The Michigan Child Collaborative Care Program: Building a Telepsychiatry Consultation Service.

This column describes the establishment of the Michigan Child Collaborative Care (MC3), a statewide telepsychiatry consultation program that provides support to primary care providers (PCPs) in meeting the mental health needs of youths and perinatal women. The MC3 program provides cost-effective, timely, remote consultation to primary care providers in an effort to address the lack of access and scarcity of resources in child, adolescent, and perinatal psychiatry. Data from 10,445 service requests are summarized. Common diagnoses included attention-deficit hyperactivity disorder, mood disorders, anxiety disorders, and autistic spectrum disorders, with many cases (58%) deemed moderate to severe. Co-occurring psychological trauma was suspected in 9% of service requests. Partnerships, stakeholder roles, PCP engagement, and workflow integration are highlighted as keys to the program's success.

Identification, Response, and Referral of Suicidal Youth Following Applied Suicide Intervention Skills Training.

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre-post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self-reported identification of at-risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre-test to 6- to 9-month follow-up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self-reported skill utilization including identification as a "natural helper" and attitudes about suicide prevention.

Intervention research with youths at elevated risk for suicide: meeting the ethical and regulatory challenges of informed consent and assent.

Intervention research with youths at elevated risk for suicidal behavior and suicide--a vulnerable and high risk population--presents investigators with numerous ethical challenges. This report specifically addresses those challenges involving the informed consent and assent process with parents/guardians and youths. The challenges are delineated in the context of pertinent laws and regulatory requirements, and guidelines are suggested for their practical resolution. These are illustrated with case examples from NIMH-funded intervention trials. Through the sharing of such methodological information, intervention researchers can support each other in conducting ethical research in a manner that does not unduly compromise scientific rigor.

Sequelae of aggression in acutely suicidal adolescents.

The consequences of aggression on problem course and suicide risk were examined in 270 acutely suicidal adolescents (ages 12-17 years; 184 girls). Participants were assessed during psychiatric hospitalization (T1), 6-months post-hospitalization (T2), and 15 or more months post-hospitalization (T3). Study variables included self- and parent-reported aggression; self-reported internalizing symptoms, suicidal ideation, suicide attempt, and adverse events; and clinician-rated suicidal behavior. Aggression was not directly related to suicide attempt concurrently or prospectively. However, among more aggressive youth, internalizing symptoms were more predictive of T3 suicide attempt than among less aggressive youth. T1 aggression predicted aggressive incidents and the likelihood of incarceration prior to T3. Two-level hierarchical linear modeling indicated that self-reported aggression and internalizing problems were linked in terms of severity and rates of decline over time. Overall, parent-reported aggression was negatively associated with suicidal ideation. Findings highlight (a) the continuity and consequences of aggression, (b) a possible role of aggression in worsening suicide risk factors and potentiating suicide attempt, and (c) the importance of ongoing research on subtypes of suicidal adolescents.

Assessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior.

OBJECTIVE: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. METHOD: Between 1998 and 2000, 289 psychiatrically hospitalized, suicidal youth, ages 12 to 17 years, participated in this study. Self-report measures were completed at baseline. Clinician-rated suicidality and suicide attempt were collected at baseline and 6-month follow-up. RESULTS: Baseline self-reports were internally consistent and strongly intercorrelated within male, female, white, and black subsamples. All of the measures predicted follow-up suicidality and suicide attempts. Using published cutoff scores, the Beck Hopelessness Scale and SPS were moderately to highly sensitive predictors of subsequent suicide attempts, as was the Suicidal Ideation Questionnaire-Junior for predicting suicide attempts and broad suicidality. Alternative cutoff scores that predicted outcomes with moderate and high sensitivity also were examined, with attention to resultant sacrifices in specificity. CONCLUSIONS: Baseline self-report scores predicted follow-up suicidality. SPS contributed uniquely to prediction of future suicidality and suicide attempt. SPS may supplement other sources of information when assessing suicide risk with this population.