Brief Suicide Intervention for Youth in Juvenile Detention Settings

This is an intervention development study and therefore is not designed or powered to test hypotheses. Following initial development and refinement of intervention and protocol, an open trial will be conducted at one juvenile detention facility (n=20). Following further refinement, six juvenile detention sites will be randomized to first or second wave of intervention implementation. All youth at an implementation site in suicidal crises will receive the intervention. Data will only be collected from youth with prior assent/consent. Youth will be assessed at the time of the suicidal/self-harm crisis, just prior to release from the juvenile detention facility, and at a two-month follow-up assessment. We will preliminarily examine feasibility of the intervention and associated patterns of suicidal thoughts and behavior and non-suicidal self-injury, linkage to care following release, and presumed mechanisms of change such as hopelessness, self-efficacy to remain safe, urgency to act on suicidal thoughts, and acceptance.

The primary objective of this phase of the study is to develop and refine procedures for the new multi-faceted intervention for trauma-informed suicide prevention (brief cognitive-behavioral and trauma-informed strategies and safety planning for youth who are suicidal and/or self-harming, as well as training of staff in trauma-informed crisis management and de-escalation strategies) for youth in juvenile detention settings. An associated objective is to develop procedures for training staff working with youth in short-term juvenile detention settings to conduct the new intervention for reducing suicidal thoughts and behavior. A third objective is to examine the feasibility of this trauma-informed suicide prevention intervention in terms of initial participant recruitment, fidelity to the treatment model, treatment acceptability, and monitoring of adverse events in an open trial (n=20). This intervention will be iteratively refined during this open trial based on feedback from youth and staff, and experiences using the intervention in juvenile detention. In a pilot randomized trial (n=200) in which the timing of the intervention is randomized across six juvenile detention facilities, the final objective of this study is to collect and examine preliminary data regarding the feasibility of the intervention, as well as indications of the impact of the intervention on suicidal thoughts and behavior, non-suicidal self-harm, emergency services, linkage to care after release, and presumed mechanisms of action. To address this objective, we will (a) compare data from three intervention sites with three comparison sites that did not receive training in the intervention in the same year (but rather use standard suicide intervention practices); (b) evaluate within-site changes in three sites that were comparison sites in one year but receive the intervention the next year; and (c) examine sustainability of intervention effects in the one year following training in the three sites that initially received the training. As an intervention development study, this study is not powered to test hypotheses. Rather, the purpose of this study is to demonstrate feasibility and acceptability of the intervention and procedures, and to demonstrate viability of the proof of concept. The study is a collaboration between Duke and Wake Forest investigators, and Juvenile Justice in the NC Department of Public Safety.

Open Trial is Single Group. Pilot RCT is Randomization of Site to Implementation of Intervention (Three Sites in First Wave, Three Sites in Second Wave)

New Brief Trauma-Informed Intervention (based on SAFETY-A) in addition to Enhanced Usual Care in Juvenile Detention Sites

The trauma-informed brief suicide intervention based on the SAFETY-A (single crisis session in addition to follow-up caring contacts). Delivered in addition to usual care in facilities.

Usual Care in Juvenile Facilities (e.g., suicide watch/observation and evaluation by contracted mental health professional within 24 hours). Usual care is enhanced because of the additional assessment information that can be shared with clinical staff

Inclusion Criteria: English speaking At least 13 years of age and younger than 18 years of age Without evidence from school or other records of intellectual disability Without evidence of active psychosis Not wards of the state Risk for suicidal behavior or non-suicidal self-harm behavior Exclusion Criteria: Not English-speaking or caregivers are not English-speaking Wards of the state Younger than 13 or 18 years of age or older Evidence from school or other records or suspected intellectual disability Active psychosis