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Symposia

Suicide and Self-Injury

Session: Suicide Prevention as a Platform for Social Connection: Innovations in the Stanley & Brown Safety Planning Intervention

4 - (SYM 136) RCT of Project Life Force: A telehealth Group + Skills Adaptation of Safety Planning

Sunday, November 19, 2023
10:30 AM – 12:00 PM PST
Location: Kachess (405), Level 4

Background: “Project Life Force” (PLF) is a manualized suicide-safety planning group intervention that integrates two evidence-based treatments; Suicide Safety Planning and Dialectical Behavior Therapy. This ten-session group treatment helps high-risk suicidal Veterans build personalized, meaningful and robust safety plans. Each session of PLF targets one step on the safety plan, and teaches the necessary skills to maximize the use of that step. Additional sessions focus on: 1) maximizing physical wellbeing such as sleep, 2) fostering hope/generating reasons for living,  3) placement of the safety plan on mobile applications to facilitate ease of access and, 4)  review of safety plan components. The group provides structure, connection and mitigates the loneliness that suicidal Veterans often experience. Moreover, the group format promotes “unit cohesion”. Veterans are familiar with operating in life and death situations and are guided by the principal of “leave no Veteran behind”. This value of helping other Veterans fosters personal meaning and creates hope. An open label study of PLF in 25 Veterans (Goodman et al, 2021) demonstrated high levels of feasibility, acceptability, and overall satisfaction. Drop out was minimal and 100% of participants developed updated safety plans and increased use patterns.

Methods: A VA-Merit funded randomized clinical trial comparing PLF to treatment as usual is being conducted at four sites (James J. Peters VA, Northport VA, VA Philadelphia and Central Texas Healthcare Systems),  targeting high-risk suicidal Veterans recruited from inpatient and outpatient settings is nearing completion. Assessments are completed at baseline, post treatment (3 months), 6 months and 12 months.  The primary outcome is suicidal behavior, defined by a composite of suicide deaths, preparatory behavior and aborted, interrupted and actual attempts.

Results: 205 Veterans have been randomized  and all treatment sessions are now complete. Approximately 35 subjects remain in the follow-up period, with data collection ending in August 2023.  Data to date  indicates a 70% retention with 24% of participants exhibiting suicide behaviors during the follow up period. Updated analyses with primary (suicidal behavior) and secondary outcomes (depression, hopelessness) will be presented.

Discussion:  Project Life Force which integrates skills training with suicide safety planning and offered in a telehealth group format, may enhance safety planning efficacy. The group format is well tolerated and increases social connection.