Enhancing Treatment Adherence with a Specialized Emergency Room Program for Adolescent Suicide Attempters

Rotheram‐Borus, Mary Jane; Piacentini, John; Rossem, Ronan Van; Graae, Flemming; Cantwell, Coleen; Castro‐Blanco, David; Miller, Samuel D.; Feldman, Jason S.

doi:10.1097/00004583-199605000-00021

Cited by 170 publications

(238 citation statements)

References 33 publications

(8 reference statements)

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“…Therefore, we did not anticipate differences in suicidal ideation as a function of the intervention. Consistent with the data previously reported (Rotheram-Borus, Piacentini, Van Rossem, et al, 1996), over 18 months, the brief structural intervention in the specialized ER care condition was associated with greater attendance (3.8 sessions) and completion of the SNAP therapy (81% vs. 61%) compared with the standard ER care condition. As previously reported, parents in the specialized ER care condition also reported more positive attitudes toward treatment and described their "ideal" family to be more adaptive and cohesive than did parents in the standard ER care condition (Rotheram-Borus, Piacentini, Van Rossem, et al, 1996).…”

Section: Discussionsupporting

confidence: 89%

“…As previously reported (Rotheram-Borus, Piacentini, Van Rossem, et al, 1996, 1999, the specialized ER condition increased attendance at subsequent outpatient treatment for the SA, but not for the mother. SA in the specialized ER care condition attended 3.8 more therapy sessions on average than those in the standard ER care condition.…”

Section: Variations In Outcomes Associated With Treatment Attendancesupporting

confidence: 72%

“…If there was no missing information, the sample size for comparing intervention arms was sufficient to detect an effect size of 0.3 SD or more at a = 0.05, with at least 80% power so long as the within-subject intracluster correlation (ICC) was less than 0.24, which is higher than was seen for most of the outcomes we considered. For comparisons between impairment groups, the detectable differences at 80% power were 0.37 SD if the ICC < 0.24, assuming no adjustment for Piacentini, Van Rossem, et al, 1996) …”

Section: Discussionmentioning

confidence: 99%

“…The specialized ER care intervention was associated with lower levels of depression for both the S A and their mothers immediately following the ER encounter (Rotheram-Borus, Piacentini, Van Rossem, et al, 1996). These differences persisted over the next 18 months, although they were greater among mothers than the SA.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, mothers receiving specialized ER care were significantly less depressed at the baseline (post-ER) assessment and reported less emotional distress and more positive attitudes toward treatment than mothers in the standard ER care condition (Rotheram-Borus, Piacentini, Van Rossem, et al, 1996). Thus, the effects of the specialized ER care were immediately observable in the baseline interviews.…”

mentioning

confidence: 91%

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The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

Rotheram‐Borus¹,

Piacentini²,

Cantwell³

et al. 2000

Journal of Consulting and Clinical Psychology

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160

170

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Following a suicide attempt by female adolescents, the impact of a specialized emergency room (ER) care intervention was evaluated over the subsequent 18 months. Using a quasi-experimental design, this study assigned 140 female adolescent suicide attempters (SA), ages 12-18 years, and their mothers (88% Hispanic) to receive during their ER visit either: (a) specialized ER care aimed at enhancing adherence to outpatient therapy by providing a soap opera video regarding suicidality, a family therapy session, and staff training; or (b) standard ER care. The adjustment of the SA and their mothers was evaluated over 18 months (follow-up, 92%) using linear mixed model regression analyses. SA's adjustment improved over time on most mental health indices. Rates of suicide reattempts (12.4%) and suicidal reideation (29.8%) were lower than anticipated and similar across ER conditions. The specialized ER care condition was associated with significantly lower depression scores by the SA and lower maternal ratings on family cohesion. Significant interactions of intervention condition with the SA's initial level of psychiatric symptomatology indicated that the intervention's impact was greatest on maternal emotional distress and family cohesion among SA who were highly symptomatic. SA's attendance at therapy sessions following the ER visit was significantly associated with only one outcome-family adaptability. Specialized ER interventions may have substantial and sustained impact over time, particularly for the parents of youth with high psychiatric symptomatology. Adolescent suicide attempts are a significant problem, with 7.7% of high school students reporting attempts and 2.6% saying their attempt required medical attention (Centers for Disease Control and Prevention [CDC], 1998). Adolescent suicide attempters (SA) are at increased risk for repeat attempts, long-term psychiatric symptoms, and academic, social, and behavioral problems (Shaffer & Piacentini, 1994). In spite of their great need for mental health intervention, fewer than 50% of adolescent attempters are referred for psychotherapy following their emergency room (ER) visit (Piacentini et al., 1995; Spirito, Brown, Overholser, & Fritz, 1989), and a large proportion of these individuals fail to attend their initial treatment session. Of those who do attend, many do not complete treatment (Piacentini et al., 1995; Spirito et al., 1989). Nonattendance to follow-up treatment by suicidal adolescents is especially disturbing, considering that psychiatric intervention can reduce subsequent attempts and social maladjustment (Rotheram-Borus, Piacentini, Miller, Graae, & Castro-Bianco, 1994; Shaffer & Piacentini, 1994). There are many reasons why individuals fail to attend treatment following an ER visit for a suicide attempt. Repetitive evaluations, lengthy waiting periods, bureaucratic registration procedures, and

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Section: Discussionsupporting

confidence: 89%

Section: Variations In Outcomes Associated With Treatment Attendancesupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 91%

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The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

Rotheram‐Borus¹,

Piacentini²,

Cantwell³

et al. 2000

Journal of Consulting and Clinical Psychology

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160

170

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Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

et al. 2019

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IMPORTANCE Emergency department (ED) visits present opportunities to identify and refer suicidal youth for outpatient mental health care, although this practice is not routine.OBJECTIVE To examine whether a motivational interviewing-based intervention increases linkage of adolescents to outpatient mental health services and reduces depression symptoms and suicidal ideation in adolescents seeking emergency care for non-mental health-related concerns who screen positive for suicide risk. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, adolescents aged 12 to 17 years who screened positive on the Ask Suicide Screening Questions (ASQ) during a nonpsychiatric ED visit at 2 academic pediatric EDs in Ohio were recruited from INTERVENTIONS The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) intervention included motivational interviewing to target family engagement, problem solving, referral assistance, and limited case management. The enhanced usual care (EUC) intervention consisted of brief mental health care consultation and referral. MAIN OUTCOMES AND MEASURES Primary outcomes were mental health treatment initiation and attendance within 2 months of ED discharge and suicidal ideation (assessed by the Suicidal Ideation Questionnaire JR) and depression symptoms (assessed by the Center for Epidemiologic Studies-Depression scale) at 2 and 6 months. Exploratory outcomes included treatment initiation and attendance and suicide attempts at 6 months. RESULTS A total of 168 participants were randomized and 159 included in the intention-to-treatanalyses (mean [SD] age, 15.0 [1.5] years; 126 [79.2%] female; and 80 [50.3%] white). Seventy-nine participants were randomized to receive the STAT-ED intervention and 80 to receive EUC. At 2 months, youth in the STAT-ED group had similar rates of mental health treatment initiation compared with youth in the EUC group as assessed by parent report (29 [50.9%] vs 22 [34.9%]; adjusted odds ratio [OR], 2.08; 95% CI, 0.97-4.45) and administrative data from mental health care agencies (19 [29.7%] vs 11 [19.3%]; adjusted OR, 1.77; 95% CI, 0.76-4.15). At 2 months, youth in the STAT-ED group and the EUC group had similar rates of treatment attendance (1 appointment: 6 [9.7%] vs 2 [3.6%]; adjusted OR, 2.97; 95% CI, 0.56-15.73; Ն2 appointments: 10 [16.1%] vs 7 [12.7%]; adjusted OR, 1.43;95% CI, 0.50-4.11). There were no significant group × time differences in suicidal ideation (F = 0.28; P = .72) and depression symptoms (F = 0.49; P = .60) during the 6-month follow-up period. In (continued)

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Youth suicidal behavior: Assessment and intervention

Miller

Glinski

2000

J. Clin. Psychol.

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Enhancing Treatment Adherence with a Specialized Emergency Room Program for Adolescent Suicide Attempters

Cited by 170 publications

References 33 publications

The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

Youth suicidal behavior: Assessment and intervention

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