The ASAP Center trains organizations, health, and mental health professionals in state of the art, trauma-informed treatments for youth.

Our work focuses on treating and preventing suicidal behavior, self-harm, depression, and substance abuse. As a partner in the National Child Traumatic Stress Network (NCTSN), we use a trauma-informed approach.

Explore the pages below to learn more about our approach, current training opportunities, and how to prepare for our training program.

The ASAP Center trains organizations and health and mental health professionals in state of the art, trauma-informed treatments for youth.

Our work focuses on treating and preventing suicidal behavior, self-harm, depression, and substance abuse. As a partner in the National Child Traumatic Stress Network (NCTSN), we use a trauma-informed approach.

Explore the pages below to learn more about our approach, current training opportunities, and how to prepare for our training program.

The ASAP Center trains organizations and health and mental health professionals in state of the art, trauma-informed treatments for youth.

Our work focuses on treating and preventing suicidal behavior, self-harm, depression, and substance abuse. As a partner in the National Child Traumatic Stress Network (NCTSN), we use a trauma-informed approach.

Explore the pages below to learn more about our approach, current training opportunities, and how to prepare for our training program.

Center Treatment
Programs
Training
Opportunities
Prepare for
Training

Providing Care That Fosters Hope & Builds Strengths

Treatment for Suicide, Self-Harm & Depression
FAMILY INTERVENTION FOR SUICIDE PREVENTION (FISP)/SAFETY-ACUTE(A):
Emergency Treatment for Suicide & Self-Harm

What:

A developmentally-informed approach to safety planning for children and adolescents. This cognitive-behavioral youth and family centered intervention for suicide and self-harm is a second generation adaptation of the Specialized Emergency Room Intervention and is included as the first session of the SAFETY Program. The FISP/SAFETY-A includes an in-person crisis session with youth and parents/caregivers plus caring follow-up contacts to support linkage to follow-up care. This approach is designed to address Objective 8.4 of the National Strategy for Suicide Prevention: “Promote continuity of care and the safety and well-being of all patients treated for suicide risk in emergency departments or hospital inpatient units.”

Who:

FISP/SAFETY-A is provided to youth and families/caregivers after a youth has attempted suicide, engaged in self-harm behaviors, or expressed strong suicidal urges.

Where:

FISP/SAFETY A has been used in emergency departments, urgent and crisis care, mental health, primary care, school and other settings.

Goals:

The goals of FISP include reducing risk, ensuring safety, and assisting with linkage to care in the community. Counseling on restricting access to potential lethal means of suicide and self-harm is a major component of the FISP.

Other Information and Resources:

Designated as “program with effectiveness”, see: http://www.sprc.org/resources-programs/family-intervention-suicide-prevention-fisp.

Featured in SAMHSA guidelines for youth suicide prevention: https://store.samhsa.gov/product/Treatment-for-Suicidal-Ideation-Self-harm-and-Suicide-Attempts-Among-Youth/PEP20-06-01-002.

*Also see evidence related to SAFETY (description below), which includes the FISP as the initial session.

To watch a brief video about FISP, click HERE.

To watch a webcast about the FISP and how the FISP approach build’s social connectedness, a key protective factor, click:  http://suicideprevention-icrc-s.org/event/preventing-suicide-promoting-social-connectedness-promoting-treatment-strategies-enhance

To learn more about the development of the FISP, download additional information HERE.

Evidence*:

Asarnow, J. R., Berk, M. S., & Baraff, L. J. (2009). Family Intervention for Suicide Prevention: A specialized emergency department intervention for suicidal youths. Professional Psychology: Research and Practice, 40(2), 118–125. https://doi.org/10.1037/a0012599

Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., … Tang, L. (2011). An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment. Psychiatric Services, 62(11), 1303–1309. https://doi.org/10.1176/ps.62.11.pss6211_1303

Hughes, J. L., & Asarnow, J. R. (2013). Enhanced Mental Health Interventions in the Emergency Department: Suicide and Suicide Attempt Prevention. Clinical Pediatric Emergency Medicine, 14(1), 28–34. https://doi.org/10.1016/j.cpem.2013.01.002

Evidence Related to Initial Specialized Emergency Room Intervention:

Rotheram-Borus, M. J., Piacentini, J., Cantwell, C., Belin, T. R., & Song, J. (2000). The 18-month impact of an emergency room intervention for adolescent female suicide attempters. Journal of Consulting and Clinical Psychology, 68(6), 1081–1093.

Rotheram-Borus, M. J., & Bradley, J. (1991). Triage model for suicidal runaways. The American Journal of Orthopsychiatry, 61(1), 122–127.

Rotheram-Borus, M. J., Piacentini, J., Van Rossem, R., Graae, F., Cantwell, C., Castro-Blanco, D., … Feldman, J. (1996). Enhancing treatment adherence with a specialized emergency room program for adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry, 35(5), 654–663. https://doi.org/10.1097/00004583-199605000-00021

Rotheram-Borus, M. J., Piacentini, J., Van Rossem, R., Graae, F., Cantwell, C., Castro-Blanco, D., & Feldman, J. (1999). Treatment adherence among Latina female adolescent suicide attempters. Suicide & Life-Threatening Behavior, 29(4), 319–331.

General Articles on Emergency Care: 

Asarnow, J.R., Babeva, K., & Horstmann, E. (2017). The Emergency Department: Challenges and Opportunities for Suicide Prevention. Child Adolesc Psychiatr Clin N Am, 26(4). https://doi.org/10.1016/j.chc.2017.05.002.

Babeva, K., Hughes, J. L., & Asarnow, J. (2016). Emergency Department Screening for Suicide and Mental Health Risk. Current Psychiatry Reports, 18(11). https://doi.org/10.1007/s11920-016-0738-6

Safe alternatives for teens & youths (SAFETY):
Outpatient Treatment for Suicide & Self-Harm

What:

SAFETY is a youth and family centered cognitive-behavioral treatment that is informed by dialectical-behavior therapy (DBT).

Who:

SAFETY is provided to youth and families after a youth has made a suicide attempt or engaged in repeated deliberate self-harm (e.g. cutting or burning self, serious banging of head).

Duration:

SAFETY is a 12-week treatment.

Goals:

The goals of SAFETY include increasing safety, helping youth build lives that they want to live, and assisting parents and caregivers in supporting and protecting youth. SAFETY includes counseling and support aimed at decreasing access to potentially lethal/dangerous methods of suicide/self-harm (e.g. firearms, poisons, medicines, ropes, ligatures, etc.).

Evidence:

Asarnow, J. R., Berk, M., Hughes, J. L., & Anderson, N. L. (2015). The SAFETY Program: A Treatment-Development Trial of a Cognitive-Behavioral Family Treatment for Adolescent Suicide Attempters. Journal of Clinical Child & Adolescent Psychology, 44(1), 194–203. https://doi.org/10.1080/15374416.2014.940624

Asarnow, J. R., Hughes, J. L., Babeva, K. N., & Sugar, C. A. (2017). Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 506–514. https://doi.org/10.1016/j.jaac.2017.03.015

Hughes JL, Babeva K, & Asarnow JR. (2018, in press). The SAFETY Program: A Youth and Family Centered Cognitive-Behavioral Intervention Informed by Dialectical Behavior Therapy. In MS Berk (Ed), Evidence-Based Treatment Approaches for Suicidal Adolescents: Translating Science into Practice.  Washington DC: American Psychiatric Association Press.

Depression treatment quality improvement intervention (DTQI):
Outpatient Treatment for Depression

What:

A manualized, flexible treatment program that uses evidence-based individual and/or group cognitive-behavior therapy (CBT) for youth depression, as well as medication treatment when needed.

Who:

DTQI is provided to youth with depression.

Where:

DTQI can be delivered within primary care settings through a collaborative integrated care model.

Goals:

To reduce depression and improve functioning and quality of life among youth.

Evidence:

Asarnow, J. R., Jaycox, L. H., Duan, N., LaBorde, A. P., Rea, M. M., Murray, P., … Wells, K. B. (2005). Effectiveness of a Quality Improvement Intervention for Adolescent Depression in Primary Care Clinics: A Randomized Controlled Trial. JAMA, 293(3), 311. https://doi.org/10.1001/jama.293.3.311

Asarnow, J. R., Jaycox, L. H., Tang, L., Duan, N., LaBorde, A. P., Zeledon, L. R., … Wells, K. B. (2009). Long-Term Benefits of Short-Term Quality Improvement Interventions for Depressed Youths in Primary Care. American Journal of Psychiatry, 166(9), 1002–1010. https://doi.org/10.1176/appi.ajp.2009.08121909

Ngo, V. K., Asarnow, J. R., Lange, J., Jaycox, L. H., Rea, M. M., Landon, C., … Miranda, J. (2009). Outcomes for Youths From Racial-Ethnic Minority Groups in a Quality Improvement Intervention for Depression Treatment. Psychiatric Services, 60(10), 1357–1364. https://doi.org/10.1176/ps.2009.60.10.1357

DTQI (YPIC) is listed on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices.

PRIMARY CARE EVALUATION AND MANAGEMENT OF SUICIDE AND SELF-HARM RISK
Outpatient Treatment for Suicide & Self-Harm

What:

To support primary care clinicians and practices in enhancing suicide prevention resources and care, educational materials and trainings are available. Trainings, video demonstrations, instructor guides, and manuals are available to support primary care clinicians in screening, evaluation and risk stratification, and care for patients when suicide and/or self-harm risk are concerns. These materials draw from both the Family Intervention for Suicide Prevention and due to the links between depression and suicide risk, the Depression Treatment Quality Improvement Program which emphasizes collaborative care for depression. See those sections of website for more information.

Who:

Training and materials are appropriate for any practice or clinician working to improve suicide prevention care within their practice or clinic.

Where:

Services are designed to be adapted for diverse primary care service environments, consider available mental health resources. Training emphasizes building capacity within the primary care practice as well as strategies for building and strengthening links with available mental health resources.

Goals:

To improve suicide prevention care and reduce suicide and self-harm risk.

Evidence:

Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., … Tang, L. (2011). An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment. Psychiatric Services, 62(11), 1303–1309. HTTPS://DOI.ORG/10.1176/PS.62.11.PSS6211_1303

Asarnow, J. R., Jaycox, L. H., Duan, N., LaBorde, A. P., Rea, M. M., Murray, P., … Wells, K. B. (2005). Effectiveness of a Quality Improvement Intervention for Adolescent Depression in Primary Care Clinics: A Randomized Controlled Trial. JAMA, 293(3), 311.HTTPS://DOI.ORG/10.1001/JAMA.293.3.311 Designated as “program with effectiveness”, see: HTTP://WWW.SPRC.ORG/RESOURCES-PROGRAMS/FAMILY-INTERVENTION-SUICIDE-PREVENTION-FISP

Asarnow, J. R., Jaycox, L. H., Tang, L., Duan, N., LaBorde, A. P., Zeledon, L. R., … Wells, K. B. (2009). Long-Term Benefits of Short-Term Quality Improvement Interventions for Depressed Youths in Primary Care. American Journal of Psychiatry, 166(9), 1002–1010. HTTPS://DOI.ORG/10.1176/APPI.AJP.2009.08121909

DTQI (YPIC) is listed on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices.

SELECTED REVIEWS OF EVIDENCE HIGHLIGHTING VALUE OF IMPROVING PRIMARY CARE RESOURCES FOR MENTAL HEALTH AND SUICIDE PREVENTION CARE:

Asarnow JR, Kolko DJ, Miranda J, Kazak AE. The Pediatric Patient-Centered
Medical Home: Innovative models for improving behavioral health. Am Psychol. 2017
Jan;72(1):13-27. doi: 10.1037/a0040411. PubMed PMID: 28068135.

Asarnow JR, Rozenman M, Wiblin J, Zeltzer L. Integrated Medical-Behavioral
Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health:
A Meta-analysis. JAMA Pediatr. 2015 Oct;169(10):929-37. doi:
10.1001/jamapediatrics.2015.1141. PubMed PMID: 26259143.

Perrin JM, Asarnow JR, Stancin T, Melek SP, Fritz GK. Mental Health Conditions
and Health Care Payments for Children with Chronic Medical Conditions. Acad
Pediatr. 2019 Jan – Feb;19(1):44-50. doi: 10.1016/j.acap.2018.10.001. Epub 2018
Oct 10. PubMed PMID: 30315948.

Stress Busters: A Combined Cognitive- Behavioral Family Education Program for Depression in Children
Outpatient Treatment for Depression

WHAT:

A manualized, cognitive-behavioral group and family treatment for children with depressive symptoms and/or disorder. Intended as both a preventive and treatment program. With increasingly severe disorder, “Stressbusters” may be most helpful when used to augment other individual, family, and/or medication treatments.

WHO:

Children ages 8-13 with depressive symptoms and/or disorder..

WHERE:

Stressbusters can be delivered in school and other group settings, as well as in general mental health or health services that include behavioral health care (e.g. integrated medical-behavioral health care, primary care).

GOALS:

To reduce depression and improve functioning and quality of life among children.

Stress Busters Manual

Treatment for Substance Abuse
Substance Abuse Module (SAM) for the Family Intervention for Suicide Prevention (FISP) or Safe Alternatives for Teens & Youths (SAFETY)

What:

SAM is integrated within FISP or SAFETY and is a brief, cognitive-behavioral treatment for co-occurring suicidality and alcohol or substance use problems.

Who:

SAM is provided to youth who engage in suicidal and substance abusing behaviors.

Where:

SAM is delivered in emergency departments, urgent care, or other settings.

Goals:

The goals of SAM include reducing risk, ensuring safety, and assisting with linkage to care in the community.

Motivational Enhancement Therapy & Cognitive Behavioral Therapy (MET-CBT)

What:

MET-CBT is a treatment that focuses on increasing motivation and cognitive-behavioral skills for reducing substance abuse.

Who:

MET-CBT is provided to youth with cannabis and alcohol related problems.

Duration:

MET-CBT consists of 5-12 sessions with a therapist. MET-CBT was originally developed as a group treatment, but we disseminate it as an individual treatment.

Goals:

The main goal of MET-CBT is to motivate youth to change their behaviors surrounding substance abuse.

Evidence:

Hogue, A., Henderson, C. E., Ozechowski, T. J., & Robbins, M. S. (2014). Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013. Journal of Clinical Child & Adolescent Psychology, 43(5), 695–720. https://doi.org/10.1080/15374416.2014.915550

MET-CBT is listed on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-Based Programs and Practices.

Contingency Management

What:

Contingency management is a therapeutic approach that enables parents and caregivers to use behavioral contingencies, such as incentives, to help adolescents stop or reduce substance abuse.

Who:

Contingency management can be applied by parents or caregivers of youth with substance use problems.

When:

Contingency management can be used as a stand-alone approach or used in conjunction with MET-CBT.

Goals:

The main goal of contingency management is to reduce problematic substance use among youth through enhanced monitoring and use of behavioral consequences by caregivers.

Evidence:

Hogue, A., Henderson, C. E., Ozechowski, T. J., & Robbins, M. S. (2014). Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013. Journal of Clinical Child & Adolescent Psychology, 43(5), 695–720. https://doi.org/10.1080/15374416.2014.915550

Stanger, C., Budney, A. J., Kamon, J. L., & Thostensen, J. (2009). A randomized trial of contingency management for adolescent marijuana abuse and dependence. Drug and Alcohol Dependence, 105(3), 240–247. https://doi.org/10.1016/j.drugalcdep.2009.07.009

Center Resources and Tip Sheets
Trauma-Informed Care

What:

Trauma-informed approaches are integrated into all ASAP Center Treatments and are an integral part of helping children who have experienced traumatic stress. Trauma-Informed Care engages youth and their families, identifies the presence and impact of trauma symptoms, and understands the impact that trauma has played in current and past challenges in order to respond and prevent re-traumatization.

Who:

Trauma-Informed Care is used when assessing all youth, and continues throughout treatment for youth who have experienced or witnessed a traumatic or stressful situation.

Where:

Trauma-Informed Care can be applied by providers in all treatment environments.

Goals:

Trauma-Informed Care aims to prevent, recognize, and respond to trauma-related difficulties in ways that promote recovery and adaptive functioning and development.

More Information:

National Child Traumatic Stress Network

Care for LGBTQ+ Youth

LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning) youths suffer from high rates of suicide and self-harm behavior. The UCLA-Duke ASAP Center, a Partner in the NCTSN, has developed a new tip sheet on clinical care strategies for these youths. Click here to see tip sheet and other information.

Telehealth for Youth with Suicidal/Self-harm Ideation and Behaviors

In response to the COVID-19 pandemic, care providers increasingly offer mental health services via telehealth and other virtual platforms. We offer some trauma-informed recommendations for care providers, who are remotely evaluating and treating youths with suicidal and self-harm thoughts and behaviors. This tip sheet covers a variety of considerations which include navigating a telehealth session, addressing youth safety, and working with the patient’s caregiver to foster a safe environment. Although we tailor tips to the COVID-19 restrictions, these recommendations could be applied outside of the pandemic.

Primary Care

Our Center has developed a primary care tip sheet for evaluating and managing suicide risk among youth patients. This tip sheet covers terminology related to suicidality, psychoeducation on the scope of suicidality in pediatrics, and guidance for suicide risk assessment in pediatrics. Please see additional resources listed at the bottom of the tip sheet.

Understanding Youth Substance Use
for Military Parents and Caregivers

This fact sheet provides practical information to help guide you, as a military parent/caregiver, navigate asking questions, and providing supportive responses to your child who may be thinking about or actively using substances. In this fact sheet, you will learn about possible warning signs and a script of questions to ask your child if you suspect that your child is using substances.

Understanding Child Suicide
for Military Parents & Caregivers

This Fact Sheet provides practical information to help guide Military Caregivers in asking questions and starting up conversations with their child who may be experiencing suicidal thoughts or behaviors. The fact sheet also presents additional resources for immediate and longer-term assistance.

Lock and Protect™
A Web-Based Lethal Means Decision Aid For Parents of Youths at Risk for Suicide

Lock and Protect™ is a parent-oriented, web-based lethal means decision aid that provides information on restricting access to lethal means, including firearms and medications. Parents of youths at risk for suicide can access this tool by clicking the link below. We also have a general tool for restricting access to lethal means.

*Suicide Prevention: https://ucla.chsprc.com/

*General Tool: https://ucla.asapnctsn.org/

© 2019 The Regents of the University of California. All Rights Reserved.

*URLs subject to change in the future

 

The ASAP Center is currently offering training in treatments for suicide, self-harm, depression, and adoption-specific psychotherapy. As a partner in the National Child Traumatic Stress Network (NCTSN), we use a trauma-informed approach. We are currently developing training in treatments for substance abuse.

Current Trainings Emphasize:
Family intervention for suicide prevention (FISP), also known as SAFETY-ACUTE(A)
Safe alternatives for teens and youths (SAFETY)
Primary Care Evaluation & Management of Suicide and Self-Harm Risk
Depression treatment quality improvement (DTQI)
Adoption-Specific Psychotherapy (ADAPT)

We work closely with our collaborators to ensure that we can help them adequately meet the needs of their organizations, patients, and communities.

This process involves:

  1. Pre-training planning calls
  2. Specialized training through in-person trainings and other training resources
  3. Follow-up consultation calls throughout the implementation process

To express interest in collaborating with our Center, send us an email.

The ASAP Center is dedicated to helping our collaborators understand and prepare for our training program. Explore the process in detail below.

Explore the process in detail below.

To help you consider how to best plan training, see the attached worksheet.

Prepare
Step1
A crucial first step!

Start by assessing the feasibility of implementing this training program and determine whether the program meets your organization’s needs.

Learn about the program

Questions to consider:

  • Will this program meet our needs?
  • How does the program fit within the guidelines or requirements of our agency?
Identify a leadership team

Questions to consider:

  • What is our “shared vision”?
  • Who are the key leaders who will champion training and implementation?
  • Are administrators and supervisors willing and able to support and encourage training and implementation?
Complete an organizational needs assessment

Questions to consider:

  • What are the goals of our organization?
  • What are the needs of our organization?
  • What training and services gaps exist in our organization?

Assessment worksheets available upon request.

Plan
Step2
A clear plan for moving forward can prevent future frustrations!

Develop a training plan

Questions to consider:

  • Who will be trained?
  • How much time can we allocate for in-person training?
  • How much time can we allocate for follow-up trainings or consultation calls?
  • What should the role of supervisors be in training?
Develop a clinical implementation and evaluation plan

Questions to consider:

  • How do we identify youth and families who could benefit from the treatment?
  • How will client outcomes be monitored and evaluated?
  • How do we determine when clients should be referred to other or additional services?
  • What will the aftercare plan be after the treatment has ended?
Develop a sustainability plan

Questions to consider:

  • What is our plan for sustaining the treatment after trainings and consultation calls from the ASAP Center have ended?
  • Will new staff be trained in the treatment?
  • Will any existing staff be trained to train new staff and conduct booster trainings?
Trouble shoot barriers and potential problems

Questions to consider:

  • What problems are likely to come up?
  • What issues have come up in implementing new programs in the past?
  • What is needed to promote comfort, competence, and feelings or safety in the training process?
  • What is needed to promote comfort, competence, and feelings of safety in using a new treatment program?
Special Considerations in Preparation for Training

Questions to consider:

  • Does the format of the site fit our national training requirements?
  • Do the trainees work within a single agency or do they have diverse practice requirements?
  • Are there specific screening protocols within the practice settings where trainees work? If so, what screener do they use?
  • Is there a care process order or triage protocol for patients with an elevated screen? If so, use this screener and risk stratification protocol within the training.
  • What is the access to healthcare professionals, are they on site all the time, or do they do handoff in the clinic?
Train
Step3
Now that you have a strong plan, it is time to begin the trainings.

Steps
  • Train staff
  • Evaluate training
  • Trouble shoot barriers and potential problems
Launch
Step4
Your team is trained and ready; it is time to begin delivering care!

Steps
  • Identify youth and families who could benefit from the treatment
  • Deliver the treatment
  • Support clinicians in delivering the treatment
  • Monitor and evaluate outcomes for clients, families, clinicians, and the organization
  • Trouble shoot barriers and problems
Sustain
Step5
Keep it going!

Steps
  • Implement sustainability plan
  • Continue to evaluate program outcomes
  • Trouble shoot barriers and potential problems
  • Engage in continuing quality improvement
  • Use information from evaluation to improve program quality
  • Use information from evaluation to enhance benefits for organization