Family Therapy as Aftercare for Adolescents Hospitalized for a Suicide Attempt
Many adolescents who are hospitalized for suicide attempts never receive aftercare treatment and effectiveness of the available services is limited (Daniel, Goldston, Harris, Kelley & Palmes, 2004). Therefore, the objective of this AFSP Distinguished Investigator grant application was to gather pilot data regarding the acceptability, feasibility, and preliminary effect sizes of Attachment-Based Family Therapy (ABFT; Diamond et. al., 2002) to a) prevent reattempts, b) reduce risk factors associated with attempts, and c) increase treatment compliance. Twenty adolescents were randomized to 14 weeks of Enhanced Usual Care (EUC, active referral, weekly assessments for three months, 24-hour hotline) or to ABFT. Measures of suicide attempt and lethality, suicidal ideation, depression and family conflict were obtained at hospital discharge, weekly and at 14 weeks post-discharge.
Attachment-Based Family Therapy for Suicidal Gay, Lesbian and Bisexual Adolescents
Youth suicide is a serious national problem. Each year, 20 percent of adolescents seriously consider attempting suicide and up to 9 percent make a suicide attempt. Lesbian, gay and bisexual (LGB) adolescents are particularly at risk. One particularly well suited treatment for treating this population is Attachment-Based Family Therapy (ABFT). ABFT was developed to treat suicidal adolescents by addressing negative family process (e.g., parental criticism and rejection) and has demonstrated efficacy in two clinical trials. However more work was needed to further develop ABFT so that it is sensitive to the unique themes and challenges relevant to LGB suicidal youth. This study was designed to adapt ABFT so that it is sensitive to the unique themes and processes relevant to working with LGB suicidal youth. ABFT is a particularly good candidate for treating suicidal LGB adolescents for three reasons. First, it is a manualized, empirically-based family treatment which specifically targets adolescent suicidal ideation and depression. Second, it addresses family conflict and parental negativity, rejection and lack of care - risk factors specifically associated with adolescent suicidality. Third, there is some preliminary data drawn from prior studies suggesting that ABFT may be efficacious with this population. To accomplish the goals of the study, a treatment development team was comprised of the originators of ABFT, experts on suicide among LGB youth and experts in counseling LGB youth. Then, six treatment development meetings were conducted in order to complete an initial revision of the ABFT treatment manual and accompanying adherence measure. These revisions were made based on the team's collective knowledge-base and clinical experience, the extant literature on counseling LGB youth and the observation of videotaped sessions from prior ABFT cases with LGB suicidal and depressed youth. After the initial revision, we conducted an open, pilot study during in which we treated 10 suicidal and depressed LGB teenagers using the revised ABFT-LGB manual.
Family Safety Net Project
Youth suicide presents a serious health problem for the nation and a clinical challenge for medical and behavioral health providers. To date, few published studies have sought to identify and treat a seriously high-risk group – adolescents with severe suicidal ideation. In addition, there is virtually not research on suicide in an urban, minority population (Joe & Kaplin, 2001). To address this deficit, this project tested the effectiveness of brief family therapy for adolescents presenting with serious risk for suicide in an urban primary care setting. Patients were identified in the primary care setting. Primary care is inundated with patients presenting with behavioral health problems yet has few resources to help them. Integrating behavioral health services into primary care may provide a safety net until long-term services are found, alleviate some of the problems motivating the contemplation of suicide and reduce barriers to long-term care. We targeted adolescents with severe and persistent suicidal ideation and depression. Sixty-six adolescents between the ages of 12 and 17 identified in primary care and emergency departments were randomized to either 12 weeks of ABFT or Enhanced Usual Care. Assessments occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access to a 24-hour crisis phone. Trajectory of change and clinical recovery were measured for suicidal ideation and depressive symptoms.