Best practice for integrating digital interventions into clinical care for young people at risk of suicide: a Delphi study

Eleanor Bailey; India Bellairs-Walsh; Nicola Reavley; Piers Gooding; Sarah Hetrick; Simon Rice; Alexandra Boland; Jo Robinson

doi:10.1186/s12888-023-05448-7

Best practice for integrating digital interventions into clinical care for young people at risk of suicide: a Delphi study

BMC Psychiatry. 2024 Jan 24;24(1):71. doi: 10.1186/s12888-023-05448-7.

Authors

Eleanor Bailey^{1

2}, India Bellairs-Walsh^{3

4}, Nicola Reavley⁵, Piers Gooding⁶, Sarah Hetrick⁷, Simon Rice^{3

4}, Alexandra Boland^{3

4

8}, Jo Robinson^{3

4}

Affiliations

¹ Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia. eleanor.bailey@orygen.org.au.
² Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. eleanor.bailey@orygen.org.au.
³ Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia.
⁴ Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.
⁵ Melbourne School of Population and Global Health, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia.
⁶ Melbourne Law School, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia.
⁷ Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand.
⁸ Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA.

Abstract

Background: Digital tools have the capacity to complement and enhance clinical care for young people at risk of suicide. Despite the rapid rise of digital tools, their rate of integration into clinical practice remains low. The poor uptake of digital tools may be in part due to the lack of best-practice guidelines for clinicians and services to safely apply them with this population.

Methods: A Delphi study was conducted to produce a set of best-practice guidelines for clinicians and services on integrating digital tools into clinical care for young people at risk of suicide. First, a questionnaire was developed incorporating action items derived from peer-reviewed and grey literature, and stakeholder interviews with 17 participants. Next, two independent expert panels comprising professionals (academics and clinical staff; n = 20) and young people with lived experience of using digital technology for support with suicidal thoughts and behaviours (n = 29) rated items across two consensus rounds. Items reaching consensus (rated as "essential" or "important" by at least 80% of panel members) at the end of round two were collated into a set of guidelines.

Results: Out of 326 individual items rated by the panels, 188 (57.7%) reached consensus for inclusion in the guidelines. The endorsed items provide guidance on important topics when working with young people, including when and for whom digital tools should be used, how to select a digital tool and identify potentially harmful content, and identifying and managing suicide risk conveyed via digital tools. Several items directed at services (rather than individual clinicians) were also endorsed.

Conclusions: This study offers world-first evidence-informed guidelines for clinicians and services to integrate digital tools into clinical care for young people at risk of suicide. Implementation of the guidelines is an important next step and will hopefully lead to improved uptake of potentially helpful digital tools in clinical practice.

Keywords: Clinical services; Delphi method; Digital; Self-harm; Suicide; Youth.

MeSH terms

Adolescent
Consensus
Delphi Technique
Humans
Risk Management
Suicidal Ideation
Suicide*