(PS5-6) Barriers to and Facilitators of Implementing Suicide Prevention in Juvenile Detention Settings

Background: Suicide is the second leading cause of death in youth in the US, and youth involved in the juvenile legal system are 3-4 times more likely to experience suicidal behaviors compared to their non-systems involved peers. Despite this, a recent study identified that the use and quality of evidence-based suicide prevention practices in juvenile detention is low. In the current study, we aimed to identify the most salient barriers to and facilitators of implementing suicide prevention in juvenile detention across 10 different sites in one state (Rudd et al., 2024).

Methods: We conducted semi-structured interviews with various stakeholders (N=13), ranging from the superintendent to case managers, from 10 juvenile detention centers in a Northeastern state. The interviews focused on the current contextual determinants of implementing suicide prevention. Data were organized into discrete implementation determinants using the Exploration, Preparation, Implementation, and Sustainment Framework (EPIS; Aarons et al., 2011). Each EPIS construct was then given a valence rating (Damschroder et al., 2022) and thematically analyzed. We operationalized the strongest facilitators and barriers as the constructs with a -2 valence (barriers) or +2 valence (facilitators) score for at least 5 out of 10 sites. We present our findings for inner context factors here. All analyses will be ready by the November conference.


Results: There were two strong facilitators of suicide prevention implementation -- professional training and quality and fidelity monitoring/support. Recurrent themes for professional training included training source, length/frequency of training, and comprehensive training content that facilitate suicide prevention implementation at their respective sites. Recurrent themes for quality and fidelity monitoring/support included leaders’ support, use of protocol/policies, and supervision and consultation with an expert (i.e., psychologists, clinical supervisors) to ensure quality and fidelity of their suicide prevention program. There was one strong barrier to suicide prevention implementation -- organizational staffing processes. Recurrent themes include inadequate staffing, low retention/high turnover rates, and low wages impacting the execution of their suicide prevention programs.


Conclusions: In sum, comprehensive training and established standards to ensuring quality and fidelity were strong facilitators of implementing suicide prevention across sites. Organizational staffing processes were the strongest barrier to implementing suicide prevention across sites. Future initiatives to improve the adoption and sustainment of suicide prevention in juvenile detention settings may leverage the most salient facilitators of (e.g., quality/fidelity monitoring, training) and address barriers (e.g., organizational staffing processes) to implementation by designing and selecting appropriate implementation strategies.