Suicide Screening Among Youth at First Court Contact.

Youth involved in the juvenile justice system are at elevated risk for suicide and co-occurring mental health symptoms. This study aims to examine the suicide risk and treatment needs of court-involved, non-incarcerated (CINI) youth, and to understand the acceptability and effectiveness of implementing a mental health screening procedure at time of first court contact. By embedding a forensic mental health screening tool into the intake process of a family court diversionary program, a total of 891 youth (aged 12-18) were assessed using the Massachusetts Youth Screening Instrument-2 (MAYSI-2). Analysis of screening responses revealed 12.5% of youth indicated risk for suicide with risk levels differentiated by youth sex, race and ethnicity. Suicide ideation was also significantly associated with flagging, an indication of clinical risk, on all other scales of the MAYSI-2, as well as subsequent referrals to treatment. Screening for suicide at first point of court contact within an existing diversionary program may serve as a critical and effective point of intervention for youth in need.

Do suicidal thoughts and behavior persist following juvenile justice involvement?

INTRODUCTION: This study examines suicidal ideation and behavior of youth in the 3 months following their initial diversion appointment in the juvenile justice system. METHOD: Participants were 99 adolescents (72.7% female; 65% racial minority) between the ages of 12 and 18 (Mage = 15.06, SD = 1.35) and a parent/caregiver (80% female; 54% racial minority; Mage = 42.7 years, SD = 8.9 years). Participants were eligible if they endorsed two or more suicide items on a mental health screener (MAYSI-2) and were able to be contacted 3 months following initial court appointment. Youth and parent/caregiver responded to questionnaires assessing SI/SA, psychiatric symptoms, treatment motivation and engagement. RESULTS: Three months post-initial court appointment, more than half of youth (55.5%) continued to flag on the Suicide Ideation subscale of the MAYSI-2, though mean scores decreased from baseline to 3-months (t[97] = 5.74, p < 0.000, 95% CI [-0.79, 1.62] Cohen's d = 0.77). There were no significant differences in parent/youth treatment motivation or engagement regardless of SI at 3 months. CONCLUSIONS: Persistence of suicidal thoughts and behaviors beyond initial legal involvement highlights the importance of targeted suicide prevention interventions (beyond screening and referral to treatment) with justice-involved youth, even at first court contact.

Implementation of a Quit Smoking Programme in Community Adult Mental Health Services-A Qualitative Study.

Little is known about the experiences of people with severe mental health difficulties in smoking cessation interventions. This study aimed to review the implementation of a smoking cessation programme across 16 community mental health day services. The aim was to establish the experience from both service user and facilitator perspectives and refine implementation for future groups. In-depth interviews were conducted with 20 service users and four focus groups held with 17 facilitators. Thematic analysis was used to analyse the data for emergent themes in relation to key enablers and barriers to implementation. Data from service users and facilitators revealed that implementation was enabled by an open and engaged recruitment approach; the resourcefulness of facilitators; programme materials and group-based format; combining the cessation programme with other and broader health initiatives; and participants' motivations, including health and money. Barriers included the structure of the service; the lack of a joined-up approach across the health services; literacy issues and the serial/logical process assumed by the programme. Barriers perceived as more specific to those with mental health difficulties included the use of smoking as a coping mechanism, lack of alternative activities/structure and lack of consistent determination. The tobacco free policy, implemented shortly before the programme, interestingly emerged as both a barrier and an enabler. In conclusion, although this group-based cessation programme in community mental health settings was well-received overall, a number of key barriers persist. A joined-up approach which addresses the culture of smoking in mental health settings, inconsistencies in smoking policies, and provides consistent cessation support, is needed. Care needs to be taken with the timing as overall it may not be helpful to introduce a new smoking cessation programme at the same time as a tobacco free policy.

Description of the types and content of phase 1 clinical trial consent conversations in practice.

BACKGROUND OR AIMS: All agree that informed consent is a process, but past research has focused content analyses on post-consent or on one conversation in the consent series. Our aim was to identify and describe the content of different types of consent conversations. METHODS: We conducted a secondary analysis of 38 adult oncology phase 1 consent conversations, which were audio-recorded, transcribed, coded, and qualitatively analyzed for type and content. RESULTS: Four types of consent conversations were identified: (1) priming, (2) patient-centered options, (3) trial centered, and (4) decision made. The analysis provided a robust description of the content discussed in each type of conversation. Two themes, supportive care and prognosis, were rarely mentioned. Four themes clustered in the patient-centered (type 2) conversations: affirmation of honesty, comfort, progression, and offer of supportive care. CONCLUSION: We identified and described four types of consent conversations. Our novel findings include (1) four different types of conversations with one (priming) not mentioned before and (2) a change of focus from describing the content of one phase 1 consent conversation to describing the content of different types. These in-depth descriptions provide the foundation for future research to determine whether the four types of conversations occur in sequence, thus describing the structure of the consent process and providing the basis for coaching interventions to alert physicians to the appropriate content for each type of conversation. A switch from a focus on one conversation to the types of conversations in the process may better align the consent conversations with the iterative process of shared decision making.