Brief Suicide Intervention for Youth in Juvenile Detention Settings

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT05225103

Enrollment

Registered

2022-02-04

Start date

2023-04-07

Completion date

2024-02-29

Last updated

2025-08-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Suicide Prevention

Keywords

Juvenile detention, suicidal thoughts

Brief summary

This is an intervention development study and therefore is not designed or powered to test hypotheses. Following initial development and refinement of intervention and protocol, an open trial will be conducted at one juvenile detention facility (n=20). Following further refinement, six juvenile detention sites will be randomized to first or second wave of intervention implementation. All youth at an implementation site in suicidal crises will receive the intervention. Data will only be collected from youth with prior assent/consent. Youth will be assessed at the time of the suicidal/self-harm crisis, and at 2 and 4 weeks after initial intervention, and at a two-month follow-up assessment. We will preliminarily examine feasibility of the intervention and associated patterns of suicidal thoughts and behavior and non-suicidal self-injury, linkage to care following release, and presumed mechanisms of change such as hopelessness, self-efficacy to remain safe, urgency to act on suicidal thoughts, and acceptance.

Detailed description

The primary objective of this phase of the study is to develop and refine procedures for the new multi-faceted intervention for trauma-informed suicide prevention (brief cognitive-behavioral and trauma-informed strategies and safety planning for youth who are suicidal and/or self-harming, as well as training of staff in trauma-informed crisis management and de-escalation strategies) for youth in juvenile detention settings. An associated objective is to develop procedures for training staff working with youth in short-term juvenile detention settings to conduct the new intervention for reducing suicidal thoughts and behavior. A third objective is to examine the feasibility of this trauma-informed suicide prevention intervention in terms of initial participant recruitment, fidelity to the treatment model, treatment acceptability, and monitoring of adverse events in an open trial (n=20). This intervention will be iteratively refined during this open trial based on feedback from youth and staff, and experiences using the intervention in juvenile detention. We will also gather information regarding the presumed mechanisms of action and targeted outcomes for this intervention (although the small open trial will not be able to statistically examine effects). As an intervention development study, this study is not powered to test hypotheses. Rather, the purpose of this study is to demonstrate feasibility and acceptability of the intervention and procedures, and to demonstrate viability of the proof of concept. The study is a collaboration between Duke and Wake Forest investigators, and Juvenile Justice in the NC Department of Public Safety.

Interventions

BEHAVIORALSAFETY-Acute intervention

The trauma-informed brief suicide intervention based on the SAFETY-A (single crisis session in addition to follow-up caring contacts). Delivered in addition to usual care in facilities.

Study design

Allocation

Intervention model

SINGLE_GROUP

Primary purpose

TREATMENT

Masking

NONE

Intervention model description

Open Trial is Single Group.

Eligibility

Sex/Gender

ALL

Age

13 Years to 18 Years

Healthy volunteers

Yes

Inclusion criteria

* English speaking * At least 13 years of age or older and 18 years old or younger * Without evidence from school or other records of intellectual disability * Without evidence of active psychosis * Not wards of the state * Risk for suicidal behavior or non-suicidal self-harm behavior

Exclusion criteria

* Not English-speaking or caregivers are not English-speaking * Wards of the state * Younger than 13 years old or older than 18 years of age * Evidence from school or other records or suspected intellectual disability * Active psychosis

Design outcomes

Primary

Measure	Time frame	Description
Number of Participants Who Reported Non-Suicidal Self Injury	Up to 2 month follow-up assessment	Assessed with Questions from the Self-Injurious Thoughts and Behavior Interview.
Number of Participants Who Were Linked to Mental Health Services After Release	Up to 2 month follow-up assessment	Assessed by CASA (Child and Adolescent Services Assessment) Parent Interview.
Number of Participants Who Reported Suicide Attempts as Measured by the Columbia Suicide Severity Rating Scale (C-SSRS)	Up to 2 month follow-up assessment	Determined by a response of yes to question #6 on the C-SSRS: Have you done anything, started to do anything, or prepared to do anything to end your life?

Secondary

Measure	Time frame	Description
Number of Participants Reporting Self-Efficacy in Keeping Safe	Up to 2-month follow-up assessment	Adapted from items used by Czyz (2016, 2019). The number of participants reporting that they very much agreed that they felt confident in keeping themselves safe is reported.
Number of Participants Reporting Urgency to Act on Suicidal Thoughts	Up to 2-month follow-up assessment	—
Number of Individuals With Emergency Mental Health Services (ED Visits and Hospitalizations)	Up to 2-month follow-up assessment	Assessed by CASA (Child and Adolescent Services Assessment) Parent Interview.
Number of Participants Reporting Hope and Reasons for Living After Leaving the Facility	Up to 2-month follow-up assessment	Adapted from items used by Cyzz et al. (2020) and Zullo et al. (2021). Number of participants who report they strongly agree that they have hope for the future and reasons for living after leaving the facility.
Number of Participants Who Report Acceptance of Their Current Situation	Up to 2-month follow-up assessment	—

Countries

United States

Participant flow

Recruitment details

Eligible youth were asked to assent to the study after being admitted to the facility, and parents and caregivers were then approached for consent.

Pre-assignment details

Data were only collected from the 8 youth who were identified as being acutely suicidal and who then received the new intervention.

Participants by arm

Arm	Count
SAFETY-A Implementation Sites New Brief Trauma-Informed Intervention (based on SAFETY-A) in addition to Enhanced Usual Care in Juvenile Detention Sites SAFETY-Acute intervention: The trauma-informed brief suicide intervention based on the SAFETY-A (single crisis session in addition to follow-up caring contacts). Delivered in addition to usual care in facilities.	8
Total	8

Baseline characteristics

Characteristic	SAFETY-A Implementation Sites
Age, Categorical <=18 years	8 Participants
Age, Categorical >=65 years	0 Participants
Age, Categorical Between 18 and 65 years	0 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	2 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	6 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants
Race (NIH/OMB) American Indian or Alaska Native	2 Participants
Race (NIH/OMB) Asian	0 Participants
Race (NIH/OMB) Black or African American	5 Participants
Race (NIH/OMB) More than one race	1 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants
Race (NIH/OMB) White	0 Participants
Region of Enrollment United States	8 Participants
Sex: Female, Male Female	3 Participants
Sex: Female, Male Male	5 Participants

Adverse events

Event type	EG000 affected / at risk
deaths Total, all-cause mortality	0 / 8
other Total, other adverse events	1 / 8
serious Total, serious adverse events	0 / 8

Outcome results

Primary

Number of Participants Who Reported Non-Suicidal Self Injury

Assessed with Questions from the Self-Injurious Thoughts and Behavior Interview.

Time frame: Up to 2 month follow-up assessment

Population: Data not collected on one participant.

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
SAFETY-A Implementation Sites	Number of Participants Who Reported Non-Suicidal Self Injury	1 Participants

Primary

Number of Participants Who Reported Suicide Attempts as Measured by the Columbia Suicide Severity Rating Scale (C-SSRS)

Determined by a response of yes to question #6 on the C-SSRS: Have you done anything, started to do anything, or prepared to do anything to end your life?

Time frame: Up to 2 month follow-up assessment

Population: Data not collected on one participant.

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
SAFETY-A Implementation Sites	Number of Participants Who Reported Suicide Attempts as Measured by the Columbia Suicide Severity Rating Scale (C-SSRS)	1 Participants

Primary

Number of Participants Who Were Linked to Mental Health Services After Release

Assessed by CASA (Child and Adolescent Services Assessment) Parent Interview.

Time frame: Up to 2 month follow-up assessment

Population: Data not collected on four participants.

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
SAFETY-A Implementation Sites	Number of Participants Who Were Linked to Mental Health Services After Release	3 Participants

Secondary