Experimental evaluation of a multi-site suicide intervention for youth during and after residential placement

摘要/概要 为了应对自杀对美国青年和被监禁青年构成的公共健康威胁， 特别是，我们建议对纽约市少年司法进行多年、多地点、设定级别的干预 系统与纽约市儿童服务管理局（ACS）合作，我们将实验性地 评估基于证据的工作人员级别培训（S4 L），以解决青年自杀的两个关键点， 青少年司法相关青少年的联系人：安置和释放后安置。S4 L结合培训， 护理之盾（SOC），一个针对少年司法工作人员的急性自杀检测培训的循证模型， 通过辩证行为疗法提供的循证自杀预防技能建设培训， 有自杀意念、行为和非自杀性自伤风险的青少年。我们将比较 S4 L的有效性，以训练作为通常的控制条件（控制），并在其中我们提供的条件 每月对员工进行现场辅导，以支持S4 L技能（S4 L+）的获取和实施。的 干预措施将作为ACS通常工作人员培训程序的一部分实施。干预的必要性是 由于最近国家一级的政策转变，将增加这些地点的青年人数， 增加自杀风险。S4 L和S4 L+将使用3组随机分组设计进行评价， 非安全安置（NSP）/善后护理中心的全部人群（N=30个中心; N=1800名青年，30%为女孩）。这些 这些场所是纽约市长期监禁的唯一基础设施。NSP/善后护理中心将随机分配至 对照（N=10个研究中心; 600名青年）、S4 L（N=10个研究中心; 600名青年）和S4 L+（N=10个研究中心; 600名青年）条件。我们 测试S4 L与S4 L+和对照相比在改善自杀行为、自杀意念、 和NSSI;心理健康结果（内化，外化和物质使用）;以及 自杀/心理健康（冲动、情绪和应对）。此外，我们还测试了网站级 实现特性（例如，受过培训的工作人员比例;平均检测和预防数量 活动）;场地和员工级别的结构特征（例如，前培训，倦怠）;和个别青年 特性（例如，人口统计学;创伤史）中度S4 L和S4 L+有效性。青年成果 关于自杀行为、自杀意念、NSSI和心理健康问题及其相关因素的数据将在 纵向跟踪1年。作为对FOA的回应，将通过基于证据的 根据NIH的常见数据元素捕捉障碍的维度方面的措施， 国家预防自杀行动联盟（National Action Alliance for Suicide Prevention）站点级干预版主将 通过工作人员调查和行政数据衡量。该项目旨在扩大科学知识 基于自杀预防和干预在高风险的青年环境，并提供基于实践的 就工作人员培训和辅导的可行性和可扩展性提供指导， 系统和司法管辖区。该项目利用了现有的合作，并得到了ACS的全力支持。

Abstract/Summary In response to the public health threat that suicide poses to American youth in general and incarcerated youth in particular, we propose a multi-year, multi-site, setting-level intervention in the New York City Juvenile Justice system. In partnership with the NYC Administration for Children's Services (ACS), we will experimentally evaluate an evidence-based staff-level training (S4L) to address youth suicidality during two critical points of contact for juvenile-justice involved youth: placement and post-release Aftercare. S4L combines training in Shield of Care (SOC), an evidence-based model for acute suicide detection training for juvenile justice staff, with evidence-based suicide prevention skill-building training informed by dialectical-behavior therapy for adolescents at risk for suicide ideation, behavior, and non-suicidal self-injury (NSSI). We will compare the effectiveness of S4L to a training as usual control condition (control), and to a condition in which we provide monthly on-site coaching to staff to support the acquisition and implementation of S4L skills (S4L+). The intervention will be implemented as part of ACS's usual staff-training procedures. The need for intervention is urgent at this time due to recent state-level policy shifts that will increase the number youth in these sites and heighten their suicide risk. S4L and S4L+ will be evaluated using a 3-arm cluster-randomized design with the full population of non-secure placement (NSP)/Aftercare sites (N=30 sites; N=1800 youth, 30% girls). These sites are sole infrastructure for long-term confinement in NYC. NSP/Aftercare sites will be randomized to control (N=10 sites; 600 youth), S4L (N=10 sites; 600 youth), and S4L+ (N=10 sites; 600 youth) conditions. We test the effectiveness of S4L compared to S4L+ and control on improving suicidal behavior, suicidal ideation, and NSSI; mental health outcomes (internalizing, externalizing and substance use); and correlates of suicide/mental health (impulsivity, mood, and coping). In addition, we test the extent to which site-level implementation characteristics (e.g., proportion of staff trained; average amount of detection and prevention activities); site and staff-level structural characteristics (e.g., prior training, burnout); and individual youth characteristics (e.g., demographics; trauma history) moderate S4L and S4L+ effectiveness. Youth outcome data on suicidal behavior, suicidal ideation, NSSI, and mental health problems and their correlates will be tracked longitudinally for 1 year. In response to the FOA, outcomes will be assessed via evidence-based measures that capture dimensional facets of disorder in line with NIH's common data elements and recommendations by the National Action Alliance for Suicide Prevention. Site-level intervention moderators will be measured by staff survey and administrative data. This project aims to expand the scientific knowledge base on suicide prevention and intervention in high-stakes youth settings and provide empirically-based guidance regarding the feasibility and scalability of staff training and coaching into different juvenile justice systems and jurisdictions. This project leverages an existing collaboration and has the full support of ACS.