/or behavior. During this open pilot trial, we will enhance treatment procedures, refine adherence measures, and develop a treatment manual. Our study sample will include 10 children, ages 5 – 11 years old, seeking outpatient services for suicidal ideation and/or behavior.

Full Title of Study: “A Pilot Study of Collaborative Assessment and Management of Suicidality (CAMS-Jobes, 2006; 2016) With Suicidal Children (“CAMS-4Kids”)”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: December 31, 2024

Detailed Description

The Collaborative Assessment and Management of Suicidality (CAMS-Jobes, 2006; 2016) is an evidence-based, therapeutic framework for addressing suicide risk in the adult population. CAMS-4Kids, the research intervention used in this study, is a 10-session developmentally-sensitive adaptation of CAMS for children ages 5 – 11 years old. Within the CAMS framework, clinicians treat patient-identified issues that contribute to their suicidal thoughts and/or behavior called "suicidal drivers." A "clinical road map" is provided through the Suicide Status Form (SSF) that guides treatment as an assessment, treatment planning, tracking and clinical outcome tool. Clinicians and children engage in the assessment and treatment planning sections of the SSF – Initial Form at the outset of treatment. A CAMS Stabilization Plan is also collaboratively developed which focuses on reducing access to lethal means, coping strategies, decreasing interpersonal isolation, and ways to address potential barriers to care. Subsequent CAMS-4Kids sessions include ongoing assessment and treatment plan reviews using the SSF – Interim Sessions Form. The CAMS Stabilization Plan is also reviewed and updated as clinically indicated. Treatment involves clinical interventions most appropriate to treat the patient's "suicidal drivers." Clinical interventions may include coping cards, "Hope Journal," behavioral activation, Virtual Hope Box, increasing social support, guided imagery, DBT relaxation skills, positive self-talk, and other cognitive-behavioral techniques. The conclusion of CAMS-4Kids occurs after 3 consecutive sessions of effectively managing suicidal ideation and behavior. The SSF Outcome/Dispositional Final Session Form is completed at the end of treatment.

Interventions

  • Behavioral: CAMS-4Kids
    • The Collaborative Assessment and Management of Suicidality (CAMS-Jobes, 2006; 2016) is an evidence-based, therapeutic framework for addressing suicide risk in the adult population. CAMS-4Kids, the research intervention used in this study, is a 10-session developmentally-sensitive adaptation of CAMS for children ages 5 – 11 years old.

Arms, Groups and Cohorts

  • Experimental: CAMS-4Kids
    • Participants will receive up to 10 sessions of CAMS-4Kids

Clinical Trial Outcome Measures

Primary Measures

  • CAMS-4Kids Suicide Status Form-4 (SSF-4)
    • Time Frame: Each session measured from baseline up to 12-week follow-up
    • The SSF-4 measures overall suicide risk.
  • Change from baseline in psychosocial functioning and impairment on the Columbia Impairment Scale (CIS) at treatment completion (up to 12 weeks), 3 months and 6 months.
    • Time Frame: Baseline, Treatment Completion (up to 12 weeks), 3 month and 6 month follow-up
    • The CIS is a valid 13-item child- and parent- report measure of psychosocial impairment with good internal consistency and test-retest reliability. Scores range from 0 (no problem) to 4 (very bad problem), with higher scores indicating worse outcomes.
  • Change from baseline in suicidal ideation and behavior on the Columbia-Suicide Severity Rating Scale (C-SSRS) at treatment completion (up to 12 weeks) 3 months and 6 months
    • Time Frame: Baseline, Treatment Completion (up to 12 weeks), 3 month and 6 month follow-up
    • The C-SSRS is a validated, semi-structured interview that assesses both suicidal behavior and suicidal ideation (yes/no, frequency), with flexible timepoints and multiple informants depending on administrator purpose and need. Scores range 0 (no ideation) to 5 (ideation with plan and intent), with higher numbers indicating worse outcomes. Suicidal behavior is present or absent, presence of behavior indicates worse outcomes.

Secondary Measures

  • Client Satisfaction Questionnaire (CSQ-8)
    • Time Frame: Up to 12-week follow-up
    • The CSQ-8 is an 8 item measure of treatment satisfaction with services with both a parent and child version.
  • Therapeutic Alliance Scale for Children, Revised (TASC-r)
    • Time Frame: Up to 12-week follow-up
    • The TASC-r is a measure of the working child-therapist working relationship.
  • Therapeutic Alliance Scale for Caregivers and Parents (TASCP)
    • Time Frame: Up to 12-week follow-up
    • The TASCP is a measure of the working caregiver-therapist working relationship.
  • CAMS Rating Scale
    • Time Frame: Each session measured from baseline up to 12-week follow-up
    • The CAMS Rating scale measures CAMS treatment fidelity.

Participating in This Clinical Trial

Inclusion Criteria

  • children between the ages of 5 – 11 years old, inclusive, at the time of consent; – current suicidal ideation and/or behavior; – resides with primary caregiver who has legal authority to consent to research participation – client of outpatient Behavioral Health Services – Outpatient or Mood and Anxiety Program visit scheduled at least 4 weeks from the diagnostic assessment and/or discharge from the Crisis Stabilization Unit. Exclusion Criteria:

  • the inability to understand study procedures (e.g. developmental disabilities, severe cognitive impairments, actively psychotic) – inability of the child and/or parent to speak or read English – current participation in weekly therapy sessions with outpatient Behavioral Health Crisis Team

Gender Eligibility: All

Minimum Age: 5 Years

Maximum Age: 11 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Nationwide Children’s Hospital
  • Collaborator
    • The Catholic University of America
  • Provider of Information About this Clinical Study
    • Principal Investigator: Jeff Bridge, Director, Center for Suicide Prevention and Research – Nationwide Children’s Hospital
  • Overall Official(s)
    • Jeffrey A Bridge, PhD, Principal Investigator, Abigail Wexner Research Institute at NCH
  • Overall Contact(s)
    • Jeffrey A Bridge, PhD, 614-722-3081, jeff.bridge@nationwidechildrens.org

References

Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach 2nd Ed. New York: Guilford Press.

Anderson, A. R., Keyes, G. M. & Jobes, D. A. (2016). Understanding and treating suicidal risk in young children. Practice Innovations, 1(1), 3-19.

Comtois KA, Jobes DA, S O'Connor S, Atkins DC, Janis K, E Chessen C, Landes SJ, Holen A, Yuodelis-Flores C. Collaborative assessment and management of suicidality (CAMS): feasibility trial for next-day appointment services. Depress Anxiety. 2011 Nov;28(11):963-72. doi: 10.1002/da.20895. Epub 2011 Sep 21.

Ellis TE, Green KL, Allen JG, Jobes DA, Nadorff MR. Collaborative assessment and management of suicidality in an inpatient setting: results of a pilot study. Psychotherapy (Chic). 2012 Mar;49(1):72-80. doi: 10.1037/a0026746.

Ellis TE, Rufino KA, Allen JG, Fowler JC, Jobes DA. Impact of a Suicide-Specific Intervention within Inpatient Psychiatric Care: The Collaborative Assessment and Management of Suicidality. Suicide Life Threat Behav. 2015 Oct;45(5):556-566. doi: 10.1111/sltb.12151. Epub 2015 Jan 12.

Ellis TE, Rufino KA, Allen JG. A controlled comparison trial of the Collaborative Assessment and Management of Suicidality (CAMS) in an inpatient setting: Outcomes at discharge and six-month follow-up. Psychiatry Res. 2017 Mar;249:252-260. doi: 10.1016/j.psychres.2017.01.032. Epub 2017 Jan 14.

Jobes DA, Wong SA, Conrad AK, Drozd JF, Neal-Walden T. The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients. Suicide Life Threat Behav. 2005 Oct;35(5):483-97. doi: 10.1521/suli.2005.35.5.483.

Ryberg W, Zahl PH, Diep LM, Landro NI, Fosse R. Managing suicidality within specialized care: A randomized controlled trial. J Affect Disord. 2019 Apr 15;249:112-120. doi: 10.1016/j.jad.2019.02.022. Epub 2019 Feb 7.

O'Connor, S. S., Brausch, A. M., Anderson, A. R., & Jobes, D. A. (2014). Applying the Collaborative Assessment and Management of Suicidality (CAMS) to suicidal adolescents. International Journal of Behavioral Consultation and Therapy, 9(3), 53-58.

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