Suicide Intervention Training for Adults Working with High-Risk Youth in the Child Welfare System

Background

There are over 400,000 children in the Child Welfare(CW) system across the US. It is estimated that 27% of youth involved in the CW system experience suicidal thoughts and behaviors compared to 16% of non-CW youth (He et al.,2015). Higher rates of suicidal ideation are reported for youth with a history of foster care placement as compared to their counterparts in kinship, residential, or in-home care (26.5%vs11.4%) (Pilowsky&Wu,2006).

The “Youth Depression and Suicide: Let’s Talk”(YDS) gatekeeper training was developed by the Massachusetts Society for the Prevention of Cruelty to Children (2010) and the Massachusetts Department of Children and Families. The goal of the training is to decrease suicide and suicidal behavior with youth through the use of evidence-based and sustainable suicide intervention practices.  The training was supplemented with a new module on adverse effects of medication (e.g.akathisia) related to suicidal behavior

The aim of this study was to test the impact of the YDS training on:

• Knowledge about risk factors and warning signs
• Attitudes about suicide
• Self-efficacy for intervening with high-risk youth
• Reluctance to engage in intervention
• Use of intervention behaviors

Method

Training was conducted with 44 employees with direct contact with youth receiving services a local agency. Approximately 60% of youth were involved in the CW system. Data were collected at pre-training, post-training, and 3- and 6-months.

Results 

Results indicate that providers are interacting regularly with suicidal youth. Nearly 86% of participants reported encounters in the previous 3 months (M=6). At the 3-month follow-up 74% reported identifying youth with suicidal thoughts in the previous 3-months. At the 6-month follow-up 77% reported identifying youth with suicidal thoughts in the previous 3-months. Staff rated the likelihood of encountering a suicidal youth as part of their job as “likely”.

Most participants reported previous on-the-job suicide training (76%). Approximately 79% reported they were aware of agency protocol regarding suicidal youth, with 85% having read the protocol.

Large effects (F_(3,90)=15.16,p<.001;η²=.32) were observed for changes in participants’ knowledge about suicide and suicide intervention (declarative and self-perceived level of knowledge).

No statistically significant longitudinal differences were observed in attitudes towards suicide/intervention or reluctance to engage with suicidal youth. Notably, results were very desirable even pre-training.

Statistically significant differences (F_(3,90)=6.75,p<.001) in self-efficacy were found between pretest and all other observations with a moderate effect size(η²=.18). Similar results for perceived preparedness were also observed (F_(3,90)=13.82,p<.001;η²=.31).

Very small increases were observed for global measures of assessment and intervention. Statistically significant improvements were observed for specific behaviors related to asking about suicide in response to warning signs. Spending time listening to youth was the only statistically significant intervention behavior, but it is considered the primary behavioral outcome of the training. Modest increases in behavioral outcomes show promise for the impact of the training.  

Discussion

The project produced positive outcomes linked to services for youths’ mental health needs. YDS was developed specifically for use in CW systems but could be further developed to be more specific to this population of youth and providers. Recommendations for improvements will be provided.