SCCAP/Miami International Child & Adolescent Mental Health (MICAMH) Conference/2019/Day 2

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Day 2[edit | edit source]

Keynotes[edit | edit source]

Deconstructing Serendipity and School-Based Mentoring for Chronically Bullied Children[edit | edit source]

Presenter: Timothy A. Cavell, Ph.D., Professor, Department of Psychological Science, University of Arkansas


Learning Objectives:[edit | edit source]

Identify prevailing theories guiding youth mentoring programs
Describe the conceptual origins of Lunch Buddy mentoring
Become familiar with empirical research related to Lunch Buddy mentoring for chronically bullied children

Predicting Longitudinal Outcomes of Childhood ADHD[edit | edit source]

Presenter: Steve S. Lee, Ph.D., Professor, Department of Psychology, University of California, Los Angeles


Learning Objectives:[edit | edit source]

To analyze the academic, socio-emotional, and clinical outcomes of children with ADHD through adolescence and adulthood
To evaluate evidence of the strongest early predictors of differences in these outcomes
To discuss implications for clinical assessment and intervention

Adolescent Suicide Prevention[edit | edit source]

Presenter: Cheryl A. King, Ph.D., Professor, Departments of Psychiatry and Psychology, University of Michigan



  • Suicide is the second leading cause of death among adolescents [1]
    • 2,877 deaths in 2019 in U.S., ages 13-19 years
      • Increase in suicide rates begin at around age 13
      • Higher rates in males than females
    • Intervene to prevent later morbidity and mortality/suicide
  • Suicide increased by 25% from the turn of the century in the United States
  • Suicide Prevention Focus: Upstream and Downstream
    • Create Protective Environments
      • Prevent child maltreatment and interpersonal violence (e.g., bullying, victimization)
      • Reduce substance use and availability
      • Reduce access to lethal means
    • Identify and Support Those At Risk (in clinical settings)
      • Use “Gatekeeper” strategy
      • Screen for suicide risk : how to recognize/identify those carrying suicidal thoughts or plans
      • Provide psychotherapy and intervention

Learning Objectives:[edit | edit source]

Describe one school-based intervention program that has been shown to reduce levels of suicide risk in early adulthood
  • Long-Term Effects of Family Check-Up on Risk of Suicide in Early Adulthood [2]
    • A school-based prevention program, initiated in the 6th grade, that was designed to reduce substance use and behavior problems by improving parenting skills and family functioning
    • Multi-level study
      • Universal screening with family resource center in schools
      • Family Check-Up (FCU) – High-risk youth referred
      • Family Management Training – Indicated intervention
    • There were 998 adolescents and families in this randomized trial
      • High-risk youth defined by teacher ratings
      • Student surveys and teacher reports
      • Suicide Risk at Outcome:
        • Composite International Diagnostic Interview
        • Administered at 18-19 years and 28-30 years
    • Among youth those who engaged in Family Check-Up (the intervention group):
      • Intervention status related to suicide risk at ages 18-19 and 28-30
        • Idea that targeting substance abuse and aggression could have impacts on suicide rates
      • Youth in intervention condition reported lower levels of suicide risk (controlling for earlier suicide risk)
      • A prevention trial “cross-over” effect on suicide risk outcomes
Discuss two different adolescent suicide risk screening strategies
  • Identifying Youth at Risk
    • Garrett Lee Smith: Youth Suicide Prevention Gatekeeper Training Program [3]
      • The Gatekeeper method involves training community members as “gatekeepers” in recognizing youth at risk
      • Multi-state evaluation indicated one-year reduction in youth suicide deaths and suicide attempts (population-based county comparison). However, the results were not maintained: the rates of suicide deaths and suicide attempts between the intervention and control groups did not differ 2 years after training
      • These results indicate moderate, short-term benefit, demonstrating the need to do this every year.
    • Social media is a mode for recognizing suicide risk
      • Youth are using social media to communicate suicidal thoughts/intent
      • Research has focused on case identification
        • Ex: machine learning algorithms to identify high risk for suicide based on Twitter data
      • Empirical studies needed to understand the usefulness of these approaches for youth suicide prevention
  • Proactive screening instruments that identify youth at risk
    • Ask Suicide-Screening Questions (ASQ) is a publicly available screening that has questions regarding suicidal ideation and history of attempts [4]
      • Identifies previously unrecognized youth at risk
    • Tri-Risk Factor Screen is a screening test that identifies previously unrecognized youth at risk
      • Explores three key factors: suicidal ideation/recent attempt, alcohol/substance use, and depression
      • Has been associated with risk of suicide attempt within 2 months; Can set threshold for risk likelihood - # risk factors
    • Columbia Suicide-Severity Rating Scale is a screening instrument that predicts likelihood one returns to the psychiatric department due to suicide risk
      • Suicidal ideation, actual/aborted/interrupted attempt, nonsuicidal self-injury, preparatory behavior [5]
      • Scores predict suicide-related Emergency Department visits
Name and describe at least one psychotherapy approach associated with reduced risk of suicide attempts among adolescents
  • Dialectical Behavior Therapy for Adolescents [6]
    • Based on biosocial theory
    • Treatment includes:
      • Individual treatment for affect regulation & distress tolerance
      • Behavior chain analysis for self-harm
      • Skill building
      • Family intervention
      • Focus on managing strong emotions
    • Recently completed NIMH-funded Random Controlled Trial found:
      • Positive effect for DBT at 6-months (end of treatment)
      • Groups converge over time
  • Attachment-Based Family Therapy [7]
    • Draws upon family systems, attachment, & developmental theories
    • Targets relationship with parents
    • Studies show reduction in depressive symptoms & suicidal ideation
    • Recent RCT – Equivalent
  • Safe Alternatives for Teens and Youth Program [8]
    • 12-week intervention with CBT and DBT principles
    • Recruits suicide-attempting and self-harming youth
    • Links them to both individual and family therapist
    • Treatment aims to:
      • Increase protective supports
      • Decrease suicide-related behaviors
      • Develop safety plan
      • Restrict means
    • Random Control Trial demonstrated significantly lowered risk for suicide attempt at 3-month follow-up [9]
  • Youth-Nominated Support Team Intervention for Suicidal Adolescents (YST) [10]
    • Social Support and Health Behavior Intervention Conceptual Models
    • A psychoeducational, social support intervention. Adolescents nominate “caring adults” to be support persons to them after hospitalization. These adults attend psychoeducational session and receive weekly telephone calls from YST staff for 3 months.
      • The YSF staff had individual meetings with the nominated adults where they reviewed guidelines, various crisis phone numbers, and how to listen non-judgmentally to these adolescents
    • Found that youth nominated women more than men, who tended to be older siblings, youth leaders, aunts etc.
    • 448 participants, aged 13 to 17 year old and were psychiatrically hospitalized for suicide risk, were randomized to treatment as usual (TAU) or YST plus TAU (YST).
    • National Death Index records were reviewed. There were 13 deaths in the TAU group and 2 deaths in the YST group (hazard ratio, 6.62; 95% CI, 1.49-29.35; P= 0.004).
    • Results suggest YST intervention is associated with reduced mortality. These results should be replicated to further explore the mechanisms behind the reduced mortality rate

Workshops[edit | edit source]

What Should Mental Health Care Providers Know About Youth Mentoring?[edit | edit source]

Presenter: Timothy A. Cavell, Ph.D., Professor, Department of Psychological Science, University of Arkansas


Learning Objectives:[edit | edit source]

Identify distinct goals underlying use of community- versus school-based mentoring
History of youth mentoring
  • Big Brothers Big Sisters of America began in 1904
  • Began as charity, then became a type of social service for youth from single-parent homes.
  • Aspires to be an evidence-based prevention strategy
  • Today, there are more than 300 bbbs agencies across the u.s.
  • BBBS organizations are also found the world over
  • And—BBBS is the largest but not the only mentoring organization in the u.s.

History of research on youth mentoring First large RCT: Grossman & Tierney (1998)

  • Demonstration study to show that BBBS “works”

All programs followed BBBS standards:

  • Meet 3-4/month for at least 1 hour.
  • Volunteer screening & background checks.
  • Training focused on supportive relationship
  • Matching based on youth/mentor preferences.
  • Monitoring and support of each match.
  • 12-month commitment

The BBBS Impact Study (Grossman & TIierney, 1998)

  • Youth ages 10-16 years
  • Randomized to bbbs (n = 487) or no mentoring (n = 472)
  • Outcomes assessed at bl & 18 months later
  • 47 different outcomes across 5 domains (self-report only)
  • Antisocial activities (e.g., initiated drug use)
  • Academic outcomes (e.g., grades)
  • Family relationships (e.g., communication with parents)
  • Peer relationships (e.g., intimacy in communication)
  • Self-concept (e.g., global self worth)
  • Social and cultural enrichment (e.g., # hours/week in sports or recreation programs)

Results Of The Impact Study

  • Highlighted findings (self report - limitation):
  • 46% less likely to begin using illegal drugs
  • 27% less likely to begin using alcohol
  • 52% less likely to skip school
  • 37% less likely to skip a class
  • 33% less likely to hit someone
  • But overall effects relatively small
  • No impacts on theft, property damage, involvement in

fights, cheating on tests, school referrals, or smoking

  • 43% of matches ended early (before 12 months)

Early ending/disruption of the “promise” leads to poorer outcomes - children who have a mentor or other authority figure who doesn’t show up for them perceive themselves as less attractive

The “Impact” Of The Impact Study

  • Touted as ”proof” that mentoring works
  • Listed by OJJJD as an evidence-based prevention
  • Positive ROI: wa state institute of public policy
    • Most recent score indicates that ROI has been decreasing and possibly negative
  • Used as PR to close the mentoring “gap”
  • Federal funds provided to grow mentoring in the U.S.
    • SMP (Student Mentoring Program) funded by Department of Education
  • Result: tremendous increase in school-based mentoring
    • Going to a school is less risk, more predictable, and often more convenient - more volunteers
    • High schoolers can also be mentors, especially coupled with elementary school kids
    • “Double benefit hypotheses” - both mentee and mentor could benefit

Community- Vs. School-based Mentoring Community-based Mentoring (CBM):

  • Meetings are in the community (i.e., outside of school)
  • Parents usually initiate the referral
  • Parents must actively enroll their child
  • 12-month commitment usually

School-based Mentoring (SBM):

  • Meetings are in the school
  • School staff usually refer
  • Parents need only give consent
  • Commitment usually for the school year only

The 2nd BBBS Impact Study (Herrera et al., 2007; 2011) Due to findings from the CBM Impact Study, SBM increased greatly in the U.S.

  • From 1999 to 2006, 400% growth
  • Much of that involved use of high school mentors

Led BBBS-America to launch a 2nd impact study Poor understanding of how SBM works

  • SBM but guided by a CBM model of mentoring
  • Strong + long = positive outcomes

At the end of the spring semester, mentored youth had significant gains in

  • overall academic performance, science, written and oral language
  • quality of class work
  • serious school infractions
  • scholastic efficacy
  • school attendance

By the end of the fall semester, nearly all gains were lost

  • Only one significant difference - school attendance
  • Disappointing results viewed as due to the shorter
  • Length of the SBM matches
  • BBBS revised SBM to make it look more like CBM
  • One calendar year commitment; not the academic year
  • Involvement during the summer months
  • Limit the use of high school mentors

Almost half the mentors were high-schoolers who leave when they graduate

Doubts About SBM

  • Meta-analysis of 3 large SBM studies (Wheeler et al., 2010)
  • From 2007-09 - 3 large studies of SBM in the U.S. all yielded modest outcomes - Herrera et al.’s (2007/11) study of BBBS SBM, Karcher (2009) study of SMILE (attractiveness perception), Bernstein (2009) study of SMP
  • Found significant effects for 6 of 19 outcomes (p<.10)
    • Range of significant effects was .07-.18 (avg=.11)
    • Modest effects on truancy and school misconduct
    • But limited impact on academics and other areas
  • “One year of participation in a school-based mentoring program tends to have modest effects on

selected youth outcomes. However, the findings for the second year of the BBBS a trial suggest that many of these effects may not persist over time without students’ continued participation in mentoring programs or other supportive services (p. 14).”

  • Results from Bernstein et al. (2009) led to ending department of education funding for SBM

10 Beliefs About Youth Mentoring

  1. Youth mentoring has the potential to help children become healthy, productive adults
    1. Children’s development is influenced by the relationships in their lives (parents, teachers, siblings, peers)
    2. Mentoring is critical to resilience - presence of at least one supportive adult to whom the youth matters (Werner’s work)
    3. Interpersonal relationships can be transformative
      1. Good: secure mother-infant attachments, child friendships, healthy marriages, therapeutic relationships
      2. Bad: child abuse, gang involvement, intimate partner violence
  2. Youth mentoring, as routinely practiced, often falls short of its potential
    1. Researchers who work closely with youth mentoring organizations can have bias or motivation to not be as critical as they should be
    2. Modest effects from meta-analytic studies (1960-2019)
      1. Stein (1987): 1960-1985, 19 studies, mean effect sizes = .15 & .22
      2. Dubois et al. (2002): 1970-1998, 55 studies, effect sizes, mean effect sizes = .14 & .18
      3. Dubois et al. (2011): 1999 to 2010, 73 studies, mean effect size = .21
      4. Tolan et al. (2013): 1970 to 2011, 46 (mainly delinquency) studies, mean effect size = .
      5. Raposa et al. (2019): 1975 to 2017, 70 studies, mean effect size = .21
  3. Youth mentoring will not reach its full potential if we invest too narrowly in the hope that 1-on-1 mentoring relationships will change the life course of at-risk youth
    1. Goal is to have the kid come back the next week - just to be present in their lives
    2. Study waiting to submit looks at attachment tendencies - attachment security matters a lot in romantic relationships, but also mentors
      1. Securely attached mentors do well with conflict
        1. “Attachment overrides conflict”
        2. “You’re responsible for your own health and well-being in a relationship"
      2. BFI
        1. Openness, conscientiousness, extraversion, agreeableness, neuroticism
        2. Openness was the most significant indicator of a good mentor
    3. The history of youth mentoring has shaped theory and research on mentoring
    4. Theoretically, assumed that the benefits of mentoring rise and fall with the quality and length of the relationship (assumption is seldom tested)
    5. Instead we look for and generally find correlational support for them
    6. Close alliance between mentoring organizations and mentoring researchers
    7. Role of risk study (Herrera et al., 2013)
      1. Can mentoring benefit high risk youth?
      2. Few significant impacts; effect sizes =.04 to .14
      3. Unexpectedly, largest effect was for reduced depression
      4. Investigators also found that mentored youth had a larger number of outcome that showed positive change
        1. Analysis based on premise that mentoring is “not an intervention with one or two specific targeted goals but a broad-based intervention that addresses specific and differing needs of participating youth across a wide range of areas” (p. 52)
      5. Meta-analyses by Tolan et al. (2013) indicates that there hasn’t been much progress - especially w/ the end of federal funding
  4. Youth mentoring needs a new frame that updates and improves how we define youth mentoring (2 perspectives)
    1. Mentoring-as-relationship
      1. Outcomes depend on match length and strength (focus of long-term matches)
    2. Mentoring-as-context
      1. Outcomes depend on fit between the specific prevention-oriented activities/experiences provided and targeted risk/protective factors
    3. Proposed definition of formal youth mentoring
      1. The practice of using program-sponsored relationships between identified youth and older volunteers (or paraprofessionals) as a context for prevention-focused activities and experiences
      2. Implications
        1. The relationship could be the primary tool of mentoring, but it wouldn’t have to be
        2. Other change processes are likely operating in more focused, short-term matches
  5. Youth mentoring can better reach its potential if it positioned itself as a sub-discipline of prevention science
    1. Key questions/FAQ
      1. Is youth mentoring a form of prevention?
      2. Is youth mentoring an evidence-based prevention strategy?
      3. How well has research and development of youth mentoring followed the basic tenets of prevention science?
    2. 3 key tenets of prevention science
      1. Prevention begins with current knowledge of fundamental causal processes
      2. Effective prevention targets malleable risk and protective factors implicated in the model of risk
      3. Prevention trials are guided by development theory but yield results that inform and revise that theory
  6. Youth mentoring can better reach its potential if we know when it works, why it works, for whom it works, and we use that knowledge to reproduce positive outcomes
    1. Prevention Research Cycle
      1. Identify burden of disease
      2. Define theories for causation
      3. Establish efficacy
      4. Establish effectiveness
      5. Community effectiveness, economic implications
      6. Implementation
      7. Program evaluation
    2. When youth mentoring research started, it really started with step 7 and didn’t go through the whole cycle
  7. Youth mentoring needs well-specified, testable theories derived from more basic research
  8. A scientific approach to youth mentoring should optimize the fit between models of risk and models of mentoring
    1. Delinquency as an example
      1. Likelihood of “moving on” to delinquency (Patterson et al., 1992)
      2. Aggressive at age 9-10 years -> 50% arrested by age 14 -> 75% 3 or more arrests by age 18 years
      3. Dynamic cascade model of the development of serious violence in adolescence (Dodge et al., 2008)
      4. Youth challenge - voluntary boot camp for 6 months + 1 year youth-chosen mentor
    2. What approach to mentoring could possibly fit this model of risk and protection?
      1. Friends of the Children - identified in K/1st grade, mentored for 12 years by paid professionals
      2. Original model was based on a relationship-based theory of mentoring
      3. Little attention to the cascade of risks
        1. Recent RCT found that significant treatment effects did emerge in grade 5
  9. A scientific approach to youth mentoring should be able to measure the proximal change processes thought to be operating
  10. Evidence-based mentoring will involve a range of programs that vary in target population, format, context, duration, goals, mode of delivery, and reliance on the relationship
    1. Intensive community-based mentoring
      1. Campus connections (Haddock, Weiler)
      2. Friends of the children (Haggerty, Eddy)
    2. Mentoring of foster care youth
      1. Fostering healthy futures (Taussig)
      2. Take charge (Powers, Geenen)
    3. School-based mentoring
      1. Achievement mentoring (Bry)
      2. Academic mentoring program (McQuillin & Lyons)
Recognize the basic structure and goals of Lunch Buddy mentoring

Lunch buddy mentoring - meant to be an inert control condition

  • Based on theory suggesting no benefit if the match is not “strong and long” (watered down)
  • Visits in school cafeteria, 2x week for 30min, new mentor each semester, minimally trained mentors

Outcomes (Hughes et al., 2005; Cavell et al., 2009)

  • Child-rated mentor support was weaker for children w/ lunch buddy mentors but
    • Significant differences at the 1-year and 2-year FU favored lunch buddy mentoring
      • Lower teacher-rated aggression
      • Higher teacher-rated behavioral competence
      • Higher teacher-rated scholastic competence
    • Conflict a better predictor of outcomes than relationship support
    • At 1-year follow-up, lunch buddy children had higher scores on school belonging and teacher-rated school engagement

How might lunch buddy mentoring help children at risk? (Cavell & Henrie, 2010)

  • Enhanced reputation among lunchtime peers?
  • Improved lunchtime peer interactions?
  • Modeling of appropriate social behavior?
  • Increased sense of school belonging?
Describe current research on Lunch Buddy mentoring for chronically bullied children

The plight of the bullied child

  • Bullying is common in the elementary grades
    • For most it’s transitory
    • For some it’s a chronic problem (6-10%)
  • Chronically bullied children are at risk
    • Without help, problems with anxiety, depression, and substance use
    • In extreme cases, youth can become a danger to self or others
  • Bullied children are reluctant to ask for or accept help (believe adult help could make matters worse)

What explains chronic peer victimization?

  • Bullying is a tool used to gain or maintain social status
  • Often directed at children who are different and disliked
  • Chronic victimization fueled by peers’ collective participation in stigmatizing, ostracizing, and dehumanizing children who are different or disliked
  • Chronic victims accept their socially constructed role
  • Helps explain why current anti-bullying interventions might not help chronically bullied children

Examples from lunch buddy mentoring (Craig et al., 2016; Sourk et al., 2018)

  • Proposed change mechanisms
    • Improved peer acceptance, social reputation, and prosocial group membership
  • Measures of proximal change mechanisms
    • Mentors’ rating quality of lunchtime peer interactions after each visit
    • Peer reports of lunchtime peer acceptance
    • Self-rated lunchtime peer acceptance
    • Observational ratings of lunchtime peer interactions

Mechanisms of ADHD Outcomes: What Are the Optimal Intervention Targets?[edit | edit source]

Presenter: Steve S. Lee, Ph.D., Professor, Department of Psychology, University of California, Los Angeles


Learning Objectives:[edit | edit source]

To synthesize evidence of mechanisms underlying ADHD outcomes
To describe how empirical evidence reveals mechanisms and their implications for intervention
To discuss evidence-based assessment and intervention strategies targeting mechanism of outcome

Adolescents at Risk for Suicide: Recognizing Risk, Evaluating Risk, and Managing Care[edit | edit source]

Presenter: Cheryl A. King, Ph.D., Professor, Departments of Psychiatry and Psychology, University of Michigan


Learning Objectives:[edit | edit source]

Discuss at least two key considerations in the implementation of any suicide risk screening program
  • Primary Recognition Strategies
    • Universal Screening - Proactive Identification
    • Gatekeeper Training - Prepare adults to recognize risk and respond
    • School-Based Awareness/Education - Create an accepting and helping culture - increase likelihood that peers will support each other, recognize risk and respond
    • Indicated Screening - clinical settings
  • Challenges in Youth Suicide Risk Screening
    • Finding At Risk Males
    • Socio-demographic and cultural variation
    • Sensitivity and specificity of screening instruments
      • Most screening instruments try to capture as many at-risk youth as possible (high sensitivity), but fail to pair out the false positives (low specificity)
    • Heterogeneity of risk factors
      • Not one simple set of risk factors can be used each time to predict a suicide attempt
      • Many factors to consider: psychopathology, suicidal ideation, history of suicide attempt, family, peer, community, and social context
    • You who deny or conceal suicidal thoughts, or do not experience/report them at time of assessment
  • Promising Screening Instruments
    • Columbia Suicide Severity Rating Scale
      • Assesses suicidal ideation on a spectrum
      • Details actual, interrupted, aborted attempts, preparatory acts, and self-injurious behaviors
    • Tri-Risk Factor screen for Youth Suicide Risk
      • Positive screen is defined by history of suicide attempt, SIQ-JR score above the clinical cut point, and co-occurring depression and alcohol/substance abuse
      • Concurrent validity and utility have been evaluated
    • Computerized Adaptive Testing (CAT)
      • Starts with a large bank of items, and based on the classification outcome (e.g., suicidal event), develops an algorithms that individualizes sequence and content of questions that is dependent on the previous responses
      • Aims to develop a short screen that is personalized and more efficient
      • Benefits of CAT:
        • Streamline assessment in the emergency department
        • Match patients to their needed level of care
        • Reduce the rate of youth suicide attempts
  • Screening Strategies
    • Screen broadly for suicide risk
    • Screen universally: emergency departments, juvenile detention, foster care, etc.
      • Screening in mental health settings is insufficient, especially in respect to males
    • Combine universal, selected, and indicated approaches
      • Emphasis on high risk youth
      • Reduce the prevalence of social/behavioral risks
List the components of a comprehensive suicide risk evaluation
  • Three types of information that we need to do a suicide risk formulation are: risk factors, current suicidal ideation/impulses, and mental status
  • Risk Factor Checklist [11]
    • Demographic Characteristics
      • Male (suicide) vs female (nonfatal suicidal behavior)
      • Black females have the lowest suicide rate
      • Native American/Alaskan Native males have the highest suicide rate
    • Clinical Features
      • Previous suicide attempt
      • Suicidal ideation and/or intent
      • Psychiatric Disorders (depressive or bipolar disorder, alcohol/drug abuse, conduct disorder, PTSD, other)
      • Certain behaviors and characteristics including non-suicidal self-injury, learning disorders, Cluster B traits, hopelessness, impulsivity, insomnia, psychic pain
      • Recent discharge from psychiatric hospital
      • Recent change in treatment
    • Family and Interpersonal Factors
      • Family history of suicidal behaviors
      • Family history of psychiatric disorder
      • Sexual abuse, physical abuse
      • Perceived burdensomeness
      • Bully victimization/perpetration
      • Interpersonal conflict/loss - low connectedness
    • Contextual Factors and Life Stressors
      • Exposure to suicide
      • Access to lethal means of suicide (firearms)
      • Precipitants include: disciplinary action, shame experience, social loss/conflict
  • Accessing Current Suicidal Ideation/Impulses
    • Consider attitudes/approach
    • Be familiar with suicide assessment tools, and understand their appropriate use
    • Use strategies for decreasing youth’s reluctance to discuss suicide
      • Be direct, unhurried
      • Use careful phrasing, sequencing
      • Remember that “no, not really” in response to an initial question may indicate some suicidality
    • Manage Own Reactions to Youth
      • Become self-aware, tolerate, and regulate emotional reactions to suicidal youth
      • Understand suicidal thoughts and behaviors may make sense to youth; Validate depth of feelings to be free of pain
      • Understand functional purpose of suicidal ideation and behavior
      • View each youth as individual rather than as a stereotypic “suicidal patient”
    • Maintain a Collaborative and Non-adversarial Stance
      • Listen thoroughly to attain a shared understanding of youth’s suicidal thoughts, impulses
      • Be emphatic to suicidal thoughts; honestly express why important for the youth to live
    • Elicit Suicidal ideation, plans, behaviors: Interviewing strategies
      • Normalization
        • “When adolescents feel this bad, they sometimes have thoughts…”
      • Four Validity techniques [12]
        • Gentle assumption: “How frequently do you have thoughts about killing yourself?”
        • Behavioral incident: “What did you do next?”
        • Symptom amplification (set at high level): “How many pills did you take...50, 100?”
        • If an adolescent responds “not really” to an inquiry about suicidal thoughts, the clinician can respond with one of the following: “Not really?”, “Would you tell me a bit more about that?” “I wonder if you would be willing to share with me what types of thoughts about death, dying, or suicide you have experienced.” “You answered my question about suicide with ‘not really’ which leaves me wondering whether you may be thinking about suicide.”
    • Clinically Useful Instruments
      • Suicidal Ideation Questionnaire - Junior
      • Beck Hopelessness Scale (BHS)
      • Columbia Suicide Severity Rating Scale (C-SSRS)
    • Specific Inquiry: Suicidal Thoughts and Behaviors
      • Conduct a suicide-specific inquiry relatively early in interview
      • Assess current, recent, and previous history of suicidal thoughts, impulses and behaviors.
      • Assess antecedents, consequences, and “function” of suicidal thoughts, impulses, and behaviors.
      • Assess exposure to suicidal behavior and suicide within family, peer group, and community.
  • Mental Status Evaluation
    • Warning Signs of Imminent Risk
      • Threatening to hurt/kill self or talking of wanting to hurt/kill self
      • Seeking access to firearm, pills, or other means
      • Talking/writing about dying or suicide, when out of ordinary for youth
      • Additional warning signs:
        • Hopelessness, rage/uncontrolled anger, recklessness, feeling trapped, increased alcohol/drug use, social withdrawal, anxiety/agitation, no reason for living
    • High Acute Risk
      • Suicidal intent (any level of positive intent) plus a suicidal plan that includes specific method.
      • Suicidal intent (any level of positive intent) plus preparatory actions (such as securing firearm or securing materials for suffocation).
      • Suicidal ideation plus history of multiple suicide attempts plus high levels of hopelessness and impulsivity plus alcohol intoxication.
      • Chronic, unrelenting suicidal thoughts plus command hallucinations (to hurt self) plus availability of means.
    • Warning Signs of High Acute Risk
      • Threatening to hurt/kill self or talking of wanting to hurt/kill self
      • Looking for ways to kill self by seeking access to firearm, pills, or other means
      • Talking/writing about dying or suicide, when such action out of ordinary for youth
      • Additional warning signs: Hopelessness, rage/uncontrolled anger, recklessness, feeling trapped, increased alcohol/drug use, social withdrawal anxiety/agitation, dramatic mood change, no reason for living.
Describe the therapeutic strategies of two psychotherapy or intervention approaches for suicidal adolescents that have an emerging evidence base for their effectiveness
  • Evidence Based “Best Practices” Model
    • 1. Address safety first
    • 2. Specify interventions
      • Immediate Response
        • Remove accessible lethal means
        • Consider hospitalization
        • Crisis Response Plan
      • Acute
        • Provide external support
        • Treat symptoms and build individual’s resources
        • Continuing treatment/Care management
    • 3. Consider use of Crisis Response Plan or Coping Cards - Target suicidality directly
    • 4. Involve parent/guardian in developing and implementing treatment plan
    • 5. Use evidence-based interventions to impact modifiable risk and protective factors
    • 6. Assess youth - risk is not static
  • The Collaborative Care Approach: How Clinicians, Teachers, and Parents Can Help
    • Informing the school of the teen’s safety plan is encouraged (despite fears of stigma)
      • obtain a release of information to allow communication between parents, the school, and mental health providers
  • Strategies for parents
    • Include parents in mental health treatment
    • Psychoeducation: 4 things parents should know:
      • Warning signs for suicidal behavior and suicide
      • Language for asking about suicidal thoughts and impulses
      • Crisis contact information and an emergency plan
      • The importance of means restriction
    • Precautions to take:
      • Removing weapons/firearms from the home
      • Securely storing prescription and OTC medications
      • Closely monitoring the teen’s behavior
      • Asking the teen about his/her mood and the presence of suicidal thoughts
      • Monitoring contact with problematic peers or others
    • What to do if your teen feels suicidal:
      • Work with your teen on his/her safety plan
      • Contact his/her therapist or psychiatrist
      • Call a crisis number
        • National Crisis Hotline: 1-800-273-8255
      • Go to the Emergency Department
      • Call 911
  • How to Talk with Youth Who May Be Suicidal
    • Ask the Question - Show Concern - Get Professional Help
    • AMSR – Assessing and Managing Suicide Risk
      • One-day interactive workshop
      • Focus on attitudes, approach, skills
    • ASIST — Applied Suicide Intervention Skills Training
      • Two-day interactive workshop in suicide first aid
      • Recognize when someone at risk and collaborate to create plan to support safety
    • safeTALK
      • Half-day training that prepares you to become a suicide-alert helper
      • Available for individuals 15 years or older

Engaging Caregivers and Youth in Treatment Planning: How to Apply Shared Decision Making to Youth Psychotherapy[edit | edit source]

Presenter: David Langer, Ph.D., Assistant Professor, Department of Psychology, Suffolk University


Learning Objectives:[edit | edit source]

Describe the shared decision-making model of treatment planning
Explain how this model can be applied to psychosocial treatment approaches
Discuss ways in which the shared decision-making process can be applied to one's own practice

National Institutes of Mental Health (NIMH) Workshops[edit | edit source]

Presenter: Mary Rooney, Ph.D., ABPP, Program Officer, Division of Services and Interventions Research, National Institute of Mental Health (NIMH) Joel Sherrill, Ph.D., Deputy Director, Division of Services and Intervention Research, National Institutes of Health (NIH)


Learning Objectives:[edit | edit source]

  1. NIH Submission and Review: What to Expect from the Submission, Review, and Resubmission Process
  2. Training Opportunities and Funding Mechanisms: Information for Mentors and Trainees
  3. NIMH Priorities for Clinical Research: Optimizing Your Application’s Responsiveness to Current Priorities and Funding Opportunities

Other 2019 Days[edit | edit source]

References[edit | edit source]

  2. 10.1111/sltb.12254
  7. Diamond, G. S., Kobak, R. R., Ewing, E. S. K., Levy, S. A., Herres, J. L., Russon, J. M., & Gallop, R. J. (2018). A Randomized-Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Suicidal Youth. Journal of the American Academy of Child & Adolescent Psychiatry
  8. 10.1016/j.jaac.2017.03.015
  9. 10.1016/j.jaac.2017.03.015
  11. King, C. A., Foster, C. E., & Rogalski, K. M. (2013). Teen suicide risk: A practitioner guide to screening, assessment, and management. Guilford Press.
  12. Shea, S. C. (2004). The delicate art of eliciting suicidal ideation. Psychiatric Annals, 34(5), 385-400.