Vulnerable yet forgotten? A systematic review identifying the lack of evidence for effective suicide interventions for young people in contact with child protection systems.

Abstract

Children and young people in out-of-home care are at a higher risk of suicide than young people not involved with child protection systems. Despite this, there is a lack of evidence of effective suicide prevention interventions for this vulnerable population. We reviewed the types of suicide prevention interventions that have been used and evaluated with children and young people and staff and carers in out-of-home care/child protection systems. We conducted a systematic review of existing literature using PRISMA guidelines. Only five studies met the inclusion criteria. Two evaluated youth-focused interventions: emotional intelligence therapy; and multidimensional treatment foster care, while three evaluated adult-focused “gatekeeper training.” Youth-focused interventions led to reductions in suicidal thoughts (suicidal ideation), and adult-focused interventions led to increased knowledge, skills, and behaviors such as referring youth to supports. Only one study, one of the youth-focused ones, evaluated the impact of the intervention in terms of suicide attempts but found no reduction. Large numbers of children enter into care with a high risk of suicide. With the considerable overlap between the trauma characteristics and mental health needs of young people in out-of-home care and suicide risk factors in the general population of young people, we recommend developing (and evaluating) new or adapted existing suicide prevention interventions designed specifically for the out-of-home care context.

Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review

“…Conversely, there was a dearth of interventions targeting subjective wellbeing and suicide-related outcomes, despite care-experienced young people reporting relative adversity in these areas compared to the general population [ 7 , 8 ]. This reflects wider findings in the research evidence, with a recent review of suicide prevention interventions for children involved in child protection services also identifying a paucity of evidence-based approaches [ 192 ]. New interventions might be developed to target these outcomes, or existing approaches adapted if theoretically appropriate.…”

Reducing Suicidal Ideation in Preadolescents With a History of Foster Care by Promoting School Readiness in Early Childhood

“…This suggests that intervention in childhood to forestall the development of ideation might reduce risks for longer-term ideation, attempts, and death by suicide. Unfortunately, a recent systematic review of interventions across the globe found that only two evidence-based interventions reduced SI in youth in foster care, and both were focused on adolescents (Russell et al, 2021).…”

“…Importantly, neither of those two programs targeted SI directly (Russell et al, 2021). Instead, they focused on building positive skills in the youths and/or their caregivers.…”

“…Further, these higher rates are apparent as early as preadolescence (Taussig et al, 2014; Thompson et al, 2005). Despite this increased and early-onset risk for SI, there are few preventive interventions specifically designed for youth in foster care (Russell et al, 2021). To address this critical need, this study examines whether an intervention designed to promote school readiness in children with histories of maltreatment and placement in foster care could also reduce SI in preadolescence both directly and indirectly through self-esteem.…”

Peripheral and neural correlates of self-harm in children and adolescents: a scoping review

“…Unfortunately, we do not yet have an evidence-based, validated set of clinical treatment guidelines for treating pediatric self-harm [ 21 ]. Despite a growing number of encouraging treatment studies in recent years, systematic reviews and meta-analyses conclude that replication of positive effects from dialectical behaviour therapy (DBT) is needed and that more clinical trial research is still required for mentalization and family-based therapies to determine efficacy [ 22 – 24 ] Moreover, gaps in this corpus of work include an absence of studies about treatments for self-harm in children younger than 12 years and a paucity of trials for particularly vulnerable sub-groups such as those in care [ 25 ] and non-cis-gender children or adolescents [ 24 ]. No randomized controlled trials (RCTs) of pharmacological interventions for pediatric self-harm have been published and the results from non-RCT studies using adaptations of adult medication treatments have been disappointing [ 26 – 28 ].…”