LEADS was developed using a rigorous process, which included student and teacher focus groups, an online teacher survey, and a thorough review of suicide prevention research literature. SAVE also worked closely with several leading experts in the field of suicide prevention.
Experts consulted on program content, design, and current best practices for school based programs. In A Crisis? Upon completion of LEADS: for Youth, students will gain the following: Increased knowledge of depression, depression symptoms, and facts about suicide.
There were no differences in parent-reports of self-harm behavior or suicidal ideation. Donaldson and colleagues compared a skills-based cognitive-behavioral intervention to supportive therapy for suicidal adolescents. The skills-based intervention emphasized problem solving and affect management skills and routinely included parents in providing collateral information at each treatment session.
Two optional family sessions were allowed in the treatment protocol in situations where the family difficulties appeared to be interfering with treatment progress. The treatment was kept brief because of rates of treatment drop-out by suicidal youths. The intervention did not result in differences in severity of suicide ideation or in rates of suicide attempts over the follow-up. King and colleagues examined the effectiveness of assistance provided by a Youth-Nominated Support Team YST in addition to routine care for formerly hospitalized adolescents.
Weekly contact between the youth and the YST members nominated by the youth was encouraged, and psychoeducation and training was provided to the support team. However, the YST approach also recognized that outside-the-family supports e. The YST intervention did not result in significantly reduced suicide attempts, but girls in the YST group showed greater reductions in severity of suicidal ideation and functional impairment relative to those assigned to TAU.
The intervention was designed to be sensitive to the developmental needs of adolescents and included approaches from cognitive-behavioral therapy, dialectical behavior therapy, and psychodynamic group psychotherapy. The intervention consisted of an initial assessment, six acute group sessions, and a long-term group therapy continuing until the youth considered themselves ready to leave. The long term group primarily focused on group processes.
Two studies evaluated aspects of service utilization in the context of interventions for suicidal youth Cotgrove et al. Cotgrove and colleagues examined the impact of providing youth who had been hospitalized with suicide attempts a token allowing readmission to the hospital on demand. The intervention also recognized the need for youth to be active participants and decision makers in their psychiatric treatment and care. In the second service utilization study, Spirito and colleagues examined the effectiveness of a compliance enhancement and problem-solving intervention developed to increase adherence to outpatient treatment.
In the ED intervention, clinicians fostered appropriate expectations for treatment among both parents and adolescents, reviewed or identified factors that might interfere with treatment adherence, and elicited a contract for attendance for at least four outpatient sessions.
At three months, the ED intervention did not result in an overall change in number of treatment sessions attended. However, after controlling for barriers to treatment, the intervention was associated with increased treatment attendance. The effects of the intervention on suicidal behavior were not assessed.
Despite public health concern, there are insufficient data available from controlled trials to recommend one intervention over another for the treatment of suicidal youths. To date, however, it appears that interventions for suicidal youth have been in general more successful at affecting aspects of service utilization and delivery e.
That observation notwithstanding, most studies have focused on suicidal youth with heterogeneous clinical presentations, and have been underpowered to detect differences in low base rate outcomes such as suicide attempts. For example, outcomes ranged from emergency room admissions for suicidal thoughts and suicidal, life-threatening, or nonsuicidal self-injurious behaviors Deykin et al.
This diversity of defined outcomes of interest can lead to markedly different inferences both about the prevalence rates of suicide-related behaviors e. Weisz and Hawley have highlighted the importance of creating developmentally appropriate interventions for adolescents with emotional and behavioral problems. The developmental features in the treatment studies reviewed range from involvement of family or efforts to engage families in the treatment process, to the length of treatment itself, to in-home interventions so that youth can be treated in their natural environments, to incorporation of developmental themes in group and individual therapy.
In addition, most interventions included family involvement or intervention, although the degree of family involvement in treatment protocols varied dramatically. Although details of interventions are often not well-described, it appears that it has been less common for interventions to explicitly address issues with peers, or to include some attention to the school environment or the school-based setting.
It remains an empirical question as to whether developmental modifications in treatment approach or considerations of developmental context in interventions are directly related to increased effectiveness. Weisz and Hawley , however, have argued that developmentally appropriate therapeutic approaches for adolescents are important for treatment effectiveness because risk and resilience factors, as well as the nature and context of dysfunction, differ in adolescence relative to other developmental periods.
The lack of compelling data regarding the relative effectiveness or efficacy of youth suicide interventions raises questions about whether developmental considerations in most interventions to date are adequate. Certainly, developmental appropriateness of interventions may not be sufficient for reducing suicidality, but developmental sensitivity or appropriateness may be an important factor related to increased effectiveness, sustainability, and generalizability of positive therapeutic changes, as well as treatment engagement.
In the section that follows, we discuss developmental considerations in interventions for suicidal youths, and suggest future directions for research. Most interventions that have been developed for suicidal teenagers have not focused on differences among suicidal youths, but rather have been predicated on the notion that a single approach might be useful for all such youths.
The importance of considering the differences among suicidal youth is underscored by patterns of differential response to interventions. For example, in Harrington et al. Additionally, in King et al. Different developmental trajectories also are evident in patterns of suicidal behavior over time among youths. Some youth attempt suicide only once and never think seriously about suicide again.
Other youth appear to be more chronically suicidal with persistent morbid ideation and repeated suicide attempts. By definition, youth with different histories of suicidal thoughts and behaviors have different developmental trajectories, and by implication, they likely also have many differences in clinical presentation and history Esposito et al.
Other than the Wood et al. Different interventions may be needed for youth at greater risk for recurrent suicidal behavior than for youth whose suicidal behavior did not occur in the context of multiple and persistent risk factors.
Conner and Goldston have suggested that some youth may evidence traits such as impulsivity and aggression that put them at higher risk for developmental failures such as difficulties in interpersonal relationships, school problems, and legal difficulties.
Such developmental failures may have a cascading effect wherein they set the stage for subsequent difficulties, increase the likelihood of distal risk factors for suicide such as depression and substance use, or even serve as proximal risk factors or triggers for suicidal behavior.
In this regard, multisystemic family therapy is an intervention that explicitly focuses on multiple areas of difficulties and the contexts vrithin which behavioral and emotional problems, including suicidal behavior occur Huey et al. Furthermore, most clinicians would readily admit that working with a suicidal year-old is usually a considerably different task than working with a suicidal year-old. However, most interventions have not explicitly acknowledged developmental differences or different levels of maturity, or the different developmental milestones faced by youth at different ages.
As such, it is not clear if interventions developed to prevent or deter suicidal behavior among adolescents are always appropriate for use across the entire age span of adolescence. The goals of interventions for suicidal adolescents can be broadly conceived of as reducing current distress or resolving a current crisis and preventing episodes of future suicidal behaviors. For example, the YST intervention King et al.
Nonetheless, it is striking that no interventions for suicidal adolescents have been explicitly framed in the language of established relapse prevention approaches for other problems such as alcohol and substance abuse e. Developmentally, an implication of a relapse prevention approach is that experience with a specific behavior and the outcomes of the behavior need to be taken into account when planning for the future.
For example, in therapy, it often is useful for adolescents to focus on identifying triggers of suicidal thoughts or behavior so they can plan how they will cope more effectively with such situations in the future.
The treatments that included a focus on problem-solving skills Donaldson et al. Nonetheless, learning is often context-dependent. As such, skills learned when patients are not acutely distressed or suicidal may not generalize to those situations when they are more distressed or at higher risk. In such tasks, patients are asked to reimagine the situations that culminated in their suicide attempts, and then to describe, or imagine how they might deal with such situations differently to avoid suicidality.
Relapse prevention in the framework of Marlatt and Donovan is a self-control model. However, younger adolescents in particular often do not have appreciable autonomy. A resulting challenge of therapy is to identify opportunities for enhancing self-esteem and self-control given these constraints. The green card intervention of Cotgrove et al.
Suicidal individuals commonly experience ambivalence about participation in treatment and discussions of suicidal behavior. The Rotheram-Borus et al. Nevertheless, these interventions did not specifically address the motivational issues of adolescents that are often associated with treatment drop out.
There are a variety of reasons that suicidal adolescents drop out of therapy prematurely. For example, they may experience shame or embarrassment associated with participating in treatment, may have a desire to put the suicidal crisis behind them, may be uncomfortable discussing past suicidal crises or prevention of future difficulties, or may simply believe that a suicidal crisis cannot possibly recur Goldston, From a developmental perspective, adolescents may not want to be in therapy because participation underscores the fact that they are different from their peers.
In addition, adolescents may fear the reactions of peers if they find out about the attempt. Furthermore, teenagers may be uncomfortable with parental involvement in treatment, particularly when there is conflict between parent and teen or the teen does not want to discuss matters with parents. Parents likewise may not want their youth to continue in therapy because it implies that their adolescent has a problem, or they may question the necessity of adolescents continuing in treatment after the immediate crisis is over.
Parents may reinforce tendencies toward dropping out of therapy when they do not acknowledge the seriousness of what has happened e. Therefore, both suicidal adolescents and their parents or guardians need to be engaged in or motivated by the treatment process. Moreover, such approaches might help resolve ambivalence regarding the need to be in treatment or the need to make changes in the life circumstances in which the suicide attempt occurred, and may be useful in eliciting directions for treatment directly from the adolescent, and thus, more effectively establishing commitment to change.
Motivational approaches also may be useful in increasing the likelihood of follow-through in practicing skills or participating in therapeutic endeavors between and following therapy sessions. In this regard, in a recent analysis of process variables from a randomized controlled trial of cognitive behavior therapy and nondirective supportive therapy for depressed and suicidal teens Donaldson et al. There was a trend for client involvement in treatment, in turn, to be related to the outcome of level of depressive symptoms in CBT but not the nondirective supportive therapy.
Although the results of this study should be interpreted with caution given the small sample size, the findings highlight the importance of the therapist-client relationship in maintaining motivation and involvement in treatment, and the need to be especially sensitive to the emotional state of adolescents who have made suicide attempts.
As mentioned, many interventions for suicidal youth include a focus on family issues, ranging from the home-based interventions e. Parents or caregivers are responsible for accessing and mamtaining services for youth. Parents are also crucial in establishing and mamtaining a viable safety plan including parental or caregiver monitoring of the youth and securing of all potential lethal means of harm to self.
They first watch a video filmed in the community with Native American actors which demonstrates the serious impact of an attempt on individuals, families and the community, as well as elders emphasizing in the Apache language that life is sacred and youth must get help.
Natural Helpers discuss the video with youth and a family member, develop a safety plan, use problem-solving and motivational techniques to reinforce positive aspects of treatment, and screen youth for suicide severity. All team members are tribal members from the community they serve. They also provide members of the Apache Suicide Prevention Team with extensive training offering the needed knowledge and skills to become mental health paraprofessionals.
Download 93 KB. Surveillance for violent deaths. March 20, ; 58 SS01 According to This guide for leading effective trainings includes advice about preparing for the training, teaching terminology, presenting issues of transgender Podcasts at CDC: Suicide. This collection includes the following podcasts: "Toxicology testing and results for suicide victims" in English and Spanish ; "Preventing suicide Comorbidity: Addiction and other mental illnesses.
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