Addressing suicide risk in primary care to reduce youth suicide

Suicide is a leading cause of death among 10- to 24-year-olds in the US, and half of youth who die by suicide contact a primary care provider within one month prior to suicide. Suicide risk screening and access to brief and effective suicide prevention interventions remain an important step in reducing suicide, yet comprehensive suicide prevention pathways focused on youth have not been widely implemented or evaluated in primary care settings, in part due to lack of trained clinicians and time to provide services.

This project aims to address these challenges by developing clinician training and adapting and optimizing a brief, evidence-based suicide intervention, SAFETY- Acute(A), for use in primary care to support the development of an effective and sustainable primary care-based suicide prevention pathway for youth with low to moderate suicide risk.

Evidence synthesis for policy program

Using a scoping review approach, CoLab is systematically looking for reviews and authoritative sources to guide a model for value-based care for pediatric behavioral health. Our review approach was informed by guidelines for scoping reviews and rapid evidence reviews. The initial goal of this project was systematically looking for reviews and authoritative sources to guide a model for value-based care for pediatrics and mental health. Then, we would compile and synthesize the literature to see if there are any value-based models that would appear to be most effective for pediatric behavioral health care.

Embedded clinical coaching

Using an embedded clinical coaching framework, the Evidence Based Practice Institute (EBPI)/CoLab is promoting the development of quality care expertise within behavioral health agencies to reduce the cost and improve the speed of clinical workforce training. The goal of this project is to move principles of effective behavioral health care more quickly into practice, and to foster agency resilience to workforce turnover. This project is part of a broader Leadership Initiative for Quality.

To develop and eventually implement an embedded clinical coaching model, EBPI/CoLab partnered with multiple organizations in Washington to determine priorities and gather feedback. Through these partnerships, EBPI/CoLab identified key characteristics of an effective clinical coaching model, and incorporated stakeholder feedback to ensure scalability and adaptability. This coaching model includes the development of an asynchronous training for new clinicians, an embedded peer consultation structure, and competency checks through clinician-submitted videos. Through this novel embedded coaching structure, organizations can retain internal expertise and better support a shifting workforce.

Supervisor tools for quality

The Supervisory Tools for Quality initiative recognizes the integral role that clinical supervisors play in supporting behavioral health clinicians’ use of effective practices in community mental health agencies, and aims to leverage this role to improve the scale up and sustained use of quality behavioral health services. Specifically, this project is focused on the development of cost effective, easy to use, and practical strategies to elevate supervision practices. This project is part of a broader Leadership Initiative for Quality.

This initiative involved partnering with supervisors to form a Supervisor Advisory Team. This team worked to provide practical and tangible supports to supervisors in order to improve delivery of quality and effective behavioral health services, and ultimately strengthen outcomes for economically and racially marginalized children and adolescents. This advisory group included experienced supervisors in behavioral health organizations across the state. Geographic regions represented included Bellingham, Bellevue, Lakewood, Spokane, Walla Walla, and Yakima. To date, we have completed three Supervisor Advisory Team meetings.

Housing stability for youth

The Housing Stability for Youth (H-SYNC) model was developed by the UW CoLab team in collaboration with Snohomish and Kitsap County workgroups and is intended to serve as a prevention tool for youth homelessness. Specifically, it’s designed to identify youth at risk of or currently experiencing homelessness within existing processes in juvenile court systems and refer youth and their families to appropriate prevention and housing services via a stepped-care navigation model. The court system serves as a pivotal resource for the identification of these populations in need due to the high frequency of police and court contact these populations experience. This model is being implemented in four counties in Washington State, including King, Snohomish, Kitsap, and Okanogan Counties and in collaboration with community-based organizations such as the YMCA of Greater Seattle, Cocoon House, and Kitsap Mental Health Services.

As of 2022, H-SYNC prevention program is coordinated by the Y Social Impact Center at the YMCA of Greater Seattle. H-SYNC now represents a state-wide partnership between juvenile courts and local social service providers across counties including King, Snohomish, Peirce, Spokane, Okanagan and Kitsap.

Opportunity Based Probation

Opportunity-Based Probation (OBP) is a new juvenile probation model that expands on adolescent development research by leveraging adolescents’ drive towards independence as well as their heightened receptivity to rewards. In collaboration with their probation officers, youth create meaningful goals and incentives that reward the development of prosocial behavior. Probation officers scaffold prosocial behavior by reinforcing success and constructively addressing probation violations and problem behaviors. OBP was originally developed through a collaboration between UW CoLab and juvenile court leadership in Pierce County, Washington with funding from the Annie E. Casey Foundation and is now being implemented, refined, and tested for acceptability, implementation, and preliminary effectiveness. In 2021, a second OBP site was started in Hartford County, Connecticut and is currently undergoing co-design and implementation efforts with an eye for eventual testing and expansion statewide.

Accelerating research use in courts

Measuring the use of research evidence within organizations and systems is a rapidly growing area of study in the social sciences as researchers, policymakers, and practitioners in a variety of systems try to bridge the research-to-practice gap. With growing calls for justice systems, especially juvenile justice systems, to integrate developmental and behavioral health science within all aspects of the justice process, it is critical to develop a standardized measure of how individuals use research evidence within these systems. This will allow researchers to examine how research is used across studies, sites, and points in time, as well as to refine and compare new interventions aimed at increasing the use of research. Toward this end, the UW CoLab research team with the help of the William T. Grant Foundation, is developing and validating a measure of research use with collaborators nationwide.

COVID-19 Student Survey

This project involved an anonymous needs assessment for 6th through 12th graders in Washington to collect data on what students thought was going well, what challenges they had encountered, and what their needs were as schools replied to largely in-person instruction following a largely virtually year because of the COVID-19 pandemic.

Understanding the support needs of gender expansive youth

Approximately 35% of youth who identified as transgender report having attempted suicide in the past 12 months. Despite this high risk, few preventive interventions have been developed specifically to address the unique needs of this group who experience high rates of marginalization, victimization and social isolation based on their gender identities. This study will use human centered design principles to adapt the Caring Contacts intervention for suicide prevention for transgender and gender expansive (TGE) youth and user test this intervention with suicidal ideation who are identified via a Zero Suicide-based screening program in the Seattle Children’s Gender Clinic.

Evaluation of a new approach to youth suicidal crises: Swift Outpatient Alternatives for Rapid Stabilization (SOARS)

The study will evaluate a novel program developed by our team to improve the effective outpatient management of youth with acute suicide risk. This program evaluation examines just-in time intervention to assess suicide risk level, address imminent risk, and begin treatment to address ideographic suicidal drivers over time. The clinic has served over 200 youth and families since 2019. Qualitative and quantitative data from youth, caregivers, and clinicians demonstrate high levels of fidelity, feasibility, appropriateness, and acceptability, however, impact on core health outcomes has not been conducted. This funding will allow for analysis of the treatment program to demonstrate the impact of the intervention on suicidal thoughts and behaviors.