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Table 3 Deductive analysis of transcripts for intervention content

From: Developing a post-discharge suicide prevention intervention for children and young people: a qualitative study of integrating the lived-experience of young people, their carers, and mental health clinicians

Theme

Description

Key quotes

What works

 Structure

Participants discussed importance of a comprehensive, structured, and reliable phone call that provided assessment (where possible) of key outcomes and risk factors (e.g., mood) as well as supporting the young person and the carers with problem-solving techniques or advice and being able to facilitate appointments with community services

“But I also like how it goes over the mood stuff and suicide risk assessment with the safety planning and then…” [Clinician—Assertive Model]

“I feel it's nice to go, hey, have you made it to your appointment? Okay, let's troubleshoot what happened, what stopped you from going. Let's sort that out. But again it does have that thing about, what if there's an insurmountable barrier stopping you from taking care of yourself. But I like that it's, we're going to—not just, have you been? What's happening there? How do we sort it out so that you can go?” [Young person—Assertive Model]

“Or, you haven’t used your safety plan? Is that because you're fine or because it's not working for you? Do we need to change something about it?” [Young person—Assertive Model]

“structure around questions or what we're checking on, like…” [Clinician—Assertive Model]

 Consistency

Participants and clinicians expressed desire for an intervention that was consistent, but able to be adapted as needed (i.e., tailored to the individual), and one that could be counted on was preferred (e.g., consistent clinician where possible)

“at the moment I think different clinicians have very different processes [unclear] so it provides consistency…” [Clinician—Assertive Model]

“that reassurance that things are going to be okay and there is somewhere to go and someone to call…when things get tough again. So I think it's helpful in that sense.” [Clinician—Assertive Model]

“I think clinicians want it, they want that level to be able to do appropriate follow-up like that, we want that sort of stock standard response, we want to be able to say yes, we're going to provide this.” [Clinician—Assertive Model]

“This takes all that sort of unknown away and it's this [unclear] organisation that's there if you need us.” [Clinician—Caring Contacts]

“The contact. The actual contact opens conversation” [Young person—Assertive Model]

 Contained/finite

Satisfaction was expressed with models that were clear and contained (as opposed to ongoing with fuzzy boundaries). Comments showed preferences for a model that would have an endpoint and support the young person to progress back into community and family-led care

“This is good, it's contained, it's got clear guidelines [with the] 72 h. It's one phone call and these are the points that we're going to hit.” [Clinician—Assertive Model]

“like it's got a finite amount of calls and it's spaced out enough that it's not a stalker-ish kind of setup” [Clinician—Assertive Model]

“in terms of a system as well it's less work for us, because I think if we have all these [supportful] letters and postcards and text messages already set out, so then you can send it out …” [Clinician—Caring Contacts]

“I think in terms of workload for us that is by far the easiest option.” [Clinician—Caring Contacts]

What does not work

 Practicality

While the structure and content of the assertive model was appealing, and the empathic nature of caring contacts reassuring, there was doubt expressed around whether each model would be practical to implement. Clinicians’ comments centred on the extensive requirements and the concern around whether accurate assessment of outcomes could be made. Perceptions of the caring contacts model were positive, but agreement on the model losing authenticity over time and potentially confusing the follow-up services’ purpose (i.e., a key foundational requirement; see phase 1):

“In an acute team that's 24/7, I'd feel like we're still getting lost.” [Clinician—Assertive Model]

“First of all, what if the young person has already used their 10 sessions for the year and it's September? Are you going to give them a weekly phone call until January? Because that seems like a really resource-heavy way of doing things, and I feel that's not going to happen in Q Health.” [Young person—Assertive Model]

“on paper this is a really good idea but it has the capability to be really quickly, I'm going to say the word, delegitimised.” [Young person—Caring Contacts]

“we don't want to be the ones that build the ongoing therapeutic relationship.” [Young person—Caring Contacts]

 Disempowering

Participants expressed concern around possibility of disempowering the young person and their family, particularly in response to the assertive model. Clinicians cautioned that there must be a clear separation from their services into the hands of the parents and guardians or community services (may be more difficult with more intensive interventions). Young people perceived structured, and highly detailed interventions as intense (may run the risk of taking control and autonomy away from the individual). Sentiment also verbalised by the carers and returns to the notion of a person-centred foundation

“… elements of it, but the onus has got to go back to the family too make their own follow-up.” [Clinician—Assertive]

“Support them as much as you possibly can, I agree with you 100 per cent, but the onus has got to go back to the family at some point.” [Clinician—Assertive]

“I think with this it’s 0 to 100 real quick. There’s no middle ground, and I think that is potentially a mistake.” [Young person—Assertive]

“She has to be involved. You can’t do a safety—we can’t give her a safety plan.” [Parent/Guardian—Assertive]

 Call purpose

Clinicians expressed need for clear boundaries (assertive and caring contacts models) and the notion that calls should facilitate connection with community services (rather than continuing contact with the emergency response unit)

“Well state your purpose.” [Clinician—Assertive Model]

“…what's the purpose of the call, yeah, are they always suicidal?” [Clinician—Assertive Model]

“you're asking people to come in and build a relationship with that clinician rather than the community clinician.” [Clinician—Caring Contacts]

“… we're a crisis team, it's just … people who are in there, then once we see them we need to move them on to someone else.” [Clinician—Caring Contacts]

 Helpful messages

Two primary themes emerged from suggestions which can be used as a template to generate messages. ‘Validating the person and their experience’ as well as ‘normalising the experience’ were broad focus areas along with ensuring the messages were ‘person-focused’. General suggestions on the type of message that could be sent (e.g., providing advice on who to speak with, what to do in risky situations, or how their discharge/safety plan is going)

“You did really good the other night chatting to us or calming down” [Clinician]

“I can see a really resilient young person and you were really motivated to engage in therapy, that should be applauded, if you don't have hope for yourself, I have hope for you.” [Clinician]

“I'll hold the hope for you.” [Clinician]

“We know you've been discharged and you've been travelling quite well. If you have any concerns feel free to give us a call.” [Clinician]

“A journey and having bumpy parts in the road or whatever” [Clinician]

“I'm sorry that this sucks”[Young Person]

“Out of suffering have emerged the strongest souls. The most massive characters are seared with scars” (Poetry quotation)[Young Person]