Exploring Service Use Disparities among Suicidal Black Youth in a Suicide Prevention Care Coordination Intervention.

OBJECTIVE: The aim of this study is to examine service utilization disparities among Black youth participating in Linking Individuals Needing Care (LINC), a 90-day research-informed suicide care coordination intervention. METHODS: An open trial pilot was conducted to examine the effectiveness of LINC in increasing access to and engagement in mental health and non-mental health services among suicidal youth (N = 587). Other variables of interest included service use facilitators and service use barriers. Generalized linear mixed models with binomial distribution and logit link were performed to ascertain if service use facilitators and barriers were associated with service utilization and if disparities in service use and engagement existed between Black and White suicidal youth through a comparative analysis. RESULTS: Service utilization differences were found between Black and White youth. While Black and White youth were both likely to engage in individual therapy (OR = 1.398, p < .001) and non-mental health services (OR = 1.289, p < .001), utilization rates for mental health and medication management services were lower for Black (55.1% to 60.6%) youth compared to White (66.0% to 71.0%) youth. Specifically, Black youth were significantly less likely than Whites to receive medication management (OR = .466, p = .002). Systemic barriers such long waitlists for care (OR = 1.860, p = .039) and poor relationship with providers (OR = 7.680, p = .028) increased odds of engagement in non-mental health services. Clinical disorders and engagement in suicide-related behaviors increased the likelihood of obtaining care from both medication management and non-mental health services. CONCLUSION: Care coordination services for suicidal youth can increase access and engagement in mental health and non-mental health services. Culturally adapted models attending to cultural and social assets of Black families are needed to reduce disparities and suicide risk among Black youth.

Are they ready yet?: A theory-driven evaluation of suicide risk assessment trainings in psychology graduate programs.

OBJECTIVES: The present study sought to understand the state of suicide risk assessment trainings in clinical psychology graduate programs. METHODS: We surveyed 167 clinical psychology doctoral students' behavioral competency in responding to suicidal clients and their attitudes, perceived behavioral control, subjective norms, and intentions related to suicide risk assessment. Hypotheses were tested using path analysis. RESULTS: Ninety six percent of participants reported receiving some type of suicide risk assessment training at their program. Results provided partial support for significant relationships between attitudes, perceived behavioral control, subjective norms, and intentions. Unexpectedly, amount of training in suicide risk assessments was not related to theory of planned behavior variables including behavioral competency. CONCLUSION: These findings have implications regarding the effectiveness of current suicide risk assessment training practices and ways to improve trainings to help increase the number of clinical psychologists competent in suicide risk assessment and management.

Adolescent Decision-Making: The Value of Perceived Behavioral Control in Predicting Engagement in Suicide Prevention Behaviors.

Adolescent perceived behavioral control (self-efficacy) plays a key role in influencing decision-making processes within the context of suicide prevention programming. Guided by Theory of Planned Behavior, models tested attitudinal and social factors predicting adolescent intentions and actual engagement in suicide prevention behaviors. Participants included 233 racially and ethnically diverse high school students (54% female) in a southwestern U.S. school district. Measures included attitudes, norms, perceived behavioral control, intentions, and behavior over follow-up. Structural equation modeling indicated that perceived behavioral control, rather than intentions, was the direct predictor of behaviors. For adolescents, beliefs about effectively utilizing learned suicide prevention behavior may be more important than intentions. The design of suicide prevention efforts should account for this important influence on adolescent decision-making.

The Role of Youth Trainee-Trainer Alliance and Involvement in School-Based Prevention: A Moderated-Mediation Model of Student Gatekeeper Suicide Prevention Training.

This study examined the roles that youth involvement and youth trainee-trainer alliance play in school mental health prevention within the context of youth suicide gatekeeper training. Measures included youth involvement in programming, trainee-trainer alliance, and intentions to refer at-risk youth at pre- and post-training. A moderated-mediation design was used to examine associations among these factors. Results show alliance mediating pre- and post-training referral intentions, and involvement moderating the relationship between alliance and post-training intentions. On average, trainee intentions improved from pre- to post-training, but trainees reporting high alliance endorsed higher post-training referral intentions regardless of involvement level. Low alliance resulted in lower than average post-training referral intentions, even with active involvement in programming, and those with both low alliance and involvement showed the lowest post-training referral intentions. Given these findings, fostering the youth trainee-trainer relationship may be an avenue to optimize prevention program effectiveness.

Online Suicide Risk Assessment and Management Training.

BACKGROUND: Many mental health professionals (MHPs) encounter youth at risk for suicide but lack knowledge and confidence to assist these individuals. Unfortunately, training for MHPs on suicide risk assessment and management is often not adequately accessible. AIMS: The aim of this study was to evaluate whether MHPs' knowledge, attitudes, perceived social norms, and perceived behavioral control in working with at-risk suicidal youth improve following an online training (QPRT: Question, Persuade, Refer, Treat). METHOD: QPRT was provided to 225 MHPs from three large urban areas in the United States. Suicide prevention literacy, attitudes, perceived social norms, and perceived behavioral control in assessing and managing suicide risk were assessed before and after training. Data were also collected on training engagement and completion. RESULTS: Suicide prevention literacy in most competency domains and perceived behavioral control increased significantly after participation in QPRT. Suicide prevention attitudes and some knowledge domains did not significantly improve. MHPs reported high satisfaction with the training. CONCLUSION: The current study provides initial support for offering MHPs online suicide risk assessment and management training. Online training programs may be an engaging and feasible means for providing advanced suicide prevention skills to MHPs who may have numerous barriers to accessing face-to-face training.

Self-perceived burden as a mediator of depression symptoms amongst individuals living with a movement disorder.

OBJECTIVE: Movement disorders are chronic illnesses that can lead to functional impairment and psychological distress. This study examined the relations between functional impairment, depression, and anxiety in individuals with movement disorders, and whether these associations were mediated by feelings of self-perceived burden. METHOD: This cross-sectional study sampled individuals (57 males and 57 females; mean age of 62) with chronic movement disorders from a movement disorders clinic. Patients completed measures of depression, anxiety, functional impairment, and self-perceived burden. RESULTS: Functional impairment was associated with depression, but not anxiety, and was mediated by self-perceived burden for individuals with chronic movement disorders. CONCLUSIONS: Self-perceived burden may have an important role relative to individuals' adaptation to chronic illness with implications for future interventions.

Multiple informants in the assessment of psychological, behavioral, and academic correlates of bullying and victimization in middle school.

The present study assessed agreement between student self-report and teacher ratings of bullying and victimization relative to psychological, behavioral, and academic correlates. Middle school students (N=1442) and teachers completed surveys evaluating peer relationships and psychosocial adjustment. Analyses of variance and logistic regressions were used to examine rater agreement on bullying/victimization and adjustment among groups (bullies, victims, bully/victims, and uninvolved) identified by rater (student self-report only, teacher-report only, concordant reports, and controversial reports). Concordant and controversial groups had among the greatest psychosocial and academic difficulties. Student learning difficulties and moodiness interacted with teacher reports of bullying and victimization, respectively, with agreement between teacher and student self reports of bullying greater at higher levels of learning problems and agreement for victimization lower at higher levels of moodiness. The results indicate biases in rater perspective of student behavior and continue to support the need for multiple raters of student functioning.