This study was initiated by the administrator of
a county jail in the Northern Plains of the United States who was
concerned about the incidence of suicide behaviors in that facility,
particularly among the American Indian population. The county jail is
situated within the center of the region in which the contemporary
Plains Indian tribes reside. It houses persons arrested for
misdemeanor and felony charges and, by contract, persons incarcerated
under the jurisdiction of federal authorities. Approximately 45
percent of the yearly average intake bookings into the jail are
American Indians. However, in 1996 there were 17 total suicide gestures
in this facility and over 75 percent of them involved an American Indian.
This study was a two-year project to evaluate the existing suicide
screening protocol and improve it for use with the American Indian
incarcerated population. Because the admission screening tool used in
the county jail to interview inmates at their intake was developed in
New York, one research objective was to determine if that instrument
was culturally appropriate for use with the county jail population,
particularly with the American Indian population. This endeavor
involved exploring the connection between American Indian and
non-Indian inmates' responses to suicide screening questions as they
were asked within the jail setting. The specific objectives of the
first year of this research project were: (1) to determine the
prevalence rates of suicide ideation within and between American
Indian and non-Indian jail populations, (2) to examine concordance of
the current screening tool used in the county jail with other
self-report measures of suicidal ideation and associated risk factors,
(3) to examine the cultural relevance of the current suicide risk
screening tool and of the intervention methods employed in response to
suicidal behavior within this particular jail setting, (4) to develop
measures of culturally-specific symptoms of suicide ideation that
could be incorporated into a suicide screening protocol, and (5) to
provide recommendations for culturally-sensitive suicide ideation
detection and intervention or treatment policies in this detention
setting. The principal objective of the second year of this research
project was to determine whether the employment of different suicide
screening protocols would make a difference in the responses of new
detainees with regard to the likelihood of securing their honest
reports of experiencing suicide ideation and its associated risk
factors. In particular, the research goals of the second year were:
(1) to identify, through the use of an experimental design, a suicide
screening process that influenced Northern Plains detainees' comfort
level in disclosure of suicidal ideation as well as future
help-seeking behavior and depression management within the jail
setting, and (2) to determine if the wording and format of screening
questions and the type of screener made a difference in the detainees'
comfort level for self-disclosure, management of depression, and
future help seeking behavior.
For the duration of this two-year research
project, all male and female inmates aged 18 and older who were booked
into the jail went through the customary booking procedure that
included the administration of the New York Suicide Prevention
Screening Guidelines (NYSPSG) questionnaire. Developed in New York and
implemented in New York jails and lockups in 1986 in response to
systemic problems thought to be contributing to a high rate of suicide
in those facilities, the NYSPSG instrument was designed to assess two
groups of risk variables: (1) factors enhancing the level of risk at
the time of booking, and (2) demographic and personal characteristics
correlated with suicide risk. This questionnaire was the suicide risk
detection tool historically used in this detention center. Consistent
with accepted jail practice and with the legal and correctional
literature, these questionnaires were always completed prior to the
inmate being asked to participate in the research. During the sampling
periods, all new prisoners who gave their informed consent were given
a self-report survey after they had been interviewed using the NYSPSG
questionnaire. In Year One (Part 1, Year One Data) researchers
administered a short self-report survey consisting of measures
commonly associated with suicidal ideation. With the exception of the
relatively few self-report surveys completed early in this project,
which were completed just prior to the detainee being moved into his
or her housing unit, all self-report surveys were completed in the
booking area within approximately four hours of admission into the
jail. The self-report survey measured stress, anxiety, suicide
ideation, hopelessness, and the suicidal behavior history of both the
inmate and his or her family. The protocols in the second year of the
project (Part 2, Year Two Data) reflected efforts to test
different screening conditions for four experimental groups and one
control group of new detainees. Each group was assigned to a specific
data collection period during which inmates admitted into the jail on
a certain day and during a certain time period were considered
potential participants. The control group consisted of inmates booked
under normal procedures without any change to the assessment tool or
process already in use in the jail. Additionally, for those subjects
included in the control group, there were no changes made in the
characteristics or credentials of the person doing the screening, nor
was there a change in the type of setting in which the screening
occurred. The use of this control group allowed for an accounting of
the effects of each of the subsequent four experimental groups. The
first experimental group consisted of new detainees screened in a
private area of the booking section of the detention center by a
uniformed officer. The second experimental group was comprised of all
incoming inmates being screened by an American Indian officer in the
more private area of the jail. The third experimental group had
incoming inmates screened in private by someone with a credentialed
mental health background. The fourth experimental group consisted of
all incoming inmates being screened in private by a non-uniformed
American Indian. The outcome variables were included in a short
self-report survey consisting of measures of demographics, comfort
experience during booking and the screening process, self-efficacy
management of depression, knowledge of the mental health support
available within the jail, and general well-being. All study
participants were asked to complete this self-report survey after
their booking and screening process was complete and just prior to
either their release on bond or their transfer to housing units within
the detention center. Part 2 of this data collection contains the
quantitative responses to the Year Two questionnaire, while Part 3,
Year Two Open-Ended Responses, contains the open-ended responses for
the question asking the respondents' opinions about the Year Two
questionnaire. The quantitative data collection was supplemented with
qualitative data during both years of this project. The goal of the
qualitative portion of the first year research endeavor was to develop
the most straightforward assessment of suicide ideation criteria in
this specific jail setting using semi-structured focus group
interviews. The first three focus groups during Year One discussed the
NYSPSG screening instrument, examining each item through probative
questions. These focus groups were conducted with American Indian
males (Part 4, Year One American Indian Male Focus Group Data on
NYSPSG), American Indian females (Part 5, Year One American Indian
Female Focus Group Data on NYSPSG), and non-American Indian males
(Part 6, Year One Non-American Indian Male Focus Group Data on
NYSPSG). The second set of focus groups in Year One reviewed the
jail's suicide prevention policies and procedures. These focus groups
were conducted with American Indian males (Part 7, Year One American
Indian Male Focus Group Data on Jail Policies), American Indian
females (Part 8, Year One American Indian Female Focus Group Data on
Jail Policies), non-American Indian males (Part 9, Year One
Non-American Indian Male Focus Group Data on Jail Policies), and
non-American Indian females (Part 10, Year One Non-American Indian
Female Focus Group Data on Jail Policies). Every inmate participant's
informed consent was obtained prior to initiation of the group process
and questioning. Focus group discussions generally lasted one to two
hours. All focus group discussions were audiotaped and later
transcribed and summarized. Lastly, a focus group comprised of
officers having primary responsibilities in both the intake and
housing areas of the jail was held (Part 11, Year Two Officer Focus
Group Data). A semi-structured questioning method which allowed for
the pursuit of emerging themes was utilized. The officers' focus group
lasted nearly two hours and occurred after their evening shift, from
approximately 11:00 p.m. to 1:00 a.m.
For Part 1, all inmates brought into the jail were given
an explanation of the research project and asked to sign the informed
consent form and take the survey in a reasonably private but
supervised space in the booking area. Rather than place a time limit
on the sampling, the administrator and shift supervisors agreed to
allow for ongoing sampling until a sufficient number of subjects was
obtained. Except for a four week period between December 14, 1999, and
January 13, 2000, detainees coming into the jail were asked to
participate in the study. Exclusion criteria included those who were
not proficient in reading and understanding the English language. The
sampling period for the second year of research (Parts 2 and 3) was
initiated in October 2000 and continued through May 31, 2001. Several
sampling strategies were employed and these varied according to the
intake protocol used by the booking officer after she or he received
specific training in the nature and purpose of the study and the
protocol to be used during the data collection period. In the initial
months of the study period, using the jail's customary intake
procedures, baseline data were collected by asking every inmate who
was admitted into the jail to participate in the study by completing a
Feedback and Satisfaction Survey after having been through the routine
booking process. For Parts 4-11 a convenient, qualitative purposive
sampling strategy was used. The jail mental health counselor
approached detainees who she thought would be able to contribute to
the focus group discussion. She described the study and asked for
participation. Once the detainee agreed, their names were then added
to a list that the officers used to "call out" when the focus groups
where convened.
All inmates and officers in a county jail in the Northern
Plains of the United States.
individuals
The data for Parts 1-3 came from self-report surveys,
and from the New York Suicide Prevention Screening Guidelines portion
of the booking interview. The data for Parts 4-11 were collected
through focus groups.
survey data, and focus group data,
experimental data
Demographic variables in Part 1 include age,
gender, ethnic identity, tribal affiliation, education level, income,
marital status, number of children, religious beliefs, and official
charges for arrest. Respondents were also asked about their previous
arrest history, experience being jailed, and experience being
hospitalized for emotional or substance abuse problems. Other items
measured the severity of suicidal ideation, the extent of social
support from significant others, and the types and amount of help
received from resources other than family or friends for emotional
support, substance abuse, domestic violence, anger control, or health
problems. Additionally, respondents provided descriptions of anxiety
symptoms, measures of loneliness, amount of stress from being in jail,
and negative attitudes about the future. They also answered questions
about their personal suicidal behaviors and those of their family
members. Lastly, respondents provided information on traumatic life
events and coping mechanisms. In Part 2, demographic information
included age, gender, ethnic identity, tribal affiliation, and pending
criminal charges. Additional questions inquired about the inmate's
comfort and truthfulness response levels during the screening
process. Other questions asked about the inmate's self-efficacy to
perform self-management behaviors for depression.
Not Applicable.
Part 1 includes the Beck Scale for Suicide Ideation (SSI),
Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), Jail
Stress Scale, a scale of spiritual or religious beliefs developed by
the National Center for American Indian/Alaska Native Mental Health
Research, Scale of Perceived Social Support, UCLA Loneliness Scale,
Brief COPE Scale, and the Stressful Life Events Screening
Questionnaire. Part 2 includes some questions from the Self-Efficacy
Control/Manage Depression Scale of the Stanford Patient Education
Research Center.