Comparing the Effectiveness of Brief Versus In-Depth Gatekeeper Training on Behavioral Outcomes for Trainees.

BACKGROUND: A common suicide prevention strategy is training gatekeepers to identify at-risk individuals and refer them to services. AIMS: The study aimed to examine whether differences in training outcomes were observed for brief versus in-depth gatekeeper trainings for trainees from varied professional settings while controlling for differences in trainee characteristics and community context. METHOD: Trainees' identification and referral behavior 3 months after gatekeeper training was compared with a sample of respondents matched on individual- and community-level variables using propensity score-based techniques. The value was estimated, in terms of additional identification and associated costs, of adopting in-depth training. RESULTS: A higher proportion of trainees who participated in in-depth trainings from K-12 and community settings identified at-risk youth, and a higher proportion of in-depth trainees from mental health settings referred youth to services compared with participants of brief trainings from the same setting and with similar characteristics. The effect of training type on outcomes varied by professional role and community context. LIMITATIONS: Self-report measures were used to assess outcomes. Similar measures are used in other studies; their validity has not been conclusively established. CONCLUSION: Findings suggest certain individuals may benefit from in-depth training more than others, which favors targeting this intervention to particular gatekeepers.

An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program.

For more than a decade, the Garrett Lee Smith Youth Suicide Prevention Program has provided funding for community-based suicide prevention programs to states, tribes, and colleges across the United States. Recent studies provided evidence of the program's effectiveness in reducing suicide mortality and suicide attempts among youth. This study compares the cost of implementing the program with the estimated savings resulting from avoided hospitalization and emergency department visits associated with the averted suicide attempts. The findings suggest that the cost of implementing multifaceted community-based suicide prevention strategies may be more than outweighed by savings in the health sector.

Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality.

OBJECTIVES: We examined whether a reduction in youth suicide mortality occurred between 2007 and 2010 that could reasonably be attributed to Garrett Lee Smith (GLS) program efforts. METHODS: We compared youth mortality rates across time between counties that implemented GLS-funded gatekeeper training sessions (the most frequently implemented suicide prevention strategy among grantees) and a set of matched counties in which no GLS-funded training occurred. A rich set of background characteristics, including preintervention mortality rates, was accounted for with a combination of propensity score-based techniques. We also analyzed closely related outcomes that we did not expect to be affected by GLS as control outcomes. RESULTS: Counties implementing GLS training had significantly lower suicide rates among the population aged 10 to 24 years the year after GLS training than similar counties that did not implement GLS training (1.33 fewer deaths per 100 000; P = .02). Simultaneously, we found no significant difference in terms of adult suicide mortality rates or nonsuicide youth mortality the year after the implementation. CONCLUSIONS: These results support the existence of an important reduction in youth suicide rates resulting from the implementation of GLS suicide prevention programming.

Gender differences in patterns of child risk across programmatic phases of the CMHI: a multiple group latent class analysis (LCA).

Data from 18,437 children enrolled in the national evaluation of the Children's Mental Health Initiative between 1994 and 2005 were used to examine the evolution of patterns of risk among boys and girls across funding phases using multigroup latent class analysis. Consistent with previous research, this study identified four subgroups of children with similar patterns of child risk. Membership to these risk subgroups varied as a function of age and was associated with differences in impairment levels. Changes in the distribution of boys and girls in the risk classes suggest that, over time, an increasing proportion of boys have entered the system of care program with complex histories of risk. Information on children's exposure to child risk factors can aid policy makers, service providers, and clinicians in identifying children who may need more intensive services and tailoring services to their needs.

The Garrett Lee Smith memorial suicide prevention program.

In response to calls for greater efforts to reduce youth suicide, the Garrett Lee Smith (GLS) Memorial Act has provided funding for 68 state, territory, and tribal community grants, and 74 college campus grants for suicide prevention efforts. Suicide prevention activities supported by GLS grantees have included education, training programs (including gatekeeper training), screening activities, infrastructure for improved linkages to services, crisis hotlines, and community partnerships. Through participation in both local- and cross-site evaluations, GLS grantees are generating data regarding the local context, proximal outcomes, and implementation of programs, as well as opportunities for improvement of suicide prevention efforts.

Trends in characteristics of children served by the Children's Mental Health Initiative: 1994-2007.

Data from 14 years of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program were used to understand the trends of the emotional and behavioral problems and demographic characteristics of children entering services. The data for this study were derived from information collected at intake into service in 90 sites who received their initial federal funding between 1993 and 2004. The findings from this study suggest children entering services later in a site's funding cycle had lower levels of behavioral problems and children served in sites funded later in the 14 year period had higher levels of behavioral problems. Females have consistently entered services with more severe problems and children referred from non-mental health sources, younger children, and those from non-white racial/ethnic backgrounds have entered system of care services with less severe problems. The policy and programming implications, as well as implications for local system of care program development and implementation are discussed.

Caregiver strain and youth suicide attempt: Are they related?

There are scant data documenting the relationship between caregiver strain and suicidal behavior among youth. This study includes data from the caregivers of 1,854 youth who received services through the Comprehensive Community Mental Health Services for Children and Their Families Program. Caregiver strain, family functioning, and youth functional impairment were assessed with the Caregiver Strain Questionnaire, Family Life Questionnaire, and Columbia Impairment Scale. Caregivers of suicidal and nonsuicidal youth differed in subjective internalizing strain (e.g., worry and guilt) and objective strain (e.g., constraints on activities). Differences in objective strain persisted even after controlling for family life and youth functional impairment.

The potential to reduce mental health disparities through the comprehensive community mental health services for children and their families program.

Few service systems are currently in place with the explicit purpose to reduce youth mental health disparities across socioeconomic status and race-ethnicity, despite substantial interest by the federal government and other institutions to redress health disparities. This study examines the potential for the Comprehensive Community Mental Health Services for Children and Their Families Program to address health disparities, even though this program was not explicitly designed for disparity reduction. Specifically, this study examines whether program sites disproportionately provide services within their catchment areas for youth who come from poor families, who are Black, and who are Hispanic. Data for this study come from 45 sites and 19,189 youth who were enrolled in program sites from 1997 to 2005. Meta-analysis was used to generate Forest plots and to obtain single, pooled estimates of risk ratios and their standard errors across all Children's Mental Health Initiative communities. The results indicate that in comparison to the targeted catchment area (a) the percentage poor youth in the programs was almost three times higher, (b) the percentage Black in the programs was about twice as high, and (c) the percentage Hispanic in the programs was about the same. These results indicate that the program successfully reaches disadvantaged youth and can bring substantial infrastructure to address youth mental health disparities. In fact, to the extent that the program successfully improves mental health among enrollees it may be serving as one of the largest initiatives to redress health disparities, although its role in disparity reduction is not widely recognized.

Understanding expanded school mental health services in Baltimore City.

This article explores the nature of expanded school mental health (ESMH) services in Baltimore City, which at the time of the study were incorporated into 40% of the city's public schools. A provider survey was distributed to ESMH clinicians to gather information on the characteristics of service providers and recipients, types of services being provided, and their proposed outcomes. Provider reports indicated an impressive service capacity, augmentation of traditional school-based services, and the continual need for increased mental health service hours in their buildings. In addition, the most frequently voiced benefits of the ESMH programs were increased mental health awareness and improved school climate. Implications of the findings for future programming development and research are discussed.

School-based mental health services in Baltimore: association with school climate and special education referrals.

This study investigated the association between school-based mental health services and two proposed but untested outcomes of these services: (a) school climate and (b) patterns of referrals to special education. Results from a climate survey found that teachers and staff in eight elementary schools with expanded school mental health (ESMH) services gave higher ratings on the survey's mental health climate subscale than respondents from schools in a matched comparison group. No differences were found for the General Climate subscale of the survey. Results also indicated that teachers in ESMH schools referred fewer students to the special education eligibility process because of emotional and behavioral issues and that fewer students in ESMH schools were found eligible for special education for emotional and behavioral disabilities. Results of this study provide beginning evidence for the positive impact of ESMH programs on these two schoolwide indicators of functioning.