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

项目摘要/摘要 美国年轻人中的自杀和自杀行为代表着重大的公共健康 有问题。参与少年司法系统的青年在以下方面的风险因素负担更重 与不公正的同龄人相比，自杀的想法和行为涉及到更多的年轻人 有自杀的风险。因此，这一以患者为导向的导师研究职业发展奖的总体目标 (K23)是支持申请者发展技能，以启动专注于独立研究的计划 关于传播和实施对涉及法院的非监禁人员的循证干预 (CINI)青少年参与少年司法系统，以减少精神疾病发病率。具体的培训目标是： (1)参加密集的临床和研究培训，以增加我在进行简短干预方面的专业知识 对于青少年自杀，(2)在传播和实施战略和研究方面发展专门知识 少年司法系统，(3)掌握混合方法研究方法的技能，包括设计和 在不可能随机化的情况下支持因果推断的研究分析。申请者将继续 这些目标是通过指导、教学和实践经验相结合的方式实现的。的具体培训目标 这5年的时间将在安东尼·斯皮里托博士(布朗大学)的指导下实现，码头 Tolou-Shams(加州大学旧金山分校)、吉娜·文森特(加州大学马萨诸塞州医学院)和Peter Friedmann(贝州健康)。这个 拟议的研究性研究的目标是：1)确定个人、行政和系统层面的因素 促进或阻碍青少年司法前线人员进行的简短自杀干预 CINI青少年和2)对自杀的CINI青少年实施循证的简短干预、安全规划和 评估它对这些年轻人的效用。在治疗适应阶段，12个少年司法利益攸关方将 访谈干预前和干预后的实施情况，以及24名青年和24名照顾者在干预后3个月 干预，关于少年法庭设置中的短暂干预的可接受性。在治疗试验中 阶段，我们将研究针对有自杀倾向的青少年的安全计划干预的有效性。 减少自杀念头，减少自杀事件(自杀未遂以及紧急评估和 因自杀而住院的精神疾病)，更多地参与门诊精神卫生治疗，以及 提高了青年接受治疗的动力。CINI青少年，年龄12-17岁(基线N=100(历史对照)) 队列；疗效试验N=100；替代因果设计N=100)，将从 目前少年儿童法庭参与的研究。参加药效试验的CINI少年将收到证据- 基于短期自杀干预作为护理标准的一部分，并将与历史对照和 可供选择的因果设计。基线数据将作为常规护理的一部分进行收集。年轻人和照顾者将会是 在少年最初被法院任命后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.