Dialectical Behavioral Therapy in Juvenile Justice

NCT05583279 | Withdrawn

• 1 other identifier: CUA-002
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Self-injurious thoughts and behaviors (SITBs) are a serious public health concern, particularly for youth involved in the juvenile justice system (JJS), which the Georgia State Juvenile Justice System (GAJJS) intends to address by the implementation of Dialectical Behavior Therapy (DBT) in its JJS facilities. This proposal aims to support and study the GAJJS' pilot implementation of DBT at its facilities using a mixed-methods cross-over design involving a three-phase clinical trial assessing the feasibility, acceptability, and preliminary effectiveness of DBT-A adapted for youth in the GAJJS. By the end of the proposed project, the investigators will have (1) established a research team to continue researching SITB interventions in the GAJJS, (2) developed protocols for implementing and evaluating DBT-A adapted for the JJS delivered in person and via telehealth, and (3) preliminary data on the feasibility, acceptability, and effectiveness of DBT-A adapted for the JJS.

Conditions

Non-Suicidal Self Injury; Suicide; Self-harm; Emotion Regulation

Keywords

dialectical behavioral therapy; adolescents; self-injury; suicide; juvenile justice

Outcome Measures

Primary Outcomes (4)

• The short form of the self-injurious thoughts and behaviors interview (SITBI)

  Measures changes in suicidal and non-suicidal self-injurious thoughts and behaviors

  six months to 12 months for cohort 1, six months for cohort 2

• The Life Problems Inventory (LPI)

  Measures the four core treatment components of DBT-A: emotion dysregulation, impulsivity, interpersonal chaos, and confusion about self.

  six months to 12 months for cohort 1, six months for cohort 2

• The DBT-Ways of Coping Check List (DBT-WCCL)

  Measures the use of DBT skills and dysfunctional, non-DBT coping strategies

  six months to 12 months for cohort 1, six months for cohort 2

• The Acceptance and Action Questionnaire II (AAQ-II)

  a self-report measure of experiential avoidance

  six months to 12 months for cohort 1, six months for cohort 2

Study Arms (3)

Phase 2

EXPERIMENTAL

Cohort 1 and 2 youth will then complete baseline assessments (see 4.5) and Cohort 2 will continue receiving TAU while Cohort 1 begins receiving DBT-A (randomized by facility to either in-person or via telehealth delivery) for the next six months while Cohort 1 staff continue consultation with DBT-A. After six months, Phase 2 of this study will conclude with the youth of Cohorts 1 and 2 completing their first follow-up assessment. The implementation plan will be altered accordingly based on feedback from stakeholders prior to the start of Phase 2. The modified implementation plan will be used in the training of the staff in DBT-A at the second four facilities prior to the launch of Phase 3.

Behavioral: Dialetical Behavioral Therapy for Adolescents

No intervention

ACTIVE COMPARATOR

Cohort 2 will not receive any treatment during Phase 2 of the study, which is the first part of the clinical trial. They will serve as a comparison group for Cohort 1.

Behavioral: Dialetical Behavioral Therapy for Adolescents

Phase 3

ACTIVE COMPARATOR

Phase 3 will begin with making any modifications to the treatment protocol based on a review of feedback from stakeholder interviews from Phase 2. Cohort 2 facilities will be randomized to delivering DBT-A in-person or via telehealth (one long-term and one short-term facility will be assigned to each condition). Staff in Cohort 2 will receive training and consultation in DBT-A and implement either telehealth or in-person delivered DBT-A in their facilities. Cohort 1 facilities will cross-over from in-person delivery of DBT-A to telehealth delivery, or vice-versa, thereby facilitating a within-facility comparison of DBT-A delivery methods. After six months, Phase 3 will conclude with the youth of Cohorts 1 and 2 completing their second follow-up assessment and all stakeholders of Cohorts 1 and 2 completing stakeholder interviews.

Behavioral: Dialetical Behavioral Therapy for Adolescents

Interventions

Dialetical Behavioral Therapy for Adolescents BEHAVIORAL

DBT is an evidence-based treatment for individuals with complex clinical presentations, including borderline personality disorder (BPD), suicidality, and NSSI. Standard DBT (which includes individual therapy, skills group, between-session skills coaching, and peer consultation for therapists) is associated with symptom reductions in patients across a variety of domains, including BPD symptoms, SA, NSSI, hospitalizations, and social functioning. DBT focuses on teaching skills (e.g., emotion regulation) and facilitating the replacement of impulsive and/or ineffective behaviors (e.g., NSSI), with more effective/skillful behaviors.

No intervention; Phase 2; Phase 3

Eligibility Criteria

• Age: 10 Years - 21 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• must be in the custody of the GAJJS and placed at one of the eight facilities participating in the study,
• can speak, read, and understand English well enough to participate in a DBT-A therapy program,
• there is written informed assent, and
• verbal parental/guardian or youth advocate informed consent has been obtained.

You may not qualify if:

• \- any youth who are cognitively/decisionally impaired, the GAJJS conducts detailed psycho-diagnostic evaluations on all youth during their intake evaluation - and, part of this evaluation includes a thorough mental status exam, conducted by one of the mental health staff.

Sponsors & Collaborators

• The Catholic University of America: lead
• Butler Hospital: collaborator

Study Sites (1)

Catholic University

Washington D.C., District of Columbia, 20064, United States

Location

Related Publications (32)

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Related Links

• Center for Disease Control Injury Data
• Ford JD, Chapman JF, Hawke J, Albert D. Trauma among youth in the juvenile justice system: Critical issues and new directions. National Center for Mental Health and Juvenile Justice. 2007;6:2007.
• Wilks CR, Gurtovenko K. Virtual delivery of dialectical behavior therapy. In: Rolnik A, ed. Advances in online therapy. ; in press.
• National Action Alliance for Suicide Prevention: Research Prioritization Task Force. A prioritized research agenda for suicide prevention: An action plan to save lives. . 2014.
• Courtney-Seidler, E. A., Burns, K., Zilber, I., \& Miller, A. L. (2014). Adolescent suicide and self-injury: Deepening the understanding of the biosocial theory and applying dialectical behavior therapy.
• Drake EK, Barnoski RP. Recidivism findings for the juvenile rehabilitation administration's mentoring program. Washington State Institute for Public Policy; 2006.
• Harned MS, Coyle TN, Garcia NM. The inclusion of ethnoracial, sexual, and gender minority groups in randomized controlled trials of dialectical behavior therapy: A systematic review of the literature. Clinical Psychology: Science and Practice. 2022.
• BOND DM, HOMAN J, BEACH B. DBT in juvenile justice programs. Dialectical Behavior Therapy in Clinical Practice: Applications across Disorders and Settings. 2020;159.
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• Hughes CD, Rizvi SL. Applying a cognitive-behavioral, principle-based approach to the treatment of personality disorders: An extension of Rosenthal, Wyatt, and McMahon.
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MeSH Terms

Conditions

Self-Injurious Behavior; Suicide; Emotional Regulation

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior; Self-Control; Social Behavior

Study Officials

• Melissa D Grady, PhD

  Catholic University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The proposed project consists of a mixed-methods cross-over design involving a three-phase clinical trial aimed at assessing the feasibility, acceptability, and preliminary effectiveness of comprehensive DBT-A adapted for youth in the GAJJS. DBT-A/outcomes will be assessed across two different levels of care (i.e., at short- vs. long-term facilities) and service delivery methods (i.e., in-person vs. telehealth).

Study Record Dates

• First Submitted: October 13, 2022
• First Posted: October 17, 2022
• Study Start: February 1, 2024
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): August 31, 2026
• Last Updated: February 9, 2024

Record last verified: 2024-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: the data will become available one year after completion of the trial and will be available for three years.
• Access Criteria: Researchers who work within juvenile justice systems.

Locations

US (1)