2013 Garrett Lee Smith (GLS) Combined Annual Grantee Meeting
Using the Best Training for your Population: Choosing and Adapting Training Programs
Program Adaption Exercise:
Emergency Room Intervention for Adolescent Females
Emergency Room Intervention for Adolescent Females is a program for teenage girls 12 to 18 years old who are admitted to the emergency room after attempting suicide. The intervention, which involves the girl and one or more family members who accompany her to the emergency room, aims to increase attendance in outpatient treatment following discharge from the emergency room and to reduce future suicide attempts. A review of the literature suggests that factors related to treatment noncompliance following a suicide attempt include family discord, maternal psychopathology, attempter depression, and negative experiences with emergency room staff. The intervention consists of three components designed to improve the emergency room experience for the adolescent and family, thereby changing the family's conceptualization of the suicidal behavior and expectations about therapy. First, 2-hour training is conducted separately with each of the six groups of staff working with adolescents who have attempted suicide. Second, the adolescents and their families watch a 20-minute videotape, filmed in Spanish and dubbed in English that portrays the emergency room experience of two adolescents who have attempted suicide. Last, a bilingual crisis therapist delivers a brief family treatment in the emergency room.
Three measures of treatment adherence were used: attendance at a minimum of one treatment session, completion of the outpatient treatment program (i.e., attendance at six or more treatment sessions), and the total number of treatment sessions attended. Treatment adherence data were obtained from weekly logs completed by clinicians.
The White Mountain Apache Indian community is located in the mountains of eastern Arizona. Youth who attempted were selected by the Community Advisory Board as the primary indicated intervention target. Community advisors surmised that intervening close in time after an ED visit with youth and family members in their home or another private setting offered a unique opportunity (“teachable moment”) for behavior change and motivation to engage in treatment.It was also stated that paraprofessionals would deliver the intervention because they provide a trusted and culturally-competent resource to improve access, engagement and continuity of care by navigating the family’s social mores/cultural beliefs, helping to problem solve barriers to care, and facilitating relationships between AI youth and families and non-AI professional providers.
1)What are threeadaption’s you think would need to be made to this program to meet the needs of the White Mountain Apache community?
2)Would these adaptions be Green light, Yellow light or Red light adaptions?
Content adaptations included:
1) The content and skills conveyed in theoriginal intervention materials remained similar, but were adapted into a workbookfor youth and families and training guide for the paraprofessionals that depict familiar American Indian characters, styles, environments and cultural practices. For example, description of the relationship between thoughts, feelings and behaviors was changed to include a fourth component— spirituality.
2) The original video was adapted to include primarily American Indian actors, dramatic vignettes specific to the characteristics male and female attempts in this community, and emphasis on connecting with locally specific resources. Messages from Elders to youth in the primary language highlight the seriousness of this problem and how it impacts everyone in the community, concern about the youth on the behalf of the Elders, local leaders and community as a whole, and local beliefs about the sacredness of life.
3) The training workshop for ED providers was omitted due to resources since the intervention was no longer taking place in the ED.
4) On-call therapist or other follow-up components are now delivered by paraprofessionals.
2013 Garrett Lee Smith (GLS) Combined Annual Grantee Meeting