Family Safety Net Project 2

Suicide is the third leading cause of death for American adolescents, with nearly 500,000 adolescents admitted, per year, to psychiatric hospitals for attempts or serious ideation. Still, there are few effective treatments for preventing this public health problem. One promising treatment is Attachment-Based Family Therapy (ABFT). ABFT was developed to treat adolescent suicidality by strengthening or repairing the parent-adolescent bond so that adolescents are more likely to turn to parents for support. ABFT has demonstrated efficacy in reducing suicidal ideation and depressive symptoms in two clinical trials, compared to uncontrolled comparison treatments. However, more work is necessary to establish ABFT’s internal validity.

Therefore, this study compares the efficacy of ABFT to a non-directive Supportive Therapy (NST), a treatment that has already been shown to reduce suicide symptoms. In NST, the therapist mostly meets with the adolescent and focuses on mood, symptoms, and behavior, as well as factors that contribute to adolescent suicidal behavior. NST incorporates a parent psycho-education component, which offers parents knowledge, skills and support to improve management of a suicidal teen. As a whole, participants in both treatment groups are expected to significantly improve, based on previous studies on both of these therapies. Both treatments are manualized and have been used in previous trials.

For more information, please contact Jody Russon, Project Coordinator: jody.m.russon@drexel.edu.

Attachment-Based Family Therapy for LGBTQI suicidal youth: Feasibility, acceptability and transportability

Youth suicide is a serious public health problem in the United States. It is the second leading cause of death for 15-to-24-year-olds, (Hoyert, 2012), yet only 14% of youth with suicidal ideation and 22% of those who make a suicide attempt report receiving mental health services (Nock et al., 2013). LGBTQI youth are particularly at risk. These adolescents report higher rates of both suicidal ideation and suicide attempts than their heterosexual peers (Haas et al., 2011). Surprisingly, only one suicide treatment model has been modified and tested with this high risk population. Attachment-Based Family Therapy (ABFT), an empirically supported treatment for suicidal adolescents, has been successfully adapted specifically for LGBTQI youth (G. M. Diamond et al., 2012). Although a fully powered RCT with this population may be warranted, given the high public health significance of this at-risk population and the fact that ABFT has been successful with LGBTQ patients, efforts to bring this treatment into community settings seem necessary. Research, however, demonstrates that importing empirically supported treatments into community settings can be challenging. Barriers exist at the level of the patients, providers, health care organizations, state regulators, and payers (Landsverk et al., 2011). Thus, successful treatment implementation depends on collaborative partnerships with a broad range of stakeholders (Aarons, Hurlburt, & Horwitz, 2011; Bernal, Jiménez-Chafey, & Rodríguez, 2009; Simpson & Flynn, 2007). Using both quantitative (e.g., survey or claims data) and qualitative methods (e.g., focus group and interviews), early stage effectiveness and implementation research focuses on better understanding the context within which the treatment will be used as well as the manual modifications required to improve fit and sustainability.

Using the implementation models referenced above, the research team is using the following approaches to adapt ABFT to the clinical ecology of a community center treating LGBTQI youth: a) quantitative and qualitative data sources, and b) results from an open trial study. Innovations in this project include partnering with a large LGBTQI program, use of a web-based assessment tool to monitor clinical severity, and building a relationship with the LGBTQI task force out of the Department of Health. The research team is working on several aims: 1) Engage multiple stake holders in the modification and adaption of the delivery of ABFT to meet needs of patients, parents, therapists and program administrators; 2) Provide ABFT co-therapy, with therapists from an LGBTQI youth center, for 10 suicidal LGBTQI adolescents. This study explores transportability, feasibility, acceptability and preliminary effectiveness. Appropriate modifications to the treatment and its delivery format will be completed in a manual addendum. Procedures for implementation and evaluation will be developed to support a future effectiveness study.

For more information, please contact Jody Russon: jody.m.russon@drexel.edu.