Implementation and evaluation of a juvenile mental health training for law enforcement in a medium-sized jurisdiction.

The need for specialized training programs that are focused on youth mental health needs, awareness of community-based services, and de-escalation skills is growing across law enforcement agencies due to calls for service that involve youth in mental health crisis. The current study evaluates a juvenile mental health training for law enforcement that was developed based on agency needs. The training was completed by 159 officers and a pre-/post-test design was used. Findings suggest that officers were satisfied with the training and improvements were seen across several training constructs (confidence, preparedness, stigma, resource awareness, and de-escalation skills). Satisfaction with the training predicted change in confidence and preparedness. Recommendations for future research and the implementation of juvenile mental health trainings are discussed.

Promoting Antiracist Mental Health Crisis Responses.

Clinicians cannot always directly or effectively engage patients experiencing mental health crises. This article considers the common practice of relying upon law enforcement personnel to facilitate mental health checks and considers its implications for Black patients. An antiracist approach to decriminalizing acute exacerbations of mental illness requires clinicians' engagement in educating, training, and policymaking. This article recommends strategies for effective real-time communication before, during, and after a 911 call involving a person experiencing a mental health crisis.

Modeling the effects of Crisis Intervention Team (CIT) training for police officers: How knowledge, attitudes, and self-efficacy drive de-escalation skills and referral decisions.

OBJECTIVE: Prior research on Crisis Intervention Team (CIT) training for police officers has demonstrated improvements in knowledge, attitudes, self-efficacy, and stigma, but how these factors work together to influence behavioral outcomes like de-escalation skills and referral decisions remains unstudied. METHOD: 251 CIT-trained and 335 non-CIT officers completed in-depth surveys measuring these six constructs. We used structural equation modeling to test fit of the data to our hypothesized model and made indicated changes to improve fit. RESULTS: An alternate 8-path model (with three paths originally hypothesized being removed) fit reasonably well, and allowing path coefficients to differ for CIT and non-CIT groups resulted in models with similar fit statistics. CONCLUSION: CIT training enhances knowledge and attitudes, both of which have beneficial effects on stigma. Though an important outcome itself, lower stigma does not have an effect on de-escalation skills and referral decisions, though self-efficacy clearly does.

Examining Factors Related to Departmental Adoption of Crisis Intervention Team (CIT) Models: A Survey of Police Chiefs.

In an effort to improve police responses for handling incidents involving people with mental illness (PWMI), many police departments have adopted the Crisis Intervention Team (CIT) model. However, to date, there has been very little published research that has focused on examining factors related to the adoption of CIT models through the lens of police chiefs. To help fill this gap in the literature, the current study used data collected from a sample of 204 police chiefs in the Commonwealth of Pennsylvania to examine variables related to departmental adoption of the CIT model. Findings show that several factors (e.g., chief training, chief educational attainment, and departmental resources) were associated with departmental adoption of the CIT model. Policy implications and suggestions for future studies based on these findings are discussed within.

Effects on Participant Knowledge, Situational Anxiety, and Social Distance Attitudes Following CIT Training.

Crisis Intervention Teams (CIT) promote community collaboration to better assist people living with mental illness and/or drug addiction who are in crisis (Mission, n.d.). A core element of the CIT model is the 40 h training focused on increasing law enforcement officers' knowledge of behavioral health issues and use of de-escalation skills in crisis response (CIT International, n.d.). The purpose of this study was to examine the effectiveness of CIT training in a mid-size, Midwestern county on (1) participants' knowledge of mental illness and related concepts, (2) situational anxiety in crisis response, and (3) enhancing perceived comfort with people living with mental illness. This one-group pre-test/posttest study was conducted with four CIT training groups (n = 72) between 2017 and 2019. Findings indicate that participant knowledge and perceived comfort interacting with persons living with a mental illness were improved after the trainings, supporting use of CIT trainings in mid-size and rural communities.

Using the Theory of Planned Behavior to Understand How Crisis Intervention Team (CIT) Training Facilitates Police Officers' Mental Health Referrals.

The Theory of Planned Behavior posits that behaviors are predicted by one's intention to perform them; intention is driven by attitude toward the behavior, subjective norm, and perceived behavioral control. We used this theory to predict Crisis Intervention Team (CIT)-trained and non-CIT officers' intention to facilitate referral of persons with suspected mental illnesses to mental health services. CIT-trained (n = 251) and non-CIT (n = 335) officers from six law enforcement agencies participated. CIT-trained officers had significantly greater scores on all constructs. Theory constructs fit the data well, and fit did not differ meaningfully between the two groups. Direct and indirect predictors together accounted for 28% and 21%, respectively, of variance in behavioral intention. Attitude was the strongest predictor. Intentions to facilitate mental health referrals may be driven by the same factors among CIT-trained and non-CIT officers, but CIT officers, even at a median of 22 months after training, have significantly higher scores on those factors.

Psychological first aid (PFA) and disasters.

A disaster is commonly thought of as an occurrence that results in property damage and physical injuries that exceed the response capabilities of local resources. History teaches that disasters also result in a surge in demand for psychological support amongst survivors and disaster responders. This surge quickly exceeds local response capacities and has the potential to exceed even the mental health resources that may be imported from neighbouring jurisdictions and disaster relief agencies. Efficient and effective acute mental health intervention is, therefore, needed. However, the effectiveness of traditional multi-session counselling during and shortly after disasters has been questioned. Instead, the utilization of efficient and effective crisis-focussed psychological interventions has been suggested as acute phase alternatives. This paper asserts psychological first aid (PFA) may be considered a specific crisis-focussed disaster mental health intervention for use during and after disasters. PFA is designed for use in assessing and mitigating acute distress, while serving as a platform for psychological triage complementing more traditional psychological and psychiatric interventions. PFA may be employed by mental health clinicians as well as 'peer responders'.

[Sentinel program: Example of suicide prevention for an agricultural population in Switzerland]. / Programme sentinelle : exemple de prévention du suicide auprès d'une population agricole en Suisse.

OBJECTIVES: In the field of suicide prevention, the identification of risk groups is important, as is the training of front-line workers, to raise awareness of suicide issues. Agricultural workers represent a group at high risk of suicidal behavior due to various factors (low income of farmers, work related to climatic conditions, social isolation, poor access to primary care). The main objective of this article is to present the implementation of prevention training in suicide prevention for a population of agricultural workers in two cantons of French-speaking Switzerland (Vaud and Neuchâtel) which represent a population of about 980,000 inhabitants. The second objective is to identify the experiences of the participants in this training and their expectations. METHODS: Suicide prevention training sessions are organized in collaboration with public health departments, agriculture departments and suicide prevention professionals. Each session is led by four trainers experienced in suicide prevention and belonging to the "Groupement Romand Prévention du Suicide" (GRPS) which manages the training and other training modules on this topic in French-speaking Switzerland. The GRPS guarantees the content of the training as well as the updating of scientific knowledge. The training model is based on a concept that alternates between brief theoretical contributions, exchanges between participants in plenary sessions and role playing in small groups. The training has two main objectives: on the one hand to work on the participants' representations of suicide and to modify their posture by training "sentinels", i.e. "peers" who can establish a link between suffering individuals and the available support resources. On the other hand, to give key messages: dare to talk about the suicidal question and to not remain alone with this. RESULTS: Between December 2016 and May 2018, nine sessions were held in the two cantons of Vaud and Neuchâtel with a total of 220 participants. The sessions took place in agricultural schools or buildings related to agriculture. Invited to express themselves on the theme of suicide as well as on the concept of training, agricultural workers all verbalized the importance of this issue and were often very moved when the subject was discussed. The topics addressed by the participants were the taboo aspect of the subject, the difficulty of talking about it and the need to be able to address the subject (breaking the isolation). Participants also highlighted the need for peers to act as relays for help. CONCLUSIONS: The sessions were highly appreciated by the organizers concerned, particularly by the public health and agricultural departments. Participants expressed their satisfaction at the opportunity to express their views on this subject, regretting that such initiatives are all too rare. Although studies highlight the difficulty of emotional expression in the agricultural field, we observed on the contrary a great facility of the participants to express their emotions in relation to the suicidal theme. We have highlighted that the issue of suicide in this population is linked to several causal factors, as is the suicidal issue more broadly. Factors specific to this population emerged from the sessions, including working conditions and difficulties related to the family environment of farmers. There is a need to strengthen suicide prevention with training programs among the agricultural population. We also note the major importance of improving access to mental health care which is often very deficient in rural areas.

Dissemination of the Safety Planning Intervention (SPI) to University Counseling Center Clinicians to Reduce Suicide Risk Among College Students.

Suicide risk on college campuses remains a pervasive problem. Structural deficits in current clinical care models often result in sub-optimal treatment for suicidal students. This study reports on the feasibility, acceptability, and utility of the Safety Planning Intervention (SPI), a brief, empirically validated, clinician-administered suicide prevention intervention, in a university counseling center (UCC) setting. A group of 12 university counseling center direct service staff completed a 2-hour training in SPI. Participants reported on suicide intervention practices, training needs, and confidence at baseline and 10 weeks post-training. Acceptability, utility, and frequency of SPI use were assessed at follow-up. All clinical staff attended the training and found it useful, reporting that confidence in managing suicide risk increased as a result. Two-thirds of staff implemented SPI least once. Results suggest that SPI is a feasible, acceptable, and useful suicide intervention tool for UCCs.

PROTECT: Relational safety based suicide prevention training frameworks.

Preventing suicide is a global priority, and staff training is a core prevention strategy. However, frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper was to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK: 333 - a recovery-oriented model of inpatient/community crisis care and PROMISE - a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalize ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well-established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; and NOTES for documentation. PROTECT aims to improve self-awareness of mental shortcuts and risk-taking thresholds and increase rigour through time-efficient cross-checks. The training frameworks should support a relational approach to self-harm/suicide risk detection, mitigation, and documentation, making care safer and person-centred. The goal is to enthuse practitioners with recovery-oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualized solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine-tuning.

Implementation and evaluation of SBIRT training in a Community Health nursing course.

OBJECTIVE: The purpose of this paper is to report on the implementation and evaluation of a Screening, Brief Intervention and Referral to Treatment (SBIRT) educational program into an undergraduate nursing curriculum and to recommend modifications for future trainings. DESIGN AND SAMPLE: A one-group pre-test/post-test design was used. The sample consisted of senior level undergraduate nursing students. MEASURES: Core knowledge, perceived competency, and program satisfaction were measured. Process evaluation activities were performed to gather feedback on the training and solicit ideas and recommendations for improvement. RESULTS: Of the 354 nursing students enrolled in the training, 249 (70%) participated in the research portion, with 240 (96%) completed the pre- and post-training evaluations. All four core knowledge components and 13 perceived competency indicators were statistically significant (p ≤ .001) when comparing pre- and post-t test values. Process evaluation data collected through 25 telephone interviews found that the training improved the students' confidence and ability to screen for substance misuse with patients. CONCLUSION: Findings support the implementation of SBIRT training into an undergraduate nursing curriculum. Modifications for future training and research are proposed.

Effectiveness of Police Crisis Intervention Training Programs.

Approximately 1,000 people in the United States were fatally shot by police officers during 2018, and people with mental illness were involved in approximately 25 percent of those fatalities. Crisis Intervention Team (CIT) training is a specialized police curriculum that aims to reduce the risk of serious injury or death during an emergency interaction between persons with mental illness and police officers. CIT has been implemented widely both nationally and internationally. Given the increasing resources devoted to CIT, efforts to analyze its effectiveness and outcomes relative to other approaches are important. Studies of CIT and similar interventions are found within both the mental health and the criminal justice arenas, which use very different terminologies, approaches, and outcome studies, rendering unified analyses challenging. This article describes the CIT model and reviews several recent systematic analyses of studies concerning the effects of CIT. Studies generally support that CIT has beneficial officer-level outcomes, such as officer satisfaction and self-perception of a reduction in use of force. CIT also likely leads to prebooking diversion from jails to psychiatric facilities. There is little evidence in the peer-reviewed literature, however, that shows CIT's benefits on objective measures of arrests, officer injury, citizen injury, or use of force.

Law Enforcement and Clinician Partnerships: Training of Trainers for CIT Teams in Liberia, West Africa.

The crisis intervention team (CIT) model was developed in the United States to align law enforcement goals with those of mental health advocates and service users. Liberia is the first low-income country where CIT has been implemented. After preliminary training of law enforcement officers and mental health clinicians by U.S. CIT experts, the program is now entirely implemented by Liberian personnel. In this column, the authors describe topics addressed in the 5-day training-of-trainers process to prepare Liberian mental health clinicians and law enforcement officers to conduct the program, along with feedback received from participants. They hope that this model can guide future initiatives aimed at fostering collaboration of law enforcement and mental health services in global mental health.

Empowering Residents to Process Distressing Events: A Debriefing Workshop.

Introduction: Adverse events are common in medical training and practice, which can lead to distress among providers. One method of coping with distress is debriefing, which has been shown to improve participants' ability to manage their grief and has been associated with lower rates of burnout. Methods: We designed this 2-hour workshop to provide senior residents with the knowledge and skills to lead debriefing sessions within their teams. In this curriculum, we have included a workshop facilitator's guide, didactic information reviewing the components of effective debriefing, a video of a sample debriefing, two videos demonstrating potential debriefing challenges, small-group practice cases, a debriefing pocket card resource, and pre- and postworkshop survey evaluations. Results: Twenty second-year pediatric and medicine-pediatric residents were included in the pilot study of this workshop. They reported an average of 2.2 (SD = 2.4) distressing events in the preceding month. None of the residents had received previous training in debriefing, and only 10% had previously led a debriefing session. Pre- and postintervention surveys demonstrated significant increases in resident comfort in and likelihood of leading a debriefing session, as well as in recognition of personal distress. Discussion: This workshop serves as one model to enhance training and education regarding debriefing in residency training programs. The issue of distress is not unique to residents, and although this training was initially designed for that population, it could easily be adapted to reach a broader audience of medical trainees and providers.

A randomized controlled trial of suicide prevention training for primary care providers: a study protocol.

BACKGROUND: Suicide is a national public health crisis and a critical patient safety issue. It is the 10th leading cause of death overall and the second leading cause of death among adolescents and young adults (15-34 years old). Research shows 80% of youth who died by suicide saw their primary care provider within the year of their death. It is imperative that primary care providers develop the knowledge and skills to talk with patients about distress and suicidal thoughts, and to assess and respond in the context of the ongoing patient - primary care provider relationship. METHODS: This study examines the effectiveness of simulation on suicide prevention training for providers-in-training by comparing two conditions: 1) a control group that receives online teaching on suicide prevention in primary care via brief online videos and 2) an experimental group that includes the same online teaching videos plus two standardized patient (SP) interactions (face-to-face and telehealth, presentation randomized). All SP interactions are video-recorded. The primary analysis is a comparison of the two groups' suicide prevention skills using an SP "test case" at 6-month follow-up. DISCUSSION: The primary research question examines the impact of practice (through SP simulation) over and above online teaching alone on suicide prevention skills demonstrated at follow-up. We will assess moderators of outcomes, differences among SP simulations (i.e., face-to-face vs. telehealth modalities), and whether the experimental group's suicide prevention skills improve over the three SP experiences. TRIAL REGISTRATION: The study was registered on Clinical Trials Registry ( clinicaltrials.gov ) on December 14, 2016. The Trial Registration Number is NCT02996344 .

CIT in small municipalities: Officer-level outcomes.

Research on the Crisis Intervention Team (CIT) as a method to deal with mental illness in policing encounters has primarily focused on officers from large urban areas. The current study examined officer-level outcomes in a non-urban geographical setting using a pre/post-CIT training design. The sample included 46 police officers from seven departments that would be considered rural and 13 that would be classified as suburban. Officers completed scales to gauge change in mental illness attitudes at the beginning and end of their one-week CIT training. CIT training resulted in reductions in stigmatic attitudes with seven large effect sizes (ranging from η2  = .24 to .59) across the two measures. The findings from this research are a direct response to the call for greater diversity in the size of police settings in the CIT literature and serve to expand the empirical base for CIT in relation to officer-level outcomes.

Beyond crisis intervention team (CIT) classroom training: Videoconference continuing education for law enforcement.

Continuing education in Crisis Intervention Team (CIT) principles and best practices are limited. In 2015, the Albuquerque Police Department became the first law enforcement agency in the country to provide extended learning for CIT and case debriefings related to behavioral health through videoconferencing technology. The project, known as CIT ECHO, connects law enforcement agencies across New Mexico and the country to an online classroom where CIT experts and psychiatrists review behavioral health topics, and debrief complex cases with officers. An overview of CIT ECHO is provided including key elements, implementation challenges, and how we are evaluating its reach and effectiveness.

A Systematic Process for Selection of a Crisis Prevention/De-Escalation Training Program in the Hospital Setting.

INTRODUCTION: The current de-escalation program utilized in this organization was not adequately meeting the needs of all the pediatric populations served. AIMS: Identify a de-escalation program, which is evidenced-based and able to be effective across all sizes and ages of patients served at this organization. METHOD: The work described in this article displays the thorough systematic process used to select a new behavioral health crisis prevention/de-escalation training program within a large children's hospital. RESULTS: Fourteen de-escalation programs were initially identified, nine of them were further analyzed based on curriculum, cost, training requirements, emphasis on verbal de-escalation, ability to address needs of those with Autism Spectrum Disorders, and overall fit for this organization. One final program was selected for implementation after a robust selection process. CONCLUSIONS: The team used a comprehensive approach during program selection to attempt to decrease or limit potential resistance to change from affected employees.

Enhancing knowledge of adolescent mental health among law enforcement: Implementing youth-focused crisis intervention team training.

This study explores the feasibility, acceptability, fidelity, and outcomes of a youth version of the Crisis Intervention Team training (CIT-Y). This intervention is designed to keep youth with a mental health problem out of the criminal/legal system by equipping police officers with developmentally appropriate information and techniques. Whereas much is known about the adult-focused CIT training, little is known about the youth-focused training. This preliminary investigation uses multiple methods (training observations, officer interviews, and pre/post-tests) to assesses the implementation of CIT-Y in two Midwest counties. Multiple 8-hour training sessions were offered in both counties with 127 officers participating and completing the pre/post measure. The findings of this study confirmed that CIT-Y training was feasible in these counties and acceptable to the officers who participated. Outcomes from the pre/post-tests show that 86% of officers positively changed their knowledge and attitudes regarding youth with mental health problems. Interviews revealed a positive impact on officers' reported behaviors. While this preliminary investigation of CIT-Y showed positive outcomes, recommendations for enhancing the curriculum and subsequent research are discussed.

Comparison of Mental Health Nursing Student Academic Achievement and Satisfaction: Classroom Versus Online Education in Teaching Therapeutic Crisis Management Techniques.

BACKGROUND: Mental health nurse educators use online education in an effort to offer students the ability to practice varying skills in a safe environment. PURPOSE: The purpose of this study was to compare the effectiveness and student satisfaction of live classroom versus online education in delivering therapeutic crisis management skills content to pre-licensure nursing students as measured by overall grade point average (GPA), test scores, class grade, and student satisfaction survey results. METHODS: This quasi-experimental, post-hoc comparative study had a two-group post-test design. The participants were pre-licensure psychiatric mental health nursing students who were presented a 30-min lecture followed by group work with case studies and interventions. RESULTS: There were no statistically significant differences between the live classroom and online education group. CONCLUSIONS: This study indicates that therapeutic crisis management techniques can be taught a variety of ways for academic success and may validate the feasibility of online education within mental health nursing curricula.