Barriers and Facilitators to the Implementation of Suicide Prevention in Juvenile Detention Settings

Abstract

Youth in juvenile detention centers experience disproportionately high rates of suicide risk, yet the use and quality of suicide prevention practices in these settings remain low. The current study examined stakeholder-perceived barriers and facilitators of implementing suicide prevention across 10 juvenile detention centers in a Northeastern United States state. Semi-structured interviews were conducted with staff and leadership (N = 13). Data were analyzed using a hybrid inductive-deductive approach guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Our analysis revealed that inner context factors, particularly training and quality and fidelity monitoring, were the most salient facilitators of implementation. Outer context factors, particularly service environment and policy and fit, surfaced as major barriers to implementation. Funding emerged as a cross-cutting determinant that influenced other inner and outer context constructs. Findings underscore the importance of leveraging facilitators and addressing barriers to improve the implementation of suicide prevention. Recommendations for future efforts include integrating participatory methods to identify appropriate implementation strategies based on known barriers and facilitators. Ultimately, equity-centered implementation strategies may support the adoption and sustainment of evidence-based suicide prevention in juvenile detention settings to ensure timely and appropriate care for youth.