3 - (OP8) Adapting Brief Cognitive Behavioral Therapy for Adolescent Suicide Prevention in Community Hospitals: Practical Lessons for Translating Evidence into Care

Adolescent suicide is a critical public health concern. Evidence-based psychotherapies are central to reducing suicidal thoughts and behaviors among adolescents, yet they are infrequently implemented in routine practice—particularly in community-based hospital settings serving diverse youth, contributing to persistent mental health inequities. Brief Cognitive Behavioral Therapy (BCBT) is a well-supported, evidence-based psychotherapy for suicide prevention; however, its uptake in community hospital settings remains limited. Prior research suggests that although BCBT shows promise for adolescents in acute care settings, including inpatient hospitalization, significant implementation barriers remain (Sinyor et al., 2020).

This presentation describes the first stage of a multi-phase project focused on adapting the BCBT treatment manual for use in an adolescent inpatient setting at a safety net hospital in Massachusetts, serving a culturally, racial and linguistically diverse population of adolescents. This first stage of adaptation centered on improving clinical fit, feasibility, and acceptability for young people, their families, and clinicians of BCBT for suicide prevention.

In phase 1, needs identification, we utilized a mixed-methods, stakeholder-engaged approach guided by the Consolidated Framework for Implementation Research (CFIR), we systematically identified barriers to implementing standard BCBT protocols. Key challenges included limited session time and length of stay, concerns about developmental appropriateness for adolescents, and the need for flexible, culturally affirming approaches to meet the needs of diverse youth and families.

In phase 2, systematic adaptation, we partnered with community advisory groups, including youth and caregivers with lived experience, to adapt the BCBT manual. Our process for systematic adaptation was grounded in partnership with these groups, with community consultation meetings analyzed using Rapid Qualitative Analysis. Adaptations focused on session structure and length, developmentally appropriate language and examples, and increased flexibility within core treatment components. Throughout the process, we prioritized preserving BCBT’s core components while enhancing fit with the needs of adolescents, cultural responsivity, and feasibility in under-resourced hospital systems. In the next phase, we will pilot the adapted intervention with adolescents in an inpatient unit at a community-based safety-net hospital.

This presentation highlights practical lessons for clinicians and hospital systems seeking to translate evidence-based suicide prevention interventions into practice. Lessons include strategies for selecting appropriate treatments, identifying implementation barriers early, and meaningfully engaging clinicians and community stakeholders in adaptation efforts. Findings underscore the importance of intentional adaptation as a prerequisite for scaling rigorous CBT interventions in real-world adolescent hospital settings and advancing equitable access to effective suicide prevention care.