1
|
Meza JI, Zullo L, Vargas SM, Ougrin D, Asarnow JR. Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with intervention benefits. J Child Psychol Psychiatry 2023; 64:1409-1421. [PMID: 36878853 DOI: 10.1111/jcpp.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self-harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. METHODS A systematic search of RCTs evaluating interventions targeting suicide/self-harm in youth (ages 12-18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty-seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self-harm behavior (n = 11 supported trials) and those without supported evidence (n = 7 unsupported trials). RESULTS Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship-building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self-harm monitoring and safety planning. CONCLUSIONS This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self-harm behaviors.
Collapse
Affiliation(s)
- Jocelyn I Meza
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lucas Zullo
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sylvanna M Vargas
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry and Global Mental Health, Queen Mary University of London, London, UK
| | - Joan R Asarnow
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Simes D, Shochet I, Murray K, Gill DJ. Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study. Psychother Res 2023:1-19. [PMID: 37748115 DOI: 10.1080/10503307.2023.2253360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.
Collapse
Affiliation(s)
- Di Simes
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- New South Wales Health, Australia
| | - Ian Shochet
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kate Murray
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | |
Collapse
|
3
|
Asarnow JR, Clarke GN, Miranda JM, Edelmann AC, Sheppler CR, Firemark AJ, Zhang L, Babeva K, Venables C, Comulada S. Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:1-14. [PMID: 38799772 PMCID: PMC11114629 DOI: 10.1080/23794925.2023.2208382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide-prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes 1) our screening and case identification process, 2) variation among adolescents versus young adults; and 3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk-indicators: 97% past-year suicidal ideation, 83% past suicidal behavior; 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported: more past-year suicide attempts (47% vs 21%, p<.001) and NSSI (past 6-months, 64% vs 39%, p<.001); less depression, anxiety, posttraumatic stress, and substance use; and greater social connectedness. Pandemic-onset was associated with lower participation of racial-ethnic minority youths (18% vs 33%, p<.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide-prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic-onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.
Collapse
Affiliation(s)
- Joan R Asarnow
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Greg N Clarke
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Jeanne M Miranda
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Anna C Edelmann
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | | | - Alison J Firemark
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Lily Zhang
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Kalina Babeva
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
- Seattle Children’s Hospital, Seattle, WA
| | - Chase Venables
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Scott Comulada
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
4
|
Hughes JL, Asarnow JR. Implementing and Adapting the SAFETY Treatment for Suicidal Youth: The Incubator Model, Telehealth, and the Covid-19 Pandemic. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|