Feasibility and acceptability of a brief suicide intervention for youth involved with the family court
Article in review: Kemp, K., Pederson, C., Webb, M., Williamson, S., Rani Elwy, A. & Spirito, A. (2021). Feasibility and acceptability of a brief suicide intervention for youth involved with the family court. Behav Sci Law, DOI: 10.1002/bsl.2498
Young people involved in the juvenile just system are at an increased risk of suicide ideation and suicide attempt. In this study, interviews were conducted with those involved in the juvenile justice system to assess the accessibility and feasibility of a suicide safety planning intervention. The main issues that respondents identified related to the perceived need for suicide risk prevention, the fit of the particular intervention within the juvenile justice system, and the court system’s readiness to conduct assessments with at-risk youth.
Young people’s experience in the justice system
Because of the increased risk for young people involved in the juvenile justice system, the current recommendation is that young people should be screened for suicide risk at every point in the just system. At the point of initial contact, a young person will typically undertake a screening tool to gather information related to suicide risk- ideation, past attempts, mental health concerns, or the recent suicide of friends/ family members. Hospitalisation may occur, or the young person may be given a referral to an outpatient clinic, typically with long waitlists. This “assess and refer” approach has been criticised, and there is an increasing preference for the alternate method of suicide safety planning.
A total of ten staff at a family court in Massachusetts was involved in the semi-structured, qualitative formative evaluation interviews. Although it was only a small group of participants, such studies are important because research conducted outside of actual settings may fail to be successful inpatient care. This is because interventions can develop blockage that prevents evidence-based practices from being effectively implemented. Such research can shed light on how practices might be adopted and supported in a workplace and identify potential issues that had not yet been considered within the research.
Participants were 60% female and had an average of ten years working at the family court. The participants represented a range of positions:
• one administrative assistant
• six juvenile intake workers
• three magistrates
Acceptability and feasibility
Staff was asked about their experience working with young people reporting suicide ideation, their perceptions about the need for safety planning in the court setting and any challenges related to incorporating safety planning into existing court procedures. In this way, both acceptability and feasibility were assessed.
Acceptability was considered as perceived need and perceived fit, the degree to which the treatment, service, practice or innovation is agreeable, palatable or satisfactory and fits the goals and values of the organisation. Feasibility was the extent to which the treatment or intervention can be used or carried out in the workplace and how willing the staff might be to incorporate the change.
The types of questions asked of participants included:
• Do you believe at-risk youth would benefit from a brief intervention at the point of assessment?
• Do you feel conducting these inventions for reducing risk is an acceptable role for the juvenile justice system?
• How willing are non-clinical staff to accept a role in the process?
The perceived fit was also assessed, with questions related to staff readiness for change:
• what training and supervision strategies would assist implementation?
• how likely are the proposed strategies to work?
The overall perceptions were that safety planning is a necessary and acceptable activity, in line with the roles and objectives of the family court. The intervention was deemed acceptable within culture, with participants recognising that safety planning would have overwhelming primary benefits towards the safety and support of young people.
The positive perception about implementing safety planning was likely associated with the participant’s existing knowledge of screening and assessment for suicide ideation. All staff was able to correctly describe the referral process, which demonstrated their familiarity and understanding of young people’s potential mental health needs. Professional experiences may have helped demonstrate the potential benefits of a safely planning intervention.
The proximate timing of the invention was perceived to be both acceptable and important, given that delays in accessing support were problematic.
Participants did identify several barriers to the implementation of safety panning, including staff comfort with handling suicide intervention and logistical issues such as childcare, parking and office space. They also identified potential ways to migrate these issues by stressing the importance of training and education and modifying the assessment structure to benefit the staff.
There was also some disagreement about who was best placed to conduct the proposed intervention, and only two participants expressed the opinion they were best placed to do so. There was a hesitance about individual ability to learn and conduct the intervention without clinical support. Considerations about possible adaptations to the intervention identified potential modifications that might improve practitioner comfort in conducting the intervention.
There was almost complete agreement about the need for adequate training staff buy-in through planning, education and management tools are likely to improve engagement with the approach, rather than an informed top-down. While mental health screening is often undertaken among young people in the court system, there is a need for additional research and more options for the provision of evidence-based support at the moment it is required.