From Court to the Community: Improving Access to Evidence-Based Treatment for Underserved Justice-Involved Youth At-Risk for Suicide

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PROJECT SUMMARY Justice-involved youth (JIY) living in the community experience disproportionately high rates of suicidal thoughts and behavior (STB) and non-suicidal self-injury (NSSI) compared to adolescents in the general population. Many JIY lack access to evidence-based treatment specifically designed to treat NNSI and STB, thereby increasing the overall risk of suicide in this population. Further, even when JIY do have access to evidence-based treatment, treatment initiation in this population is low. The current proposal aims to reduce STB and NSSI among JIY, and thus reduce mental health disparities in this vulnerable and underserved youth population. Our primary aim is to implement a systems-level intervention designed to increase access to evidence-based treatment strategies specifically designed to treat STB and NSSI behaviors for JIY referred to outpatient care by the Rhode Island Family Court. We will conduct a cluster randomized stepped wedge trial in which 9 distinct community mental health agencies (CMHA) who serve JIY in the state of Rhode Island will be randomized to receive a standardized training program. A select number of CHMA administrators and providers will complete semi-structured qualitative interviews pre-implementation to assess agency/system-level and provider-level factors that may promote or hinder the uptake of evidenced-based treatment strategies for STB and NSSI in CMHAs serving JIY living in the community. Quantitative data will assess organizational, provider, and youth characteristics and will be collected through questionnaires CMHA providers complete and from the electronic medical record pre- implementation, immediately post-implementation, and 9-months into sustainment. It is hypothesized that at the systems level, the training program will be sustained for at least one year and up to 3 years by CMHA administrators. At the provider level, it is hypothesized that training in the use of evidence-based treatment strategies for STB and NSSI will significantly increase both the use of these strategies and the quality of their delivery over a year’s follow-up period. At the patient level, we hypothesize that the training program will improve parental adherence to outpatient treatment and reduce rates of adolescent STB and NSSI that require emergency medical/psychiatric care in our healthcare system. Our secondary aim is to examine factors that influence treatment initiation among JIY living in the community. We will enroll 180 caregivers of JIY youth who screen positive for recent NSSI/STB to test the hypothesis that JIY whose caregivers are randomized to the psychoeducation/action plan condition, compared to an educational video, will be significantly more likely to initiate treatment at a CMHA. Caregivers will complete follow-up assessments at 3- and 6-months post-baseline to assess whether their adolescent initiated treatment and how many sessions the adolescent attended. This application has strongly aligns with NIMH’s Strategic Objective 3.3: “Test interventions for effectiveness in community practice settings,” and the goals of the RFA-MH-21-187 to test effective “systems-level strategies for the detection and prevention of SIB and/or NSSI specifically among underserved children and adolescents.”