Implementing a Brief Suicide Intervention for High Risk Youth with Front-Line Juvenile Justice Staff

项目总结/摘要 自杀和自杀行为在美国青年代表了一个重要的公共卫生 问题.青少年司法系统中的青少年面临着更多的风险因素， 自杀意念和行为相比，他们的非正义参与同龄人，把这些青年在更大的 自杀的风险。因此，这个指导患者为导向的研究职业发展奖的总体目标 (K23)支持申请人发展技能，以启动独立的研究计划， 关于传播和实施对法院介入的非监禁 （CINI）为青少年司法系统中的青少年提供服务，以减少精神病发病率。具体的培训目标是： (1)参加密集的临床和研究培训，以提高我在进行简短干预方面的专业知识 （2）发展传播和实施战略方面的专门知识， 少年司法系统，（3）获得混合方法研究方法的技能，包括设计和 当不可能进行随机化时，分析研究以支持因果推断。申请人将追求 这些目标通过指导，教学法和实践经验相结合。具体培训目标 这5年期间将在安东尼斯皮里托博士（布朗大学），玛丽娜 Tolou-Shams（UCSF），Gina Vincent（UMASS医学院）和Peter Friedmann（Baystate Health）。的 拟议研究的目标是：1）确定个人、行政和系统层面的因素 促进或阻碍一线少年司法工作人员进行简短的自杀干预， CINI青年和2）实施基于证据的简短干预，安全规划，自杀CINI青年和 评估它对这些年轻人的效用。在治疗适应阶段，12名少年司法利益攸关方将 在干预实施前和干预实施后，以及干预实施后3个月，对24名青年和24名护理人员进行了访谈。 干预，关于在少年法庭设置简短干预的可接受性。在治疗试验中 阶段，我们将研究安全规划干预措施对有自杀倾向的青少年的有效性， 减少自杀意念，减少自杀事件（自杀企图以及紧急评估， 因自杀而住院的精神病患者），增加门诊心理健康治疗的参与，以及 提高青年治疗的积极性。CINI青少年，年龄12-17岁，（基线N=100（历史对照） 队列;对于疗效试验，N=100;对于替代因果设计，N=100），并且将从 少年法庭参与目前的研究。疗效试验中的CINI青少年将接受证据- 基于短暂自杀干预作为标准治疗的一部分，并将与历史对照进行比较， 替代因果设计。基线数据将作为常规护理的一部分收集。年轻人和一个照顾者 在该少年首次出庭后3个月重新评估。

Project Summary/Abstract Suicide and suicidal behaviors among youth in the United States represents a significant public health problem. Youth involved in the juvenile justice system have a greater burden of risk factors associated with suicide ideation and behaviors as compared to their non-justice involved peers, placing these youth at greater risk for suicide. Thus, the overall goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to support the applicant in developing the skills to launch an independent research program focused on the dissemination and implementation of evidence-based interventions for court-involved non-incarcerated (CINI) youth involved in the juvenile justice system to reduce psychiatric morbidity. Specific training goals are: (1) engage in intensive clinical and research training to increase my expertise in conducting brief interventions for adolescent suicide, (2) develop expertise in dissemination and implementation strategies and research in the juvenile justice system, (3) achieve skills in mixed-method research methodology including design and analysis of studies to support causal inference when randomization is not possible. The applicant will pursue these goals through a combination of mentoring, didactics, and practical experience. Specific training goals for this 5-year-period will be achieved under the mentorship of Drs. Anthony Spirito (Brown University), Marina Tolou-Shams (UCSF), Gina Vincent (UMASS Medical School), and Peter Friedmann (Baystate Health). The objective of the proposed research study is to 1) identify individual-, administrative-, and system-level factors that promote or hinder uptake of a brief suicide intervention conducted by front-line juvenile justice staff with CINI youth and 2) implement an evidence-based brief intervention, safety planning, for suicidal CINI youth and evaluate its utility with these youth. In the Treatment Adaptation phase, 12 juvenile justice stakeholders will be interviewed pre- and post-intervention implementation, as well as 24 youth and 24 caregivers 3-months post- intervention, about the acceptability of the brief intervention in the juvenile court setting. In the Treatment Trial phase, we will examine the effectiveness of a safety planning intervention for indicated suicidal youth in reducing suicidal ideation, in reducing suicidal events (suicide attempts as well as emergency evaluations and psychiatric hospitalizations for suicidality), increased engagement in outpatient mental health treatment, and improved youth motivation for treatment. CINI juveniles, ages 12-17, (N=100 for baseline (historical control) cohort; N=100 for efficacy trial; N=100 for alternative causal design) and a caregiver will be recruited from the juvenile court to participate in the current study. CINI juveniles in the efficacy trial will receive the evidenced- based brief suicide intervention as part of standard of care and will be compared to historical control and alternative causal design. Baseline data will be collected as part of routine care. Youth and a caregiver will be re-assessed at 3 months subsequent to the juvenile's initial court appointment.