Treat

TREAT Defined

Treat suicidal thoughts and behaviors using evidence-based treatments.  

In a Zero Suicide approach, people experiencing suicide risk, regardless of age, receive treatment to address the suicidal thoughts and behaviors directly. The Substance Abuse and Mental Health Services Administration (2020) identifies six evidence-based treatments and interventions for suicidality in youth1:

  • Dialectical Behavior Therapy (DBT)
  • Attachment-Based Family Therapy (ABFT)
  • Multisystemic Therapy-Psychiatric (MST-Psych)
  • Safe Alternatives for Teens and Youth (SAFETY)
  • Integrated Cognitive Behavioral Therapy (I-CBT)
  • Youth-Nominated Support Team-Version II (YST-II)

To learn more, view the report, Treatment for Suicidal Ideation, Self-Harm, and Suicide Attempts Among Youth.

Another promising intervention is CAMS-4Teens. In the first open clinical trial exploring the feasibility of using the Collaborative Assessment and Management of Suicidality (CAMS) framework with adolescents, results indicated effectiveness in reducing suicidal thoughts2. To learn more about this intervention, visit the CAM-Care website for two online courses: CAMS-4Teens Interactive Training and CAMS-4Teens & Parents.

Considerations for Treating Young Children with Suicide Risk

In general, the evidence-based treatments referenced in the Zero Suicide toolkit have not been tested with preadolescent children. However, a review of 136 children ages 5-11 who died by suicide between 2013 and 2017 suggests that treatment for suicidality should also include support for mental health challenges, family and school-related concerns, and trauma3. This study found that:

  • Nearly one-third of children experienced a mental health challenge at the time of their death
  • 27% experienced a trauma (i.e. confirmed or suspected abuse or neglect, domestic violence, death of a family member or friend), and 40% of those experienced multiple traumas
  • Bullying was suspected or confirmed in 18% of deaths
  • Nearly 40% of children experienced one or more family challenges, including divorce or custody issues, legal problems, parental substance use, psychological problems, or suicide and, in nearly 60% of those cases, the result was children living in single-parent homes or with another family member
  • School-related problems were identified in over 35% of cases, including suspension and expulsion, a change in schools, and a history of special education needs
  • Children were disciplined on the day of their suicide in about one-third of cases and, in those situations, 34% were related to school, and 39% involved an argument with a parent or caregiver

Considerations for Working with Families and Caregivers

It is important to engage families in the treatment process for several reasons. Children and youth will benefit from the emotional support of parents and others, providing reminders and encouragement to use their safety plan. Practical support is also needed to promote suicide safety regarding lethal means and to access care (i.e. financial support, transportation). There may be barriers to treatment that should be discussed and attempts made to mitigate these challenges when developing a youth’s suicide care plan. As noted above, family-related concerns are sometimes a risk factor for suicidality. In these instances, Attachment-Based Family Therapy can help support the wellbeing of the entire family and repair or build secure parent-child bonds.

Attachment-Based Family Therapy (ABFT) is a process-oriented, emotion-focused approach designed to treat depression, and suicidal thoughts and behaviors in adolescents. ABFT uses a manualized treatment model that includes five sequential clinician-led tasks (Relational Reframe; Adolescent Alliance; Parental Alliance; Attachment; Autonomy Promoting) over 12 to 16 weeks (10-20 sessions).  It has been used in multiple settings and with youth ages 12-251. 

Considerations for schools

Therefore, schools play an important role in educating youth about mental health, normalizing open, and transparent conversations among students and staff, and promoting help-seeking behaviors. Population-based interventions that help children and youth develop positive coping strategies and emotion regulation have been shown to be effective at reducing suicide4.  Below are some examples of school-based programs and curricula:

  • The Good Behavior Game aims to create a positive classroom environment by reducing aggressive and maladaptive behaviors, common risk factors for lower academic achievement and unhealthy later-life behaviors, such as tobacco, alcohol, and drug use.
  • Signs of Suicide teaches students to identify signs of depression and suicide in themselves and others, as well as help-seeking behaviors.
  • DBT Steps-A is a manualized approach to teaching DBT skills to students in grades 6-12 through the development of behavioral skills, such as mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.

Finally, schools should consider the backgrounds of students and families when identifying universal prevention and intervention programs. For example, American Indian Like Skills is a program designed to teach communication, problem-solving, stress management, anger regulation, and help-seeking skills while addressing issues relevant to American Indian/Alaska Native youth.

REMINDER: Visit the Zero Suicide Toolkit for additional information and resources.

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1 Substance Abuse and Mental Health Services Administration (SAMHSA).  Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth. SAMHSA Publication No. PEP20-06-01-002 Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2020.

2 Adrian, M., Blossom, J.B., Chu, P.V., Jobes,. D, & McCauley, E. (2021). Collaborative Assessment and Management of Suicidality for Teens: A Promising Frontline Intervention for Addressing Adolescent Suicidality. Practice Innovations, 7(2), 154-167 

3 Ruch, D.A., Heck, K.M., Sheftall, A.H., Fontanella, C.A., Stevens, J., Zhu, M., Horowitz, L.M., Campo, J.V., & Bridge, J.A. (2021). Characteristics and Precipitating Circumstances of Suicide Among Children Aged 5 to 11 Years in the United States, 2013-2017.  JAMA Network Open, 2021 Jul 1; 4(7).   

4 Ackerman, J.P. & Horowitz, L.M. Youth Suicide Prevention and Intervention: Best Practices and Policy Implications. SpringerBriefs in Psychology: Advances in Child and Family Policy and Practice, 2022. Available at https://link.springer.com/book/10.1007/978-3-031-06127-1.