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2000 Oregon Youth Suicide Prevention FOLLOWUP SERVICES FOR SUICIDE ATTEMPTERS
The Oregon Plan for Youth Suicide Prevention
Related WWW links.STRATEGY 15: IMPROVE FOLLOW-UP SERVICES FOR SUICIDE ATTEMPTERS
Resources for Strategy #15
OBJECTIVE
Improve emergency room and after-care services for youth suicide attempters and their families by:
  • training emergency room staff in the use of a protocol to increase treatment adherence
  • providing follow-up after-care for youth and their families
AUDIENCE
Emergency room personnel and after-care service providers.
A prior suicide attempt is the strongest predictor of a future attempt
RATIONALE AND EFFICACY
One of the strongest predictors of a future suicide attempt is a past attempt.73 Follow-up studies have found that 31% to 50% of youth whose suicide attempts are serious enough to warrant medical care will make another attempt. As many as 11% will eventually take their own lives.74, 75 Studies show that psychiatric intervention can have a positive effect in reducing subsequent attempts.76 Yet, approximately half of all adolescents seen for suicidal behavior receive no mental health intervention after their emergency room visit, and of those who do receive follow-up, as many as 75% do not adhere to the recommended treatment.75 Appropriate medical care and after-care for suicide attempters is important for preventing future attempts in this highly vulnerable population.

A specialized emergency room program for adolescent attempters has demonstrated increased adherence to treatment after-care.77 In addition, a brief family therapy model has shown promise in reducing overall symptom levels in youth suicide attempters, but research following them over time is needed to evaluate the effectiveness of the model.77, 78

IMPLEMENTATION CONSIDERATIONS Involvement of medical personnel, especially emergency room and critical care providers, is vital to the implementation of this strategy.

Model programs may need to be adapted for specific emergency room/critical care settings and staffing patterns to work in ways that do not compromise the program?s demonstrated effectiveness.

SAMPLE IMPLEMENTATION ACTIVITIES

  • Involve hospital personnel and critical care providers in community efforts to prevent youth suicide.
  • Assess the number and frequency of youth in the community receiving medical care for suicide attempts.
  • Assess emergency room and critical care provider protocols in responding to suicidal youth and the extent and nature of after-care provided to youth suicide attempters and their families.
  • Work with medical providers in selecting appropriate emergency care protocols and after-care interventions.
  • Facilitate the provision of training to emergency care and after-care service providers.


REFERENCES
73 Lewinsohn P, Rohde P, Seeley J. Psychosocial risk factors for future adolescent suicide attempts. J Consult Clin Psychol. 1994; 62(2):297-305.
74 Shaffer D, Piacentini J. Suicide and attempted suicide. In: Rutter M,Taylor E, eds. Child Psychiatry-Modern Approaches. 3rd ed. Oxford: Blackwell Scientific, 1993, in press.
75 Spirito A, Brown L, Overholser J, Fritz G. Attempted suicide in adolescence: a review and critique of the literature. Clin Psych Rev. 1989; 9:335-63.
76 Shaffer D, Piacentini J. Suicide and attempted suicide. In: Rutter M, Taylor E, eds. Child Psychiatry-Modern Approaches. 3rd ed. Oxford: Blackwell Scientific. 1993.
77 Rotheram-Borus M, Piacentini J, Van Rossem R, et al. Enhancing treatment adherence with a specialized emergency room program for adolescent suicide attempters. J Am Acad Child Adolesc Psychiatry. 1996; 35:5.
78 Piacentini J, Rotheram-Borus M, Cantwell C. Brief cognitive-behavioral family therapy for suicidal adolescents. In L VandeCreek, S Knapp & T Jackson, eds. Innovations in Clinical Practice: A Sourcebook. Vol 14, pp 151-168. Professional Resource Press. 1995. Sarasota, Florida.
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