Developing Adaptive Treatment Strategies to Address Suicidal Risk in College Students: A Pilot Sequential, Multiple Assignment, Randomized Trial (SMART)

Abstract

This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4–8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions—both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4–16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.

Keywords:

• adaptive strategies
• CAMS
• college students
• DBT
• SMART
• suicidality

Additional information

Funding

Research reported in this publication was supported by the National Institute Of Mental Health of the National Institutes of Health under Award Number R34MH104714 (PI: J. Pistorello).

Notes on contributors

Jacqueline Pistorello

Jacqueline Pistorello, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

David A. Jobes

David A. Jobes, Department of Psychology, Washington, DC, USA.

Scott N. Compton

Scott N. Compton, Duke University, Durham, North Carolina, USA.

Nadia Samad Locey

Nadia Samad Locey, School of Medicine, University of Nevada, Reno, Reno, Nevada, USA.

Joseph C. Walloch

Joseph C. Walloch, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Robert Gallop

Robert Gallop, West Chester University, Pennsylvania, USA.

Josephine S. Au

Josephine S. Au, Department of Psychology, Washington, DC, USA.

Samantha K. Noose

Samantha K. Noose, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Maria Young

Maria Young, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Jacquelyn Johnson

Jacquelyn Johnson, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Yani Dickens

Yani Dickens, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Patricia Chatham

Patricia Chatham, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Tami Jeffcoat

Tami Jeffcoat, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Georgia Dalto

Georgia Dalto, Counseling Services, University of Nevada, Reno, Reno, Nevada, USA.

Spondita Goswami

Spondita Goswami, Saint Louis University, St. Louis, Missouri, USA.