Brief Suicide Intervention for Youth in Juvenile Detention Settings

有青少年司法参与的青少年有自杀念头、自杀行为的风险显著增加 死亡和非自杀性自伤(NSSI)(Gallagher&Dobrin，2006；Stokes等人，2015)。其中很大一部分 自杀和自残行为发生在精神和物质使用问题和病史的背景下 不良生活经历(例如，Charak等人，2019年；McNair等人，2019年；Teplin等人，2015年)。这一比率 包括青少年在内的更严格的环境会增加精神健康障碍和自杀风险 拘留设施(Hayes，2005年；Stokes等人，2015；Wasserman等人，2010年)。鉴于风险增加， 被拘留的青年，本研究的目的，回应NIMH标准杆18-228，“侦测和 在与少年司法系统接触的青少年中防止自杀行为、想法和自我伤害 制定、完善和初步测试一份了解创伤情况、基于优势、适合发展的简介 对短期拘留设施中的工作人员对被拘留青少年自杀念头的干预和 行为和NSSI。我们期望，这一短暂的干预将为被拘留的青年提供支持 通过以提高青少年安全为重点的认知行为和辩证行为治疗策略， 自我效能感，生存理由，以及对当前生活环境的彻底接受。这项干预将 旨在帮助工作人员更有效地评估和应对青少年自杀的想法和行为，以及 NSSI，从而更有效地管理青年危机。这一干预将补充和加强 在少年拘留环境中的现有资源以及评估和监测议定书。特别是， 干预将由现有拘留工作人员在拘留设施现场进行，这些工作人员 与被拘留的青年一起工作。该项目的第一个目标是制定和完善新的 对有自杀倾向的青少年在少年拘留危机中的干预。第二个目标是制定程序，以 培训拘留工作人员，他们将向被拘留的青年提供这种干预。在开放的背景下 试验(n=20)，第三个目标是评估这种干预的可行性，并借鉴来自 落实看守所工作人员和青少年的干预和反馈意见，细化干预措施。最后 目的是在一项试点随机对照试验(n=200)中，获得关于以下方面的初步数据： 干预措施的可接受性，以及干预措施对自杀想法和行为的影响， NSSI、紧急服务、与出院后护理的联系以及假定的行动机制。建议数 研究旨在证明一种模型的可行性和潜在的实用性，该模型最终可以影响 拘留工作人员为被拘留的高危青年提供服务，结果是改善了结果。结果是 这项研究将为未来更大规模的混合实施有效性试验的发展提供参考。

Youth with juvenile justice involvement are at markedly increased risk for suicidal ideation, suicidal behavior and death, and non-suicidal self-injury (NSSI) (Gallagher & Dobrin, 2006; Stokes et al., 2015). Much of this suicidal and self-harm behavior occurs in the context of psychiatric and substance use problems and histories of adverse life experiences (e.g., Charak et al., 2019; McNair et al., 2019; Teplin et al., 2015). The rates of mental health disorders and suicide risk increase with more restrictive environments, including juvenile detention facilities (Hayes, 2005; Stokes et al., 2015; Wasserman, et.al., 2010). Given the increased risk of detained youth, the purpose of this study, responsive to NIMH PAR 18-228, “Pilot Studies to Detect and Prevent Suicidal Behavior, Ideation, and Self-Harm in Youth in Contact with the Juvenile Justice System,” is to develop, refine, and preliminarily test a trauma-informed, strengths-based, developmentally appropriate brief intervention for staff in short-term detention facilities responding to detained adolescents’ suicidal ideation and behavior, and NSSI. It is our expectation that this brief intervention will provide support to detained youth through cognitive-behavioral and dialectical behavior therapy strategies focused on increasing youth safety, self-efficacy, reasons for living, and radical acceptance of their current life circumstances. The intervention will be designed to help staff more effectively assess and respond to youth suicidal thoughts and behaviors, and NSSI, resulting in more effective management of youth crises. The intervention will complement and build upon existing resources and assessment and monitoring protocols within the juvenile detention setting. In particular, the intervention will be designed to be delivered on- site at detention facilities by existing detention staff who work with detained youth. The first aim of the project is to develop and refine standard procedures for the new intervention for suicidal youths in crises in juvenile detention. The second aim is to develop procedures for training detention staff members who will provide this intervention to detained youth. In the context of an open trial (n=20), the third aim is to assess the feasibility of this intervention, and to use experiences from implementing the intervention and feedback from detention staff and youth to refine the intervention. The last aim is to obtain, in a pilot randomized controlled trial (n=200), preliminary data regarding the feasibility and acceptability of the intervention, as well as the impact of the intervention on suicidal thoughts and behavior, NSSI, emergency services, linkage to care after release, and presumed mechanisms of action. The proposed research is intended to demonstrate the feasibility and potential utility of a model that can eventually impact services delivery by detention staff for detained at-risk youth, resulting in improved outcomes. The results of this study will inform the development of a future larger scale hybrid implementation effectiveness trial.