image: The PAS Meeting connects thousands of leading pediatric researchers, clinicians, and educators worldwide, united by a shared mission: connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health.
Credit: Pediatric Academic Societies
BOSTON, April 24, 2026 – Rural-residing adolescents are twice as likely to die by suicide compared to their urban-residing peers. To better support crisis care for rural youth, researchers developed Plan & Protect, a technology-guided safety planning program for youth with suicidality seeking care in rural emergency departments. Plan & Protect aims to enhance accessibility, usability, and fidelity of safety planning in resource-limited emergency departments, with a goal of supporting more effective crisis care for adolescents in rural communities. The program and findings from the study will be presented at the Pediatric Academic Societies (PAS) 2026 Meeting, taking place April 24-27 in Boston.
Emergency departments are key access points for youth experiencing mental health crises. Correspondingly, rural emergency departments are well-positioned to implement safety planning interventions. Given their limited mental health resources, digital interventions are especially promising.
"This project, Plan & Protect, was developed in response to the recognition that adolescents in rural communities often rely on emergency departments during moments of crisis, yet safety planning in these settings can feel rushed or disconnected from their experiences,” said Nikolas G. Hernandez, medical student at Geisel School of Medicine at Dartmouth and lead author of the study. “By working directly with youth, we found that adolescents preferred safety planning tools that are simpler, more personalized, and more engaging, which directly informed the development of this intervention. Plan & Protect aims to support more effective and accessible crisis care for youth in rural communities."
Researchers conducted semi-structured interviews with rural-residing adolescents (aged 12-17) presenting to a rural emergency department. Youth reported that the incorporation of colorful imagery and relatable content enhanced their engagement, while clear prompts and examples facilitated reflection without feeling overwhelming. Participants also emphasized unique psychosocial challenges faced by rural-residing youth, including resource limitations, need for connection, privacy concerns, and stigma, which informed the tailoring of the safety plan to better meet the specific contextual needs of this population.
Additional information is included in the below research abstract. The PAS Meeting connects thousands of leading pediatric researchers, clinicians and educators worldwide. View the full schedule in the PAS 2026 program guide. For more information about the PAS Meeting, please visit www.pas-meeting.org.
###
About the Pediatric Academic Societies (PAS) Meeting
The Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and educators worldwide, united by a shared mission: connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. PAS is a partnership of four premier pediatric associations: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, visit www.pas-meeting.org. Follow us on X, Facebook, and Instagram.
---
Abstract: Plan & Protect: Development of a Technology-guided Safety Planning Intervention for Rural-residing Adolescents
Presenting Author
Nikolas G. Hernandez, Medical Student, Geisel School of Medicine at Dartmouth
Organization
Geisel School of Medicine at Dartmouth
Topic
Emergency Medicine: All Areas
Background
Rural-residing adolescents are twice as likely to die by suicide compared to their urban-residing peers and rural emergency departments (EDs) are key access points for youth experiencing mental health crises. Correspondingly, rural EDs are well-positioned to implement safety planning interventions. Given their limited mental health resources, digital interventions are especially promising.
Objective
To iteratively develop Plan & Protect (P&P), a technology-supported safety planning program for youth with suicidality seeking care in rural EDs.
Design/Methods
We employed the five-stage Design Thinking framework to guide the development of P&P: (i) empathize with end-users, (ii) define the problem, (iii) ideate potential solutions, (iv) prototype interventions, and (v) iteratively test and refine the tool. We conducted semi-structured interviews with rural-residing adolescents (aged 12-17) presenting to a rural ED, employing a ‘think-aloud’ approach to receive feedback on five iterations of P&P. Interviews were professionally transcribed and analyzed to identify emerging themes to improve the developmental appropriateness, usability, and cultural relevance of the intervention.
Results
27 adolescents participated; 24 (88.9%) were female and 19 (70.4%) were Medicaid-insured (Table 1). Participants identified a need for connection, accessibility, and flexibility in the safety planning process. Reflecting these priorities, the P&P safety plan iteratively evolved from a paper-based template to a website with embedded videos and prompts to facilitate safety plan completion (Figure 1). Youth reported that the incorporation of colorful imagery and relatable content enhanced their engagement, while clear prompts and examples facilitated reflection without feeling overwhelming (Table 2). Participants also emphasized unique psychosocial challenges faced by rural-residing youth, including resource limitations, need for connection, privacy concerns, and stigma, which informed the tailoring of the safety plan to better meet the specific contextual needs of this population.
Conclusion(s)
Through an iterative, user-centered design process, we created and refined P&P, a technology-guided safety planning tool tailored to the unique needs and lived experiences of rural-residing youth. P&P aims to enhance accessibility, usability, and fidelity of safety planning in resource-limited EDs, with a goal of supporting more effective crisis care for adolescents in rural communities.
Co-Authors
Hailey M. Cantwell, Clinical Research Coordinator I, Children's Hospital at Dartmouth-Hitchcock
Saskia L. Vanderwiel, Clinical Research Coordinator, Children's Hospital at Dartmouth-Hitchcock
Emma R. Jacobs, Medical Student, Geisel School of Medicine at Dartmouth
Vinisha Velmineti, MPH, Clinical Research Coordinator I, Children's Hospital at Dartmouth-Hitchcock
Alyssa C. Helmling, Medical Student, Geisel School of Medicine at Dartmouth
Gwenyth M. Gasper, MSc, Medical Student, Geisel School of Medicine at Dartmouth
Ailyn Sierpe, MSc, Research Associate, Dartmouth Hitchcock Medical Center
Christine Finn, MD, Vice Chair for Clinical Services, Geisel School of Medicine at Dartmouth
Alison Kapadia, MD, Assistant Professor of Emergency Medicine, Geisel School of Medicine at Dartmouth
Maia Rutman, MD, Associate Professor of Pediatrics and Emergency Medicine, Children's Hospital at Dartmouth-Hitchcock
Jennifer L. Hughes, PhD, MPH, Associate Professor, Nationwide Children's Hospital
Jacqueline A. Pogue, MPH, MA, Research Project Manager, The Dartmouth Institute for Health Policy and Clinical Practice
JoAnna Leyenaar, MD, PhD, MPH, Professor, The Dartmouth Institute of Health Policy & Clinical Practice
Tables and Images
Table 1. Demographic characteristics of study participants
Figure 1. Plan & Protect safety planning iterations
Table 2. Emerging themes and representative quotes summarizing youth-reported safety planning priorities