Parker Family Episode 3

Parker Family Episode 3 Program Transcript

FEMALE SPEAKER: I want to take care of her. I really do. I mean, she's my mom, and she's not getting any younger. But I deserve my own life, my own place. And I'm always tired of feeling like I'm suffocating all the time. It's just– It's so confusing. I love her, you know?

FEMALE SPEAKER: I understand that you want a place of your own to live. You mentioned before that you and your mother argue a lot.

FEMALE SPEAKER: A lot? How about all the time? And all that stuff she hoards, it's just like, I'm drowning in it. It's like there's more room for her junk than there is for us. It just drives me crazy. Right to the hospital sometimes.

FEMALE SPEAKER: How many times have you been hospitalized?

FEMALE SPEAKER: Let's see. Three times in four years. I think I mentioned to you that I'm bipolar, and I'm lousy dealing with stress. Oh. Wait, um, there was another time that I was in the hospital. I tried to commit suicide. I guess I was pretty lousy at that too, otherwise I wouldn't be here.

FEMALE SPEAKER: What made you want to do it? I was a teenager. And when you're a teenager, you find a reason every day to try to kill yourself, right? I was– I was depressed.

I remember one night I went out with some of my friends. And, um, they were all looking up at the sky and talking about how pretty the stars were. And all I could think about was that that sky was nothing more than a black eye. It was lifeless, and it could care less about any of us.

When they finally let me go home from the hospital, my family– wow– what a trip they were. They didn't want to talk about what I had tried to do. That was off- limits. I tried to kill myself. And I they acted like nothing ever happened. I've never told anybody that before.

FEMALE SPEAKER: Are you seeing a psychiatrist now?

FEMALE SPEAKER: Um, I go to a clinic, and I see him once a month. I also go to drop-in centers for group sessions, mostly for my depression.

FEMALE SPEAKER: What about medications?

FEMALE SPEAKER: Hell, yeah. They're my lifesaver.

FEMALE SPEAKER: What are you taking?

©2013 Laureate Education, Inc. 1

Parker Family Episode 3

FEMALE SPEAKER: Let's see. For the bipolar I take lithium, Paxil. Oh. Wait a minute. I made a list so I would not forget the medications that I take. Let's see. I take lithium, Paxil, Abilify, Klonopin–

Parker Family Episode 3 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

©2013 Laureate Education, Inc. 2

CME Article

PSYCHIATRIC ANNALS • Vol. 49, No. 6, 2019 269

Suicide in Adolescents Sade Udoetuk, MD; Sindhu Idicula, MD; Qammar Jabbar, MBBS; and Asim A. Shah, MD

ABSTRACT Suicide is a leading cause of death

in many nations around the world. De- spite increased awareness of depres- sion and suicidality in adolescents, spe- cific groups continue to be affected by this growing health problem. In this ar- ticle, the authors review literature and statistics surrounding suicide in ado- lescents and young adults. Specifically, we examine the epidemiology of sui- cide in adolescents; highlight protec- tive and risk factors and warning signs of adolescent suicide; explore the roles of technology, prevention program- ming, and screening tools for youth who are at risk; and discuss treatment modalities for this patient population. [Psychiatr Ann. 2019;49(6):269-272.]

I n the adolescent and young adult population, suicide continues to be a growing and difficult challenge in

the United States and globally. World- wide, suicide is the second leading cause of death in adolescents and young adults age 15 to 29 years.1 In the United States, it has become the second leading cause of death (behind unintentional injury) for young people age 10 to 24 years.2 For younger adolescents, the number of suicide incidents for those age 10 to 14 years is 517, compared to 6,252 among adolescents and young adults age 15 to 24 years.2 It is notable that suicide ac- counts for approximately 60% of deaths compared to unintentional injury in the younger category, and approximately 47% of deaths compared to unintention- al injury in the older group.2

Gender does seem to play a role in the incidence and expression of suicidal- ity. According to the Centers for Disease Control and Prevention, adolescent boys and young adult men (age 15-24 years) have a suicide completion rate that is

approximately 4 times higher than age- matched girls and young adult women. However, adolescent girls report a sig- nificantly higher rate of suicidal ideation than boys (22% in girls, 11.9% in boys), as well as suicide plans (17% in girls, 10% in boys), and suicide attempts (9% in girls, 5% in boy).3 Additionally, girls are twice as likely as boys to present to emer- gency departments with self-inflicted injury, a well-established risk factor for future suicide.4 Also, suicide completion rates in adolescent girls have grown over time.2

Being a part of an ethnic or other mi- nority population may also play a role. In particular, Native Americans have the highest rate of suicide for people age 10 to 24 years.5 Although historically having a lower suicide rate, it is notable that the rate has been steadily increas- ing among African American adoles- cents.6 Studies of adolescents in Europe and North America have found that immigrant and first-generation youth have higher suicide rates than their na- tive peers.7,8 People who identify as part of the LGBTQI (lesbian, gay, bisexual, transgender, queer/questioning, intersex) community are also highly impacted, with meta-analyses revealing double the number of suicide attempts compared to control populations.9

RISK FACTORS VERSUS PROTECTIVE FACTORS VERSUS WARNING SIGNS

It is well established that certain psychiatric disorders increase the like-

Sade Udoetuk, MD, is an Associate Professor, Menninger Department of Psy- chiatry and Behavioral Sciences, Baylor College of Medicine. Sindhu Idicula, MD, is an Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. Qammar Jabbar, MBBS, is a Medical Officer, Children’s Hospital Karachi. Asim A. Shah, MD, is a Professor and the Executive Vice Chair, Menninger Department of Psychiatry and Behavioral Sciences; and a Professor, Department of Community and Family Medicine, Baylor College of Medicine.

Address correspondence to Sade Udoetuk, MD, Menninger Department of Psy- chiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030; email: [email protected]

Disclosure: The authors have no relevant financial relationships to disclose. doi:10.3928/00485713-20190509-01

270 Copyright © SLACK Incorporated

CME Article

lihood of suicidality in adults. For ex- ample, patients with depression are 20 to 30 times more likely to commit suicide than the general population.10,11 One analysis showed that more than one-half of adolescents who committed suicide did not have a diagnosed men- tal health or substance use disorder12 and, therefore, likely had not engaged in treatment. Therefore, it is imperative for all health clinicians (not just mental health professionals) to be mindful of risk factors and warning signs for sui- cidal behaviors in adolescents.

Much attention has been directed toward identifying factors that put adolescents at risk, serve a protective function, or warn of higher acute risk of suicide completion. Protective fac- tors are important to consider both to assess where a person is as well as to improve factors that may decrease the likelihood of suicide attempts or com- pletion. Protective factors include lack of access to deadly weapons, access to mental health services, positive con- nections with school and peers, family stability, religious involvement, and the ability to solve problems and overcome adversity.13-15

Risk factors for suicidality increase the likelihood of suicide completion over a lifetime. Although risk factors are often assessed in mental health care settings, they do little in terms of predicting an increased likelihood of suicide completion in the near future. Warning signs, on the other hand, serve as more acute signs that someone may be at more risk of suicide comple- tion. Imminent risk factors for suicide completion include factors such as nonsuicidal self-injury (NSSI), previ- ous suicide attempts, psychopathology, peer victimization, a history of sexual or physical trauma, social isolation, poor problem-solving and coping skills, low self-esteem, dysfunction in the fam- ily, repeated exposure to violence, and ease of means to deadly weapons.16,17 In

particular, NSSI confers the highest el- evation in risk, even higher than previ- ous suicide attempt, as published in the Treatment of Resistant Depression in Adolescent study.17

Warning signs were developed in a Consensus Statement by the Ameri- can Association of Suicidology and can be easily remembered by the mne- monic, “IS PATH WARM,” as follows: Increased Substance use; no sense of Purpose in life; Anxiety, agitation or sleep disturbance; feeling Trapped; Hopelessness; Withdrawal from family, friends, society; uncontrolled Anger or rage, revenge-seeking; Reckless or risky activities, seemingly without thinking; dramatic Mood changes.

Assessment of warning signs may give physicians a chance to both assess and treat vulnerability factors in people that put them at higher risk of immi- nent self-harm or suicide. As stated above, most adolescents who complete suicide do not have a diagnosed mental health condition; therefore, the role of the pediatrician becomes particularly important in recognizing the warning signs of suicide in their patient popu- lation. Upon recognizing these signs, pediatricians should be comfortable asking direct questions about suicidal thoughts and plans and should also be equipped to refer their patients to men- tal health professionals as needed to ensure proper treatment and follow-up care.18

THE ROLE OF TECHNOLOGY There has been a lot of attention fo-

cused on the use of social media and its effect on suicide in adolescents. One study found that cyberbullying can increase suicidal ideation by 15% and suicide by 9%.19 Unfortunately, the Internet is filled with information that instructs people about different ways to commit suicide. There is even a phenomenon called “cybersuicide,” in which a person livestreams his or her

suicide act for online viewership. Still, the Internet provides a semblance of connectivity for adolescents who are able to find support networks and kin- ship online. There are even smartphone apps that are available to help users access support systems and preventive measures.20 Thus, it must be emphasized that the monitoring an adolescent’s use of technology is an important reality of parenting in this technological age.

PREVENTION OF SUICIDE Suicide prevention programs have

gained prevalence as communities have sought ways of decreasing suicide in children and adolescents. Widespread programs such as public service an- nouncements, gate-keeper training programs (increasing awareness of sui- cidality in school staff ), and targeted psychoeducation programs have been implemented. Evidence of their effec- tiveness in reducing suicidal behaviors has been mixed. One study found that there was benefit to school- and com- munity-based programs in decreasing adolescent suicidality.21 However, a re- view article found that adolescents who have risk factors may be less likely to seek help after such initiatives.22 And, another study suggested that physician- education and decreased access to fire- arms proved to be the most effective means of reducing adolescent suicide.23

SCREENING TOOLS Unfortunately, there is no gold stan-

dard for assessing suicidality in adoles- cents. Still, a variety of screening tools have been developed to screen for sui- cidal ideation and can be applied in multiple clinical settings from emer- gency departments to general practi- tioner offices and range from 4- to 20- item assessments.

The Depressive Symptom Inven- tory – Suicidality Subscale is a 4-item self-report questionnaire designed to identify the frequency and intensity

CME Article

PSYCHIATRIC ANNALS • Vol. 49, No. 6, 2019 271

of suicidal ideation and impulses over the most recent 2-week period. It was developed as part of a larger depressive symptom index called the Hopelessness Depression Symptom Questionnaire.24 Scores on each item range from 0 to 3 and, for the inventory, from 0 to 12, with higher scores reflecting greater severity of suicidal ideation. Some preliminary data have supported the scale’s internal consistency and validity.

The General Health Question- naire-12 is a 12-item self-report ques- tionnaire designed to identify those patients awaiting general practitioner consultations who may require further evaluation due to generalized emotional distress. Scores range from 0 to 12, with higher scores representing more dis- tress. The scale has accrued reasonable reliability and validity data.

The Center for Epidemiologic Stud- ies Depression Scale is a 20-item ques- tionnaire developed for use in epide- miological surveys to identify persons with depressive symptoms.25 Its scores range from 0 to 60, with higher scores reflecting more depressive symptoms. The scale has been widely used in epide- miological surveys, with demonstrated reliability and validity.

Other screening tools that can po- tentially be used in adolescents include the Columbia Suicide Severity Rating Scale and the Nurses Global Assess- ment of Suicide Risk.

TREATMENT OF ADOLESCENT SUICIDE

Adolescent suicide is often the re- sult of multiple, complicated factors that can be difficult to pinpoint until after an attempt is made and even once a survivor is in treatment. Furthermore, there is evidence that suicidality during adolescence is not of the same nature as a mental illness in adults, but instead more closely linked to neurological, hormonal, and social changes associated with puberty.26 Typically, there is no

single intervention that can be credited with reducing suicidality in adolescents; therefore, a patient-centered, multi- modal-approach is usually necessary for success.

Patients who have suicidal intention and plan, or who have recently attempt- ed a suicidal act will more likely than not require inpatient psychiatric hospi- talization. Patients who appear to have lower risk factors for suicide but pres- ent with frequent somatic complaints or who joke often about suicide may require frequent follow-up with mental health providers as their risk for suicide might be higher than expected.

Pharmacology efforts have been tar- geted toward the treatment of comor- bid conditions. As depressive symptoms are most commonly associated with suicidality in adolescents, antidepres- sants are often used as first-line medi- cations. Paradoxically, antidepressants have been given a black-box label from the US Food and Drug Administration for increasing the risk of suicide ide- ation in adolescents and young adults.27 Therefore, the clinician must weigh the risk-benefit ratio of treating a major de- pressive disorder (MDD) with the risk of increased suicidality in the pediatric patient. A 2016 meta-analysis of anti- depressant use for youth with MDD found fluoxetine to be the best option.28 Lithium is known to reduce suicidality in adults with bipolar disorder; how- ever, one analysis found insufficient data to make similar claims in children and adolescents.29

Therapeutic interventions aimed at adolescents with risk factors for sui- cide with the largest effect sizes were dialectical-behaviorial therapy (DBT), cognitive-behavioral therapy, and men- talization-based therapy.30 DBT, in particular, was found to reduce depres- sion, self-harm, and suicidal ideation in adolescents.31 Further studies about the use of electroconvulsive therapy and ketamine infusions in adolescents will

be needed to establish their role in this population.

CONCLUSION Suicidality is a growing crisis in ado-

lescents around the world. More stud- ies of the factors contributing to and the nature of suicidal behavior in this patient population are needed to ensure appropriate preventive and treatment strategies. Although it is a collective societal effort to better humanity for the future, pediatricians, psychiatrists, and mental health providers play a dis- tinct role in protecting children from psychogenic distress and destruction.

REFERENCES

1. World Health Organization. Suicide. Key facts. https://www.who.int/en/news-room/ fact-sheets/detail/suicide. Accessed May 9, 2017.

2. Centers for Disease Control and Prevention. Leading causes of death reports, 1981-2017. https://webappa.cdc.gov/sasweb/ncipc/ leadcause.html. Accessed May 14, 2019.

3. Centers for Disease Control and Preven- tion. High school YRBS. http://nccd.cdc. gov/youthonline/. Accessed May 9, 2019.

4. Mercado M, Holland K, Leemis R, Stone D, Wang J. Trends in emergency depart- ment visits for nonfatal self-inflicted in- juries among youth aged 10 to 24 years in the United States, 2001-2015. JAMA. 2017;318(19):1931-1933. doi:10.1001/ jama.2017.13317.

5. Centers for Disease Control and Prevention. Fatal injury reports, National, Regional, and State, 1981-2017. https://webappa.cdc.gov/ sasweb/ncipc/mortrate.html. Accessed May 9, 2019.

6. Bridge J, Horowitz L, Fontanella C, et al. Age-related racial disparity in suicide rates among US youths from 2001 through 2015. JAMA Pediatr. 2018;172(7):697-699. doi:10.1001/jamapediatrics.2018.0399.

7. McMahon E, Corcoran P, Helen Keeley, et al. Mental health difficulties and sui- cidal behaviours among young migrants: multicentre study of European adoles-

272 Copyright © SLACK Incorporated

CME Article

cents. BJPsych Open. 2017;3(6):291-299. doi:10.1192/bjpo.bp.117.005322.

8. Peña J, Wyman P, Brown C, et al. Immigra- tion generation status and its association with suicide attempts, substance use, and depressive symptoms among Latino adoles- cents in the USA. Prev Sci. 2008;9(4):299- 310. doi:10.1007/s11121-008-0105-x.

9. King M, Semlyen J, Tai S, et al. A system- atic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bi- sexual people. BMC Psychiatry. 2008;8:70. doi:10.1186/1471-244X-8-70.

10. Osby U, Brandt L, Correia N, Ekbom A, Sparén P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psy- chiatry. 2001;58:844-850.

11. Harris E, Barraclough B. Suicide as an out- come for mental disorders: a meta-analysis. Br J Psychiatry. 1997;170:205-228.

12. Trigylidas T, Reynolds E, Teshome G, Dykstra H, Lichenstein R. Paediatric sui- cide in the USA: analysis of the National Child Death Case Reporting System. Inj Prev. 2016;22(4):268-273. doi:10.1136/ injuryprev-2015-041796.

13. Taliaferro L, Muehlenkamp J. Risk and pro- tective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year. Suicide Life Threat Behav. 2014;44(1):6-22. doi:10.1111/ sltb.12046.

14. Wang M, Lightsey O, Tran K, Bonaparte T. Examining suicide protective factors among black college students. Death Stud. 2013;37(3):228-247. doi:10.1080/0748118 7.2011.623215.

15. Choi K, Wang S, Yeon B, et al. Risk and protective factors predicting multiple suicide attempts. Psychiatry Res. 2013;210(3):957- 961. doi:10.1016/j.psychres.2013.09.026.

16. Miller DN, Eckert TL. Youth suicidal be-

havior: an introduction and overview. School Psychol Rev. 2009;38(2):153-167.

17. Asarnow JR, Porta G, Spirito A, et al. Sui- cide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TOR- DIA Trial. J Am Acad Child Adolesc Psy- chiatry. 2011;50(8):772-781. doi:10.1016/j. jaac.2011.04.003.

18. Dilillo D, Mauri S, Mantegazza C, et al. Suicide in pediatrics: epidemiology, risk fac- tors, warning signs and the role of the pe- diatrician in detecting them. Ital J Pediatr. 2015;41:49. doi:10.1186/s13052-015-0153- 3.

19. Nikolaou D. Does cyberbullying impact youth suicidal behaviors? J Health Econ. 2017;56:30-46. doi:10.1016/j.jheale- co.2017.09.009.

20. Larsen M, Nicholas J, Christensen H. A systematic assessment of smartphone tools for suicide prevention. PLoS One. 2016;11(4):e015228. doi:10.1371/journal. pone.0152285.

21. Calear A, Christensen H, Freeman A, et al. A systematic review of psychosocial suicide prevention interventions for youth. Eur Child Adolesc Psychiatry. 2016;25(5):467- 482. doi:10.1007/s00787-015-0783-4.

22. Klimes-Dougan B, Klingbeil D, Meller S. The impact of universal suicide-prevention programs on the help-seeking attitudes and behaviors of youths. Crisis. 2013;34(2):82- 97. doi:10.1027/0227-5910/a000178.

23. Mann J, Apter A, Bertolote J, et al. Sui- cide prevention strategies: a systematic review. JAMA. 2005;294(16):2064-2074. doi:10.1001/jama.294.16.2064.

24. Joiner T, Pfaff J, Acres G. A brief screening tool for suicidal symptoms in adolescents and young adults in general health set- tings: reliability and validity data from the

Australian National General Practice Youth Suicide Prevention Project. Behav Res Ther. 2002;40(4):471-481.

25. Radloff LS. The CES-D scale: a self-re- port depression scale for research in the general population. Appl Psychol Meas. 1997;1(3):385-401.

26. Manceaux P, Jacques D, Zdanowicz N. Hormonal and developmental influences on adolescent suicide: a systematic review. Psychiatr Danub. 2015;27(suppl 1):S300- S304.

27. US Food and Drug Administration. Suicid- ality in children and adolescents being treat- ed with antidepressant medications. https:// w w w. f d a . g o v / d r u g s / p o s t m a r k e t – d r u g – safety-information-patients-and-providers/ suicidality-children-and-adolescents-being- treated-antidepressant-medications. Ac- cessed May 14, 2019.

28. Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of an- tidepressants for major depressive disorder in children and adolescents: a network me- ta-analysis. Lancet. 2016;388(10047):881- 890. doi:10.1016/S0140-6736(16)30385-3.

29. Duffy A, Grof P. Lithium treat- ment in children and adolescents. Pharmacopsychiatry. 2018;51(5):189-193. doi:10.1055/a-0575-4179.

30. Ougrin D, Tranah T, Stahl D, Moran P, Asarnow J. Therapeutic interventions for sui- cide attempts and self-harm in adolescents: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2015;54(2):97- 107. doi:10.1016/j.jaac.2014.10.009.

31. Mehlum L, Tørmoen A, Ramberg M, et al. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming be- havior: a randomized trial. J Am Acad Child Adolesc Psychiatry. 2014;53(10):1082-1091. doi:10.1016/j.jaac.2014.07.003.

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Three Psychotherapies for Suicidal Adolescents: Overview of Conceptual Frameworks and Intervention Techniques

Jonathan B. Singer1 • Kimberly H. McManama O’Brien2 • Mary LeCloux3

Published online: 13 August 2016

� Springer Science+Business Media New York 2016

Abstract Suicide is the second leading cause of death

among youth, and as many as one in five youth report

having had at least one serious thought of suicide in the

past year. Despite the enormous emotional pain and suf-

fering associated with suicidal thoughts and behaviors, up

to 40 % of suicidal youth never receive treatment. Given

that social workers are employed in multiple settings where

suicidal children and adolescents are encountered (e.g.

schools, homeless shelters, emergency departments, out-

patient mental health agencies, private practice), they play

a critical role in the identification and treatment of suicidal

youth. In the past decade, evidence has emerged that

attachment-based family therapy, integrated cognitive

behavioral therapy, and dialectical behavior therapy can

reduce suicidal ideation and/or suicide attempt in youth.

The purpose of this article is to review the theoretical

assumptions, conceptual frameworks and key intervention

techniques for these three interventions so that clinicians

can integrate these approaches into their practice with

suicidal youth and families. Implications for practice are

integrated throughout the review.

Keywords Youth suicide � Empirically-supported interventions � Attachment-based family therapy � Integrated-cognitive behavioral therapy � Dialectical behavior therapy

Suicide is the second leading cause of death among youth

ages 10–24 years, and 12 % of youth report having serious

thoughts of suicide in their lifetime (Centers for Disease

Control and Prevention, 2014; Nock et al., 2013). Reducing

suicide deaths and improving quality of life has been the

focus of federal suicide prevention programs like the Garrett

Lee Smith Memorial Act, public–private partnerships like

the National Action Alliance for Suicide Prevention, and

private initiatives like Zero Suicide. Key components of the

2012 National Strategy for Suicide Prevention include

training service providers in assessment and referral and the

delivery of high-quality mental health services (U.S.

D.H.H.S, 2012). Given that nearly half of all mental health

workers in the United States are social workers who work in

nearly every service sector (Bureau of Labor Statistics,

2016), social workers are essential in achieving the National

Strategy objectives by identifying and assessing suicide risk,

and providing high quality ongoing management and treat-

ment (Erbacher, Singer, & Poland, 2015).

Despite the development of several psychosocial inter-

ventions for suicidal youth, there is evidence that social

workers are not receiving the training and education nee-

ded to deliver these potentially life-saving interventions. A

2012 study found that although MSW program adminis-

trators and faculty agreed that suicide-related education is

important, most social work students receive 4 or fewer

hours (Ruth, Gianino, Muroff, McLaughlin, & Feldman,

2012). This is problematic because Over 90 % of social

workers will work with a suicidal client in their career

& Jonathan B. Singer [email protected]

1 Loyola University Chicago School of Social Work, Water

Tower Campus, 820 N. Michigan Avenue, Chicago,

IL 60211, USA

2 Simmons School of Social Work, Boston Children’s

Hospital, Harvard Medical School, 300 The Fenway, Boston,

MA 02115, USA

3 West Virginia University School of Social Work,

P.O. Box 6830, Morgantown, WV 26506, USA

123

Child Adolesc Soc Work J (2017) 34:95–106

DOI 10.1007/s10560-016-0453-5

(Feldman & Freedenthal, 2006) and mental health profes-

sionals consistently rate working with suicidal clients as

among the most stressful of all practice situations (Ting,

Jacobson, & Sanders, 2008). To our knowledge there are

only two MSW programs in the USA that offer a course on

suicide and have evaluated pre- to post-course outcomes,

which indicated significant increases in knowledge, confi-

dence, and skills as a result of the course (Almeida,

O’Brien, Gross, & Gironda, in press; Scott, 2015). If fac-

ulty members are not likely to develop and offer stand-

alone courses on suicide-related issues, then it is essential

to have resources that they can integrate into existing

courses. Currently, faculty members have access to several

excellent reviews of suicide risk assessment (Barrio, 2007;

Joiner & Ribeiro, 2011; Ribeiro, Bodell, Hames, Hagan, &

Joiner, 2013; Shea, 2002) and several high quality sys-

tematic reviews and meta-analyses of psychosocial inter-

ventions for suicidal and self-harming youth (see Brent

et al., 2013; Calear et al., 2016; Corcoran, Dattalo, Crow-

ley, Brown, & Grindle, 2011; O’Brien, Singer, LeCloux,

Duarté-Vélez, & Spirito, 2014; Robinson et al., 2013). This

article builds off that knowledge base by providing a

concise review of theoretical assumptions and key inter-

vention techniques for psychosocial interventions for sui-

cidal youth while incorporating a key requirement in social

work education: the integration of theory and practice.

The Relationship Between Theory and Empirically-Supported Treatments

Social work students and practitioners are expected to

understand, explain and integrate practice and theory (Na-

tional Association of Social Workers, 1996/2008; Council

on Social Work Education, 2015). In social work education,

classroom professors emphasize theory while field supervi-

sors focus on practice. A perpetual challenge for students,

practitioners, and professors is how to best integrate the two

so that theory informs practice, and practice informs theory.

Understanding the relationship between theory and practice

is particularly i

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