Preventing adolescent suicide: A systematic review of the effectiveness and change mechanisms of suicide prevention gatekeeping training programs for teachers and parents.

INTRODUCTION: Suicide is a leading cause of death in young people, which may in part be because young people are notoriously poor help-seekers. Improving the identification of at-risk young people and connecting them to appropriate help is needed to prevent suicide in adolescents. The aim of this study is to examine the effectiveness of suicide prevention gatekeeper programs for parents and teachers, which are designed to improve their ability to recognise and respond to risks so that they may intervene before crisis occurs. METHODS: Academic databases and reference lists were searched for gatekeeper training programs involving teachers and parents, and which aimed to prevent youth suicide, between journal inception and May 2018. Information directly reporting on suicide literacy (knowledge, confidence, attitudes) and/or gatekeeper behaviours (identification, referral) was extracted and a qualitative synthesis was conducted. RESULTS: Thirteen studies fulfilled inclusion criteria. Significant moderate-to-large intervention effects were reported for suicide literacy outcomes among teachers and parents, with the largest gains among those with lowest baseline scores. No improvements in identification and referral behaviors among gatekeepers were noted. A need to improve evaluation research designs and outcome measurements was evident. CONCLUSIONS: While gatekeeper programs lead to increased suicide literacy, there is little evidence for behavioural change. There is need to increase the reach and uptake of gatekeeper training by offering digital versions, which may lead to improved behavioural outcomes, and to employ targeted strategies to engage parents in this training as one of the most trusted sources of support for vulnerable youth.

Practical Applications for Maintenance of Certification Products in Child and Adolescent Residency Training.

OBJECTIVE: The authors evaluated whether Maintenance of Certification (MOC) Performance-in-Practice products in training increases trainee knowledge of MOC processes and is viewed by trainees as a useful activity. METHODS: Six child and adolescent psychiatry fellowships used MOC products in continuity clinics to assess their usefulness as training tools. Two surveys assessed initial knowledge of MOC and usefulness of the activity. RESULTS: Forty-one fellows completed the initial survey. A majority of first-year fellows indicated lack of awareness of MOC in contrast to a majority of second-year fellows who indicated some awareness. Thirty-five fellows completed the second survey. A majority of first- and second-year fellows found the activity easy to execute and would change something about their practice as a result. CONCLUSIONS: Using MOC products in training appears to be a useful activity that may assist training programs in teaching the principles of self- and peer-learning.

Effectiveness of a parent training program in (pre)adolescence: evidence from a randomized controlled trial.

The present randomized controlled trial examined the effectiveness of the parent training program Parents and Children Talking Together (PCTT) for parents with children in the preadolescent period who experience parenting difficulties. The program is focused on reducing child problem behavior by improving parents' communication and problem solving skills, and disciplining behavior. Largest effects were expected for families with higher SES, and with children in mid-adolescence. Multi-informant and multi-method data were used from 78 self-referred families with children aged 9-16 (M=13.09, SD=1.75). Intention-to-treat analysis (retention rate 95%; immediate posttest only) showed that participation in PCTT significantly improved parents' communication and problem solving skills (F(1,70)=11.77, p<0.01 and F(1,70)=12.87, p<0.01), and reduced their dysfunctional disciplining behavior in conflict situations (F(1,70)=5.25, p<.0.05). The PCTT intervention was most effective for parents with higher SES and for parents with children between the ages of 14 and 16. No consistent gender effects were found.

Teaching medical professionals and trainees about adolescent suicide prevention: five key problems.

Predicting and preventing suicide represent very difficult challenges for clinicians. The awareness of adolescent suicide as a major social and medical problem has increased over the past years. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Suicide prevention efforts among adolescents are restricted by the fact that there are five key problems related to the evaluation and management of suicidality in adolescents: 1. Many clinicians underestimate the importance of the problem of adolescent suicidal behavior and underestimate its prevalence. 2. There is a misconception that direct questioning of adolescents about suicidality is sufficient to evaluate suicide risk. 3. Another misconception is that adolescents with non-psychiatric illnesses do not need to be evaluated for suicidality. 4. Many clinicians do not know about or underestimate the role of contagion in adolescent suicidal behavior. 5. There is a mistaken belief that adolescent males are at lower suicide risk than adolescent females. Educating medical professionals and trainees about the warning signs and symptoms of adolescent suicide and providing them with tools to recognize, evaluate, and manage suicidal patients represent a promising approach to adolescent suicide prevention.

Consequences of black exceptionalism? Interracial unions with blacks, depressive symptoms, and relationship satisfaction.

Using data from Wave 4 (2008) of the National Longitudinal Study of Adolescent Health (N = 7,466), we examine potential consequences of black exceptionalism in the context of interracial relationships among nonblack respondents. While increasing racial diversity and climbing rates of interracial unions have fostered the notion that racial boundaries within the United States are fading, our results add to the accumulating evidence that racial/ethnic boundaries persist in U.S. society. Results suggest that among non-Black respondents there is more stigma and disapproval attached to relationships with Blacks than there are to relationships with members of other racial/ethnic groups. Specifically, our results indicate that nonblack individuals with black partners have significantly more depressive symptoms and less relationship satisfaction than their counterparts with nonblack partners, regardless of respondent race and whether the nonblack partner is the same versus a different race from the respondent. Further, the relationship between partner race and depressive symptoms is partially and significantly mediated by relationship satisfaction.

Digital expression among urban, low-income African American adolescents.

Digital production is a means through which African American adolescents communicate and express their experiences with peers. This study examined the content and the form of the digital productions of 24 urban, low-income African American adolescents who attended a summer academic program. The content of student digital productions focused on academic experiences and friendships. Their production styles revealed that youth used perceptually salient production features, such as rapid scene changes and loud rap music. The results suggest that when placed in a supportive, academic environment and provided with digital production resources, students who traditionally face barriers due to cultural and economic inequalities digitally express to their peers an interest in academics and positive peer relationships, and that these youth communicate their experiences through a shared production style that reflects their broader cultural experiences.

Public school segregation and juvenile violent crime arrests in metropolitan areas.

Previous research has established an association between residential segregation and violent crime in urban America. Our study examines whether school-based segregation is predictive of arrests of juveniles for violent crimes in U.S. metro areas. Using Census, Uniform Crime Report, and Common Core data for 204 metro areas, a measure of school-based racial segregation, Theil's entropy index, is decomposed into two components: between- and within-district segregation. Findings reveal evidence of a significant interaction term: Within-district segregation is inversely associated with arrests for juvenile violence, but only in metropolitan areas with higher than average levels of between-district segregation.

Mother abuse: a matter of youth justice, child welfare or domestic violence?

International evidence suggests that in advanced welfare states the abuse of parents, most particularly mothers, by their (most frequently male) adolescent children is increasingly prevalent. In the United Kingdom, however, child-to-mother abuse remains one of the most under-acknowledged and under-researched forms of family violence. Although it is an issue shrouded in silence, stigma, and shame, the authors' work in the youth justice sphere, focusing on interventions to deal with anti-social behaviour, suggests that adolescent violence toward mothers is a topical and prevalent issue. We identify different ways of conceptualizing it in the policy realms of youth justice, child welfare, and domestic violence. The behaviour of both child/young person and mother is constructed in ways which inform the assignment of blame and responsibility. The paper highlights the silence that surrounds the issue in both the policy and wider academic spheres, hiding the failure of service providers to respond to this very destructive form of intimate interpersonal violence.

A Multi-Institutional Study of Dental Student Readiness to Address Adolescent Risk Behaviors.

The aim of this replication study was to determine if prior findings at one U.S. dental school about dental students' comfort discussing and perceptions of the relevance of 15 risk behaviors to adolescent patient oral health care would be observed at other institutions. All first- and fourth-year dental students (n=414) at three U.S. dental schools in fall 2017 were invited to participate, and 218 completed the survey (52.7% response rate). These students reported feeling comfortable to uncomfortable discussing risk behaviors with adolescent patients, yet perceived those risk behaviors as relevant to their oral health. There were significant differences in student comfort discussing risk behaviors with adolescents and their perceptions of relevance by gender, age, class status, and school location. Males were more comfortable than females discussing oral health risk behaviors. There were no significant differences by race/ethnicity. Fourth-year students had higher levels of comfort discussing risk behaviors than first-year students. Compared to students in the South and Midwest schools, students at the West school were more comfortable discussing selected topics and had higher perceptions of their relevance to adolescent oral health care. These results suggest there is room for improvement in this area of dental education. Dental schools should aim to strengthen students' knowledge of and comfort in discussing oral health risk behaviors with adolescent patients with the use of educational activities and clinical experiences.

Enhancing communication skills for pediatric visits through on-line training using video demonstrations.

BACKGROUND: Training in communication skills for health professionals is important, but there are substantial barriers to individual in-person training for practicing clinicians. We evaluated the feasibility and desirability of on-line training and sought suggestions for future courses. METHODS: Based on successful in-person curricula for communication skills and our previous on-line curricula, we created an on-line course consisting of 28 modules (4.75 hours CME credit) about communication skills during pediatric visits that included a mental health concern; each module included a brief case, a multiple choice question, an explanation, and a 1-2 minute video demonstrating key skills. Specific communication skills included: greeting, setting an agenda, discussing diagnosis and treatment, and managing negative interactions. The course was announced by emails in spring, 2007; the course was available on-line for 60 days; we aimed to enroll 50 clinicians. Outcomes were analyzed for those who evaluated the course within 75 days of its initial availability. RESULTS: Overall, 61 clinicians registered, of whom most were nurses (N = 24), physicians (N = 22), or psychologists or social workers (N = 12). Of the 36 (59%) clinicians who evaluated the course, over 85% agreed that all course objectives had been met; over 90% reported greater confidence in greetings and agenda-setting; and over 80% reported greater confidence in discussing diagnosis and treatment and managing negative interactions. Nearly all, 97% would recommend the course to other clinicians and trainees. Suggestions for improvement included a library of additional video vignettes and written materials to accompany the on-line training. CONCLUSION: On-line training in communication skills for pediatric mental health visits is feasible, desirable and associated with increased confidence in key skills. Positive feedback from clinicians suggests that a comparison of on-line versus in-person training is warranted.

Managing America's schools in an age of terrorism, war, and civil unrest.

When terrorism and natural disasters strike it is extremely important to be able to effectively manage America's schools. From the crises of Columbine, to Red Lake Minnesota, the World Trade Center and Katrina, we are reminded that schools are not immune from such disasters. It is essential that schools and communities review and augment their safe school plans and partnerships so that they can respond effectively in times of crisis. It is critically important to assess local preparedness, to update, train and practice crisis response. School officials should have specific plans in place that focus on crisis prevention, crisis preparation, crisis response and crisis recovery. This article addresses those key concerns that every school system should place on their educational agenda. Additional resources and strategies are also suggested that will promote safe and welcoming schools for all ofAmerica's children.

Developing a tier I CAMHS foundation course: report on a 4-year initiative.

Despite a growing recognition of the strategic importance of the UK's Tier 1 in supporting children and young people with mental health needs, detailed descriptions of the developmental hurdles and content of such courses remain obscure. There are a number of initiatives being undertaken nationally to remedy this and the aim of this article is to contribute the authors' experience to what is becoming a burgeoning national endeavour. Particular attention is drawn to the problems of developing volume multiagency trainings in areas of significant social deprivation and mental health morbidity but innovation is needed to balance the competing needs for quality, penetration into Tier 1, pressures on staff time and managers' release constraints. A core syllabus is tentatively suggested, with additional skills components, and a teaching session is explored in detail to illustrate the authors' methodology and approach.

Education and training in forensic psychiatry.

The author has chaired a national committee dedicated to developing standards for training in forensic psychiatry; he discusses the results of his work over the past several years, presenting the advantages and disadvantages of on-the-job training and formal fellowship programs.

Outcomes of a brief alcohol abuse prevention program for Israeli high school students.

PURPOSE: To implement a brief intervention aimed at reducing abuse of alcohol among adolescents, and to assess its effectiveness. METHODS: One thousand 10th-grade students from seven high schools, chosen by random from the roster of all schools in southern Israel, were assigned to intervention and control groups. The intervention, which was based on Botvin's social skills theory, was conducted over 3 days and included dissemination of information, workshops, lectures by guest experts, and activity areas. It was administered by the staff of the high schools and the Psychological Counseling Service in Israel. A self-administered questionnaire was answered anonymously by students in the 10th grade (pretest) and again in the 11th and 12th grades (posttests). It included questions on sociodemographic data, alcohol-related habits, smoking habits, use of illicit drugs, knowledge, and attitudes. Data were collected between 1994 and 1997 with a 76% follow-up rate at 2 years. RESULTS: At baseline there was no statistical difference in alcohol consumption between the intervention and control groups. At 1- and 2-year follow-up the rates of alcohol consumption did not change in the intervention group (p > .05) but rose significantly in the control group (p < .001). In multiple regression analysis the variables male gender, positive attitudes, cigarette smoking, availability of illegal drugs, and intervention group were significant predictors of alcohol consumption. CONCLUSIONS: The results of this study show the effectiveness of this intervention program, based on reduced alcohol consumption in the intervention group at 1- and 2-year follow-up, compared with the control group. Compared with other programs, the present intervention is brief, intensive, and relatively easy to implement.

The benefits of a clinician consulting in schools of education.

A psychiatric clinician was available to lecture and discuss behavior of children and adolescents. Faculty in four schools of education in Los Angeles requested this service. These were (1) a university graduate school teacher training program; (2) a school psychologist training program; (3) an undergraduate education program; and (4) an administrator training program. In the last program, experiences providing mental health consultation to administrators were presented. In the first program, an evaluation was conducted. It emerged that the teachers-in-training were able to feel more permission to see their role as counselor as an appropriate part of the teacher role. Their increased knowledge and understanding of psychopathologic behavior, especially in adolescents, seemed to increase their comfort and ability to handle these behaviors.

[New strategies for prevention in adolescents and young adults]. / Nouvelles stratégies de prévention chez l'adolescent et le jeune adulte.

For various reasons, it is justified to revise the classical strategies of intervention concerning medical and social action to help young people. New behaviours such as drug addiction, for instance, have emphasized the inadequacies of the conventional means of treatment. Since 1970, Youth Advisory Services have appeared in Europe. Their aims may be various: information, counselling, lodging, social and educative help, medical assistance. These services which were created by the community have such ethical and organizational features that it is easy to discern them among the conventional administrative services. Their users are mainly teenagers and young adults whose reasons for consultation are due to various causes. The originality of the methods, facilities and principles of these innovating services may be considered as a decisive contribution to the research of new prevention strategies to help young people.

College students as contingency managers for adolescents in a program to develop reading skills.

Behavior-modification procedures and an individualized tutorial program were used to remediate reading skill deficits in seventh-grade adolescent subjects. Forty-two college students were trained as reading tutors and contingency managers to use reading diagnostic and remedial materials, and to develop contracts and reinforce positive verbal responses toward reading. Significantly greater increases in reading scores of experimental groups, compared to control groups, substantial improvement in target behaviors, and significant changes in verbalizations toward reading were observed after 10 weeks of treatment. Six-month followup studies showed that all groups had consolidated their gains and that grade scores continued to improve. The improvement of the experimental subjects remained significantly ahead of the control subjects.

The role of family support programs in building developmental assets among young adolescents: a national survey of services and staff training needs.

A survey of 659 family support workers' regarding training and their provision of services for families with 10- to 15-year-olds showed that 30% to 50% rated their previous training as inadequate or poor, had inaccurate knowledge about young adolescent development, and felt they were doing an inadequate or poor job promoting developmental assets for youths. Higher quality training was significantly related to the programs' potential excellence. Implications for providing training for family support workers and promoting collaboration are discussed.