Suicidal behaviour in children in child protection and out-of-home care

Investigators

Dr Sebastian Trew, Douglas Russell, Professor Daryl Higgins (Institute of Child Protection Studies, Australian Catholic University)

Funding

Prepared for the National Suicide Prevention Advisor and the National Suicide Prevention Taskforce, commissioned through the Australian Government Department of Health Suicide Prevention Research Fund, managed by Suicide Prevention Australia, Suicide Prevention Research Fund

Aims

1. Consolidate understandings of the role that risk factors associated with childhood trauma and interactions with the child protection and out-of-home system play in suicidal behaviour.
2. Raise awareness of what interventions are effective in reducing suicidal thoughts and behaviours among children and young people in touch with the out of home care system.
3. Inform decision making on what evidence-based interventions may be most appropriate and feasible to deliver for children within the Australian context to reduce suicidal ideation, suicide attempts and deaths by suicide for at risk children and young people in touch with the out of home care system.

Background

Children and young people in out-of-home care (OOHC) are at a higher risk of suicide than young people not involved with child protection systems. Despite this, there is a lack of evidence of effective suicide prevention interventions for this vulnerable population. We reviewed the types of suicide prevention interventions that have been used and evaluated with children and young people and staff and carers in OOHC/child protection systems.

Project detail

The report was prepared for the National Suicide Prevention Adviser and the National Suicide Prevention Taskforce, commissioned through the Suicide Prevention Research Fund, managed by Suicide Prevention Australia.

The Fund was established by the Commonwealth Government to support world-class research into suicide prevention and facilitate the rapid translation of knowledge into more effective services for individuals, families and communities.

The Taskforce worked with an Expert Advisory Group, a Commonwealth Interdepartmental Committee and a State and Territory committee to identify key priorities: research to understand the experiences of people with lived experience of a suicidal crisis and/or a suicide attempt and evidence reviews to enhance planning for cross-portfolio initiatives. Our report was one of five evidence checks commissioned through the Fund. All evidence checks are available on the Suicide Prevention Australia website.

Findings and implications

Addressing key priority 1 of the Suicide Prevention Research Fund - to learn more about 'what works' to prevent suicide and suicidal behaviour - we conducted a literature review on interventions that focused on wellbeing and were designed for out-of-home care for at-risk children and young people. We then analysed whether and how these interventions were effective in reducing suicidal ideation, suicide attempts and deaths by suicide.

Further, addressing key priority 2 relating to factors that are protective against suicide, we identified protective factors (e.g., access to clinical interventions and support for help seeking) that contributed to the effectiveness of an intervention.

We found limited evidence on effective interventions that specifically address the risk of suicide-related behaviours for children and young people in the child protection system and in OOHC. Globally only two studies have evaluated the efficacy of interventions to reduce suicidal behaviours in young people in care. We suggest that services adopt high-quality evaluations of part of any existing interventions that are trauma informed to reduce suicidal behaviour in young people interacting with child protection and OOHC systems across Australia.

Key findings

• Trauma of children and young people in OOHC is directly related to risk factors for suicidal behaviour.
• Suicide was 4.9 times more likely for young people in care compared to young people without a history of child abuse and neglect.
• Only two interventions were found that were designed specifically to prevent or address risk factors for suicide in OOHC settings that have been evaluated and shown to reduce suicide-related behaviours.

Recommendations

• Adapt, implement, and evaluate existing clinical interventions that target suicidal behaviours in the general population for young people in OOHC
• Implement trauma-focused interventions and trauma-informed care models in OOHC
• Develop trauma-focused interventions to support the cultural needs of Aboriginal and Torres Strait Islander young people, who are overrepresented in the Australian child protection and care systems
• Adapt high-quality evaluations of any current intervention to reduce suicidal behaviour in young people interacting with child protection and OOHC

Publications

Institute of Child Protection Studies. (2020). Reducing suicidal thoughts and behaviour in young people in contact with child protection. [Video]. Suicide Prevention Australia.

Trew, S., Russell, D. H., & Higgins, D. (2020). Effective interventions to reduce suicidal thoughts and behaviours among children in contact with child protection and out-of-home care systems - a rapid evidence review. Institute of Child Protection Studies, Australian Catholic University. https://doi.org/10.26199/5f1771a5a6b9e

Suicide Prevention Australia. (2020). Effective interventions to reduce suicidal thoughts and behaviours among children in contact with child protection and out-of-home care systems - a rapid evidence review. [Infographic]. Suicide Prevention Australia.

Russell, D. H., Trew, S., & Higgins, D. J (2021). Vulnerable yet forgotten? A systematic review identifying the lack of evidence for effective suicide interventions for young people in contact with child protection systems. American Journal of Orthopsychiatry. https://doi.org/10.1037/ort0000555

Project timeline

Completed 2023

Contact

For more information contact: icps@acu.edu.au