From Court to the Community: Improving Access to Evidence-Based Treatment for Justice-Involved Youth At-Risk for Suicide

Rhode Island Hospital, Providence RI

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY Justice-involved youth (JIY) living in the community experience disproportionately high rates of suicidal thoughts and behavior (STB) and non-suicidal self-injury (NSSI) compared to adolescents in the general population. Many JIY lack access to evidence-based treatment specifically designed to treat NNSI and STB, thereby increasing the overall risk of suicide in this population. Further, even when JIY do have access to evidence-based treatment, treatment initiation in this population is low. The current proposal aims to reduce STB and NSSI among JIY, and thus reduce mental health differences in this vulnerable youth population in need of services. Our primary aim is to implement a systems-level training program, used by the investigators on psychiatric inpatient and emergency services, designed to increase access to evidence-based treatment strategies specifically designed to treat STB and NSSI behaviors for JIY referred to outpatient care by the Rhode Island Family Court, approximately 1,125 over a 5-year period. We will conduct a cluster randomized stepped wedge trial in which 9 distinct community mental health agencies (CMHA) who serve JIY in the state of Rhode Island will be randomized to receive a standardized training program. CHMA administrators and providers will complete semi-structured qualitative interviews and self-report measures pre-implementation. The self-report measures will be repeated postimplementation, and sustainment. Guided by the RE-AIM framework, we will identify agency/system-level and provider-level factors that may promote or hinder the uptake, implementation, and maintenance of the evidencedbased treatment strategies for STB and NSSI in CMHAs serving JIY living in the community. It is hypothesized that at the systems level, the training program will be sustained for at least one year, and up to 3 years in some cases, by CMHA administrators. At the provider level, it is hypothesized that training in the use of evidencebased treatment strategies for STB and NSSI will significantly increase both the use of these strategies and the quality of their delivery post-implementation. At the patient level, we hypothesize that the training program will improve adherence to outpatient treatment, increase receipt of evidence-based treatment strategies, and reduce rates of adolescent STB and NSSI that require emergency medical/psychiatric care. This application has strongly aligns with the goals of RFA-MH-21-187, to test effective “systems-level strategies for the detection and prevention of SIB and/or NSSI specifically among underserved children and adolescents.”