welcome preventing suicide among justice-involved youth: newly developed tools, recommendations, and...

Welcome

Preventing Suicide among Justice-Involved Youth: Newly Developed Tools, Recommendations, and Research

Thursday, 17 April 20141:30-2:30pm EDT

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Youth in Contact with Juvenile Justice System Task Force

Preventing Suicide among Justice- Involved Youth: Newly Developed

Tools, Recommendations, and Research

Joseph J. Cocozza, PhD – Director, National Center for Mental Health and Juvenile Justice

Linda A. Teplin, PhD – Vice-Chair for Research, Department of Psychiatry & Behavioral Sciences,

Feinberg School of Medicine, Northwestern University

Katherine Deal, MPH – Deputy Secretary, National Action Alliance for Suicide Prevention

17 April 2014

Presenters

Facilitator

Acknowledgments


About the Action Alliance

Vision: A nation free from the tragic experience of suicide.

Mission: To advance the National Strategy for Suicide Prevention (NSSP) by:

• Championing suicide prevention as a national priority

• Catalyzing efforts to implement high-priority NSSP objectives

• Cultivating the resources needed to sustain progress

Goal: Save 20,000 lives over the next five years.


About the Action Alliance

Current initiatives: Developing the Action Alliance Framework for Successful

Messaging to change public conversation

Improving healthcare for at-risk individuals (e.g. clinical workforce preparedness, quality of care, healthcare reform)

Increasing quality, timeliness, and usefulness of surveillance data

Disseminating a first-ever prioritized research agenda

Improving support for survivors of suicide attempts and loss

Improving workplace suicide prevention (e.g. law enforcement)

Work for other populations and settingsYouth in Contact with Juvenile Justice System Task Force

About the Speakers

Joseph J. Cocozza, PhD

Director – National Center for Mental Health and Juvenile Justice; Policy Research Associates, Inc.

Co-lead – Youth in Contact with the Juvenile Justice System Task Force


About the Speakers

Linda A. Teplin, PhD

Vice-Chair for Research – Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University

Member – Suicide Research Workgroup, Youth in Contact with the Juvenile Justice System Task Force


Co-leads:

Melodee Hanes, JD – Acting Administrator, Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, US Department of Justice

Joseph J. Cocozza, PhD – Director, National Center for Mental Health and Juvenile Justice, Policy Research Associates

Youth in Contact with the Juvenile Justice System Task Force


Why Focus on this Population?

Youth involved with the juvenile justice system have a higher risk of suicide than non justice-involved youth.

Youth in juvenile justice residential facilities have nearly 3x the rate of suicide compared with their peers in the general population.

Suicide is the leading cause of death for youth in juvenile confinement.

Up to one-third of justice-involved youth report having experienced suicidal ideation in the past year.


Task Force Goal

The task force was established to focus attention on the unique needs of youth in the juvenile justice

system and develop new suicide prevention resources for the juvenile justice field.


Task Force Objectives


Raise awareness Review and integrate the available research Provide guidance around suicide prevention

programming and training Encourage greater collaboration among the mental

health and juvenile justice systems

The task force included leading experts in the field organized into workgroups to address the four objectives.

Public Awareness and EducationWorkgroup Members

Lead: Deborah Stone, ScD, MSW, MPH, Behavioral Scientist, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Christy (Lentz) Malik, MSW, Senior Policy Associate, National Association of State Mental Health Program Directors

Roy Praschill, Director of Operations, National Association of State Mental Health Program Directors

Steffie Rapp, LCSW-C, Program Manager, Office of Juvenile Justice and Delinquency Prevention

Kathleen Skowyra, Associate Director, National Center for Mental Health and Juvenile Justice


Suicide Research Workgroup Members

Lead: Denise Juliano-Bult, MSW, Chief, Systems Research Programs and Disparities in Mental Health Research Programs, National Institutes of Health

Laurie Garduque, PhD, Director, Justice Reform John D. and Catherine T. MacArthur Foundation

Thomas Grisso, PhD, Director, National Youth Screening Assessment Project, University of Massachusetts Medical Center

Karen Stern, PhD, Social Science Analyst, National Institutes of Justice Barbara Tatem-Kelley, MA, MEd, Program Manager, Office of Juvenile

Justice and Delinquency Prevention Linda A. Teplin, PhD, Vice Chair of Research, Director of Health Disparities

and Public Policy, Northwestern University, Feinberg School of Medicine Additional contributors include Karen M. Abram, PhD, Kathleen P. McCoy,

PhD, and Marquita L. Stokes, MA, Northwestern University


Prevention Programming and TrainingWorkgroup Members

Lead: Ned Loughran, MA, Executive Director, Council of Juvenile Correctional Administrators

Karen Abram, PhD, Associate Professor, Health Disparities Program, Northwestern University, Feinberg School of Medicine

Donald Belau, PhD, Psychologist, Geneva Youth Residential Treatment Center

Lindsay Hayes, MS, Project Director, NCIA Jail Suicide Prevention and Liability Reduction, National Center for Institutions and Alternatives

Shawn Marsh, PhD, Chief Program Officer, National Council of Juvenile and Family Court Judges

Kara McDonagh, MSW, Program Manager, Office of Juvenile Justice and Delinquency Prevention

Nicholas Read, MA, Research Analyst, Human and Social Development, American Institutes for Research


Collaboration Workgroup Members

Lead: Eric Trupin, PhD, Director, Division of Public and Behavioral Health and Justice Policy, University of Washington

David DeVoursney, MPP, Program Analyst, Substance Abuse and Mental Health Services Administration

Simon Gonsoulin, MEd, Principal Research Analyst, American Institutes for Research

Carl Wicklund, Executive Director, American Probation and Parole Association

James Wright, MS, LCPC, Public Health Advisor, Substance Abuse and Mental Health Services Administration


Public Awareness and Education Workgroup

Objective

To promote awareness among individuals who work with adjudicated youth and youth at risk of delinquency, and the public at large, that there is an increased risk for suicidal behaviors in youth involved with the juvenile justice system and that suicide for this target population is preventable.


Primary Products

Title: Need to Know: A Fact Sheet Series on Juvenile Suicide

Overview: Provides practical information about suicide prevention to three distinct groups: 1) judges and juvenile courts, 2) juvenile detention and secure care staff, 3) juvenile probation staff. Each fact sheet includes: Prevalence of suicide among youth in the juvenile justice system and

factors that may increase suicide risk Practical steps that staff can take to prevent suicide Practical steps that systems (i.e., juvenile courts, detention and secure

care facilities, probation departments) can take to prevent suicide

http://actionallianceforsuicideprevention.org/JJFactSheets


Selected Key Findings

Youth involved with the juvenile justice system have increased risk of suicide.

There are factors that may increase the risk of suicide among justice-involved youth, such as mental health or substance use disorders, suicide or other death of friend or family member, social isolation, relationship problems, or separation from family.

There are steps that juvenile justice personnel and systems can take to prevent suicide.


Suicide Research Workgroup

Objective

To review current research on suicide and its prevention among juvenile justice-involved youth to identify gaps and make recommendations for future research.


Primary Products

Title: Suicidal Ideation and Behavior Among Youth in the Juvenile Justice System: A Review of the LiteratureOverview: Summarizes relevant peer-reviewed literature on suicide in the juvenile justice system and identifies gaps and needed research directions.

http://actionallianceforsuicideprevention.org/system/files/JJ-5-R1-Literature-Review.pdf

Title: Screening and Assessment for Suicide Prevention: Tools and Procedures for Risk Identification and Risk Reduction Among YouthOverview: Examines the juvenile justice system’s responsibilities for identifying youth at risk of suicide, the contexts in which screening and assessment instruments are used, and specific instruments available to advance suicide prevention efforts.

http://actionallianceforsuicideprevention.org/system/files/JJ-6-R2-Screening-Assessment.pdf



New research studies must be conducted to determine a current and reliable rate of suicide prevalence among youth involved in the juvenile justice system.

Information on the number of attempts, preparatory acts, method of attempts, etc. remains scant, which hinders the development of research-based suicide prevention programming.

Little has been done to-date to empirically test the effectiveness of preventative interventions and programs in reducing suicide risk among justice-involved youth.

Juvenile justice providers should implement currently available tools for detecting and intervening with youth at risk for suicide.


Suicide Prevention Training and Programs Workgroup

Objective

To develop a national strategy for implementing accepted guidelines for juvenile suicide prevention at each critical intervention point within the juvenile justice processing continuum.


Primary Product

Title: Guide to Developing and Revising Suicide Prevention Protocols for Youth in Contact with the Juvenile Justice System

Overview: Describes eight critical components of a sound juvenile suicide prevention program and strategies for implementing components across all points of contact within the juvenile justice system.

http://actionallianceforsuicideprevention.org/system/files/JJ-7-P1-ProtocolGuidelines.pdf



Suicide prevention programs should include strategies at all points of contact within the juvenile justice system, including: referral/arrest, courts, probation, detention and secure/non-secure care facilities, and aftercare.

Critical components of a comprehensive juvenile suicide prevention program – such as training, identification, housing, and treatment planning – should be incorporated at each point of contact.


Mental Health and Juvenile Justice System Collaboration Workgroup

Objective

To identify strategies for improving the level and quality of collaboration between the juvenile justice and mental health systems around juvenile suicide prevention and offer recommendations for promoting greater collaboration.


Primary Product

Title: Preventing Juvenile Suicide through Improved Collaboration: Strategies for Mental Health and Juvenile Justice Agencies

Overview: Recommends priorities and strategies that mental health and juvenile justice agencies at the state and local levels can pursue to inform joint policy and budgeting decisions associated with suicide prevention for youth involved in juvenile justice. Provides an environmental scan tool with which jurisdictions can assess strengths, weaknesses, opportunities, and threats across priority areas.

http://actionallianceforsuicideprevention.org/system/files/JJ-9-C2-CollaborationFullVersion.pdf



Thoughtfully planned collaboration across all levels of government and jurisdiction is strongly urged.

Overarching collaborative priorities and strategies are offered to foster joint policy and budgeting decisions associated with suicide prevention for justice-involved youth.


Suicide Research Workgroup


Goals

1) Estimate prevalence of recent and past suicidal

ideation and attempts

2) Examine gender and racial/ethnic differences

3) Identify associated risk factors

4) Suggest future directions for research


Method

2 independent reviewers Databases: MEDLINE/PubMed, PsycINFO, PsycARTICLES Search and inclusion criteria:

Epidemiologic studies, conducted in USPublished since 1990Empirical studies Examined suicidal ideation or attempts


Study Selection

Identified 27 studies

Omitted 3 studies because

they reported scale means, not

prevalence

Final database: 24

studies


How Did Studies Vary?

Point of contact and adjudication status

Measures of suicidal behavior

Recall periods (“recent,” past year, lifetime)


Overall Prevalence Rates

Overall Prevalence Rates

Recent a Past Year Lifetime

Suicidal Ideation

3 – 52%(n = 12) b

10 – 29.2%(n = 4)

11.8 – 58%(n = 7)

Suicide Attempts

1.4 – 8.5%(n = 9)

7.6 – 24%(n = 5)

10 – 31%(n = 17)

a Recent assessment period ranges from “current” up to 6 monthsb n=Number of studies


Gender Differences

Gender Differences

Recent Past Year Lifetime

Suicidal Ideation

Females > Males (n = 5)



Suicide Attempts

1.4 – 8.5%(n = 3)




Racial/Ethnic Differences

Racial/Ethnic DifferencesRecent Past Year Lifetime

Suicidal Ideation

W > AA, H (n = 2)

Females: H > AA

W > AA, H (n = 1)

----

Suicide Attempts

W > AA, H(n = 3)

W > AA, H (n = 1)

W > AA, H (n = 3)

W & H > AA

(n = 1)

Males: W > AA & HFemales: W & H > AA


Suicidal Ideation: Point Of Contact

Recent Past Year LifetimeYOUTH IN THE COMMUNITY

Pre-Adjudication 8 – 12.7%(n = 2)

--- 11.8%(n = 1)

Post-Adjudication 29.5%(n = 1)

--- 22%(n = 1)

YOUTH IN SECURE FACILITIESDETENTION

Intake to detention 3 – 21%(n = 4)

10%(n = 1)

13.9 – 36%(n = 3)

During detention 36.2 – 52%(n = 2)

--- ---

POST-DISPOSITION

Intake to post-disposition facility 9.6%(n = 1)

--- ---

During stay at post-disposition facility 7.7%(n = 1)

--- 51 – 58%(n = 2)

YOUTH AT MULTIPLE POINTS OF CONTACT

Combined samples18%

(n = 1)19 – 29.2%

(n=3)---


Suicide Attempts: Point Of Contact

Recent Past Year LifetimeYOUTH IN THE COMMUNITY

Pre-Adjudication 1.4 – 2.9%(n = 3)

--- 10 – 13.2%(n = 3)

Post-Adjudication 2.5%(n = 1)

7.6 – 24% (n =2)

12.2 – 16.3%(n = 2)

YOUTH IN SECURE FACILITIESDETENTION

Intake to detention 3 – 3.7%(n = 2)

--- 11 – 27%(n = 5)

During detention 8.5%(n = 1)

9.5%(n = 1)

15.5 – 31%(n = 2)

POST-DISPOSITION

Intake to post-disposition facility 3.1%(n = 1)

--- 12.3%(n=1)

During stay at post-disposition facility --- 19.3%(n = 1)

25.5%(n = 1)

YOUTH AT MULTIPLE POINTS OF CONTACT

Combined samples 2.4%(n = 1)

15.5%(n = 1)

12.4 – 14.4%(n = 3)


Risk Factors

Psychopathology

• Depression

Substance abuse

History of sexual abuse

History of physical abuse


Overall Limitations

Inconsistency in measures

Little information on where in the process samples were

drawn

Few statistics on completed suicides

Few data on Hispanics

Insufficient information on females


Recommendations For Future Research

Study different points of contact

Studies of females and racial/ethnic minorities, e.g., Hispanics

Examine additional risk and protective factors

Evaluate screening tools and procedures

Evaluate effectiveness of preventive interventions


Improve Current Practices

Routinely screen for suicidal ideation

Provide interventions during in facilities

Provide referrals when youth return to their

communities


Q&A

Please use “Submit a Question” on the right side of the screen to

send your question to the speakers.


Thank You

Visit the Action Alliance website:• www.ActionAllianceForSuicidePrevention.org – more

information about the Action Alliance and the NSSP• www.ActionAllianceForSuicidePrevention.org/task-

force/juvenilejustice – more information about the task force

Contact:• [email protected]• [email protected]


welcome preventing suicide among justice-involved youth: newly developed tools, recommendations, and...

Documents

office of juvenile justice

juvenile justice linda

settings youth

acknowledgments youth

office of justice programs

colead youth

suicide prevention nssp

research joseph