Safety Planning in Juvenile Justice for Suicidal Youth
Condition: Suicidal Ideation; Suicide, Attempted; Nonsuicidal Self-injury
MeSH terms: Suicide; Suicidal Ideation; Suicide, Attempted; Self-Injurious Behavior
Study type: Interventional

Summary: 
      This study will examine the feasibility and acceptability of a program designed to conduct
      safety planning with youth in the juvenile justice system who are at risk for a suicide
      attempt and/or self-injury and to increase the possibility of them receiving outpatient
      mental health treatment. After training staff in the intervention, the investigators will
      pilot test the safety planning intervention and gather information on how well it worked on
      reducing self-harm, getting families to follow up with referrals for mental health care, and
      how often they attend treatment.
    

Detailed description: 
      The Juvenile Justice System (JJS) has not implemented any evidenced-based interventions that
      address suicidal behavior or nonsuicidal self-injury, hereafter referred collectively to as
      self-injury, with JJS-involved youth. This application proposes to test a scalable
      intervention, safety planning, that aims to reduce self-injury in adolescents involved in the
      JJS. Safety planning, which can be a stand-alone brief intervention, was cited as a best
      practice by the Suicide Prevention Resource Center/American Foundation for Suicide Prevention
      Best Practices Registry for Suicide Prevention. This study will have two phases. In Phase I,
      the investigators will conduct an open trial with 10 adolescents which will allow us to make
      any modifications necessary for using the protocol in a Probation Department. The
      investigators will then randomize 60 youth on Probation who screen positive for recent
      self-injury into standard care or the safety planning intervention. Counselors with community
      mental health experience embedded in Probation will conduct the intervention, consistent with
      the co-responder model found across JJS in the U.S. in which a Probation Officer works
      collaboratively with a mental health professional to coordinate care. In order to further
      conduct the study under conditions most relevant to a future implementation trial, the
      investigators will also employ a training approach that has been successfully implemented in
      a psychiatric hospital with Bachelors and Masters level staff. In Phase II, of the study, the
      investigators will: a) conduct qualitative interviews in Probation about attitudes toward the
      intervention as well as barriers to a future, larger implementation trial; and b) contract
      with the National Center for Mental Health and Juvenile Justice to conduct a Sequential
      Intercept Model (SIM) Mapping. The SIM is a conceptual framework to outline a series of
      "points of interception" along the JJS continuum in a state where screening and brief
      intervention may be implemented. In the Mapping, the investigators will examine the JJS
      continuum from arrest; to an initial hearing; to jail awaiting trial or adjudication;
      incarceration; to release or reentry; and finally, to community supervision. These data will
      provide a working framework to help assess current views within the statewide JJS as a
      starting point to proposing a future, larger trial. This research also has the potential to
      directly inform treatment practices in JJ settings and has significant implications for
      scalability and dissemination in order to build a stronger, more effective system of mental
      health/JJS collaboration around self-injury screening and intervention.
    

Intervention name(s): Safety Planning; Standard care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Safety planning is an individual coping intervention to reduce suicidal risk in adolescents; Standard care entails sending an adolescent for an emergency evaluation for suicidal risk in an Emergency Department
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 group randomized controlled trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: suicidal behavior; nonsuicidal self injury; adolescents