Caring Texts: A Strength‐based, Suicide Prevention Study in 4 Native Communities

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CARE Study –Phase 1

Caring Te

xts: A Strength‐based, Suicide

Prevention Study in 4 Native Communities

Research Team:

Kate Comtois, UW

Lonnie Nelson, WSU

Dedra Buchwald, WSU

Emma Elliott‐Groves, WSU

Cindy Gamble, WSU

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  Why we are here…

Today, we will:

• Describe a suicide prevention intervention called

Caring Contacts

• Tell you about a new study of Caring Contacts

• Ask for your input on how to do this study in a wa y

that is appropriate for American Indian people with

suicide risk in this health system

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• Caring messages sent to people with suicide risk over the

course of one year

• Provides care and support, asks for nothing in return

• “Magic ingredient” is social connection

• Letters, Phone, Emails , Texts

What is the Caring Contacts intervention?

Death Attempts Thoughts

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An example of a Caring Contacts study

• Military Continuity Study

•Began in 2013

• Military Service Members with recent suicide attempt

and/or thoughts of suicide can participate.

•Participants get either:

Usual Care Alone

Whatever care they

would normally get

(nothing extra)

Usual Care +

Caring Contacts

Whatever care they

would normally get

AND

11 text messages

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Sample text messages

•David – Good to meet you yesterday. Check out our

website: www.care.org. Hope the resources are helpful. –

Kate

•Hey David –It's Kate from the Care Study. Hope you've

had a good week. www.care.org

•Hi there David

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Hope life is going well. –Kate

www.care.org

•Happy Birthday, David! Hope you have a wonderful day

and a positive year ahead. –Kate www.care.org

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A New Study of Caring Contacts:

Caring Texts in 4 Native Communities

• Goal: To culturally‐tailor and test Caring Contacts for

use with AN/AI people

• Began in June 2016, ends in May 2021

• 1,200 participants in Phase 2 (clinical trial);

• Partnership between Fort Peck Tribes, SCF, Pine

Ridge, Cherokee Nation and researchers at WSU and

• Funded by National Institutes of Health

• Approved by Northeastern State University and IRBs

at each partner site location.

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Eligibility: Who can participate?

 To participate, individuals must be:

• Alaska Native and/or American Indian

• 18‐34 years old

• At risk for suicide

• Able and willing to receive texts messages

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Recruitment: How will people join the study?

 Flyers posted in public places

• People call us to find out about the study

 Ads in media

• People call us to find out about the study

 Healthcare providers in primary care or

behavioral health clinics

• Providers provide information about the study and

then:

 Providers contact us

 People contact us through a private drop‐box

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Enrollment: What happens when a person

joins the study?

Each participant is randomly assigned for 1 year to:

1. Usual care alone OR

2. Usual care + Caring Texts

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Participation: What will participants be asked

to do?

Both study groups:

•Agree to do 2 interviews:

o When joining the study and 1 year later

o Each interview 1‐2 hours long

o Participants receive $50 per interview

•Give researchers permission to see medical records to

understand what services have been used

•Get usual medical and behavioral health care that

they choose

Caring Contacts Group ONLY:

• Receive 11 text messages over 1 year

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Interviews: What will participants be asked?

•The researcher will go through a series of questionnaires

with each participant, with questions about:

1. Demographic information (employment, marital status, etc.)

2. Personal health history

3. Family health history

4. Spiritual and religious practices

5. Any legal issues

6. Symptoms of depression

7. Past and current substance use

8. Past and current experiences with suicide risk

• Frequency of attempts/thoughts

9. Social connectedness and belonging

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     Suicide Attempt Self Injury Count Lifetime (SASI)

“What I’d like to do now is go through different types of self‐

injury and have you tell me how many times you have

harmed your self using various methods. Stop me if I get to

one that you’ve done and I will ask you additional questions

about your experience; otherwise I will keep going down the

list.

Suggestions? Questions?

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     Suicide Attempt Self Injury Count Lifetime (SASI)

5. Cut yourself on purpose?

6. Intentionally overdosed on drugs?

7. Burned yourself on purpose?

8. At tempted to str angle or hang your self?

9. Jumped from a high place to cause self‐injury?

10. Shot yourself with a gun?

11. Swallowed poisons/caustic sub. on purpose?

12. Asphyxiated or smothered yourself?

13. Tried to drown yourself?

14. Stabbed/punctured yourself on purpose?

15. Banged your head, hit yourself, hitting things?

Suggestions? Questions?

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Timing: When do the  messages arrive ?

11 messages arrive over 1‐year:

• One day after joining study

• One week after joining st udy

• One month after

• 2, 3, 4, 6, 8, 10 and 12 months after

• Participant’s birthday

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Text Delivery day Example Text

One day after enrollment John – Good to meet you yesterday. Check out our website:

www.careteam.org. Hope the resources are helpful. – Kate

One week after enrollment Hey John – It's Kate from the CARE team. Hope you've had a

good week.

One month after enrollment Hi John, Hope all's well and you're taking good care of yourself.

– Kate careteam.org

Two months after

enrollment

Hi there John, Hope you’re having a good day today. – Kate

careteam.org

Three months after

enrollment

Hey John, Hope things are going well and you’re having a good

week. – Kate careteam.org

Four months after

enrollment

Hi John, Hope life is treating you well. – Kate careteam.org

Six months after enrollment Hey John – Just wanted to say hello. Hope things are going

OK. – Kate careteam.org

Eight months after

enrollment

John - Hope everything's going well. – Kate careteam.org

Ten months after

enrollment

Hello again, John! Hope things are good.– Kate careteam.org

One year after enrollment Hi John, Hope you're having a good day today. – Kate

careteam.org

Participant birthday Hey John! It's your birthday! Hope you have a great one and

the next year brings you good things! – Kate careteam.org

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Questions for you: Message content

•What should the caring text messages say?

•How should we tailor the content of the messages to

loca l events, holidays, seasons, or activities (fishing,

pow wows)?

•What else should we think about regarding the content

of the text messages?

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What happens after the text messages end?

Follow‐up interviews:

• 12 months after enrolling

• Same as enrollment interview to see if suicide risk has decreased

and wellness has increased

• 18 months after enrolling (6 months after

intervention ends)

• Same as above PLUS open‐ended questions about what participants

liked (or didn’t like) about the study

• Some participants –how many??

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Our next steps

•Complete focus groups/interviews in all 4 communities

• Compile feedback from all 4 communities

• Use feedback to make changes to study design,

interviews, text messages (timing and content)

•Present updated study to Community Advisory Board

• Use feedback to make more changes

•Meet with you again to get your feedback on the

culturally tailored study

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Till next time . . . Thank you!

•What questions do you have for us?

•What other suggestions do you have for making this

study useful and successful in your community?