Puerto Rico Collaborative Approach Research Innovation and Behavioral Health Engagement (PR-CARIBE) - Puerto Rico Collaborative Approach Research Innovation and Behavioral Health Engagement (PR-CARIBE) employs a Collective Impact framework to co-design, pilot, implement, and evaluate a multilevel intervention aimed at improving behavioral health, developmental, family, and systems outcomes among children, youth, and families in Puerto Rico. Persistent poverty remains a key system-level factor associated with variation in health and development. According to Kids Count Puerto Rico, 57% of children and youth live below the federal poverty level, with a median household income of $21,492, contributing to limited access to resources, reduced mobility opportunities, and elevated risk for adverse behavioral health outcomes. PR-CARIBE addresses three service-system conditions: fragmented service systems that limit coordination and referrals; limited data infrastructure and use for planning and resource allocation; and restricted service access due to geographic gaps, workforce shortages, and administrative burdens. The intervention integrates two upstream components, the Health Research Assembly (HeRA) and Puerto Rico Open Data (PROD), with midstream caregiver navigation and coaching components. HeRA is a multisector collaborative and structured coordination co-governance platform that aligns stakeholders to strengthen coordination, referral pathways, stakeholder-shared decision-making, and sustainability planning. PROD strengthens data infrastructure, accessibility, interpretation, and use for policy and programmatic action, including the Mental Health Vulnerability Index, analytics supported municipality-level tool to identify high-need municipalities with elevated service demand and service gaps. These upstream strategies are complemented by a Puerto Rico–adapted and linguistically appropriate caregiver navigation and coaching component designed to strengthen caregiver service literacy, navigation skills, communication and problem-solving strategies, self-efficacy, and families’ ability to access and sustain needed services. Building on recent needs assessments, strategic planning efforts, and policy developments across Puerto Rico, PR-CARIBE advances coordinated, scalable, and sustainable system-level solutions. Guided by the National Academies of Sciences conceptual model, the project uses a mixed-methods, multilevel design to evaluate changes in collaboration, data use, caregiver capacity, service access, and child and family outcomes in Ponce and Peñuelas, with the goal of generating transferable methods for system-level interventions in municipalities with limited service capacity and documented service gaps.
