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

摘要/摘要 针对自杀对普通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、环境层面的干预 系统。与纽约市儿童服务管理局(ACS)合作，我们将试验性地 评估基于证据的工作人员级别培训(S4L)，以解决以下两个关键点的青少年自杀问题 少年司法方面的接触涉及青少年：安置和释放后的善后照料。S4L将培训与 关爱之盾(SOC)是为青少年司法人员提供的急性自杀检测培训的循证模式， 以辩证行为疗法为指导的循证自杀预防技能训练 青少年有自杀意念、行为和非自杀性自我伤害(NSSI)的风险。我们将比较 S4L对常规控制条件(控制)和我们提供的条件的有效性 每月对员工进行现场指导，以支持获得和实施S4L技能(S4L+)。这个 干预措施将作为ACS通常的员工培训程序的一部分实施。干预的必要性是 由于最近州一级的政策转变将增加这些网站的年轻人数量，因此目前情况紧急 增加他们的自杀风险。S4L和S4L+将使用三臂群集随机设计进行评估， 不安全安置(NSP)/善后照料地点的全部人口(N=30个地点；N=1800名青年，30%女孩)。这些 场地是纽约市长期监禁的唯一基础设施。NSP/善后服务地点将随机分配到 对照组(N=10个站点；600名青年)、S4L(N=10个站点；600名青年)和S4L+(N=10个站点；600名青年)条件。我们 测试S4L与S4L+在改善自杀行为、自杀意念、 和NSSI；精神健康结果(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，我们还测试了站点级别的 实施特点(例如，受过培训的工作人员比例；平均侦测和预防数量 活动)；现场和工作人员一级的结构特征(例如，先前的培训、职业倦怠)；以及个人青年 特征(例如，人口统计学特征；创伤病史)中等S4L和S4L+有效性。青春结局 关于自杀行为、自杀意念、NSSI和精神健康问题及其相关的数据将是 纵向跟踪了1年。作为对FOA的回应，将通过循证评估结果 捕捉无序的维度方面的措施符合NIH的公共数据元素和 国家预防自杀行动联盟的建议。现场级别的干预主持人将 通过工作人员调查和行政数据来衡量。这个项目的目的是扩大科学知识 基于高风险青少年环境中的自杀预防和干预，并提供基于经验的 关于不同少年司法工作人员培训和辅导的可行性和可扩展性的指导 制度和司法管辖区。该项目利用了现有的协作，并得到了ACS的全面支持。

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.