Pilot-test of an expanded approach to optimize suicide risk identification, family engagement and behavioral health treatment linkage for youth on probation - Among US adolescents, suicide is the second leading cause of death, but suicide risk is not uniform across youth. Those involved in the juvenile justice system are at even greater risk for suicide ideation and behaviors (SIB) given their increased prevalence of mood and substance use disorders, trauma exposure, and access to firearms. Yet nationwide few probation youth are systematically screened, and among those identified with behavioral health (BH) problems, data suggest only 1 in 5 are referred to services and 1 in 10 initiate treatment. Studies have documented youth/family-, and system-level obstacles that must be addressed for probation youth to increase access to services, and ultimately, achieve positive BH outcomes, underscoring the importance of multi-level, systematic approaches to identification and linkage. This application seeks to pilot-test an innovative service delivery model that augments an existing systems-level intervention (e-Connect) with an effective family- level strategy to optimize treatment initiation, treatment engagement, and reduce SIB/BH in probation youth. This proposal is from a PI/research team with considerable and complimentary expertise in SIB/BH detection, the justice system, family peer support, intervention adaptation, implementation science, clinical decision support systems, and use of large administrative data sets to achieve study aims. The proposed study will occur in n=3 original e- Connect counties in New York State. Guided by the Guided by the Gateway Provider Model (GPM) and the Exploration, Preparation, Implementation Sustainment (EPIS) implementation framework, this 3-year pilot effectiveness-implementation hybrid type-2 study will: (1) Expand e-Connect to include family engagement protocols developed through an iterative process with stakeholder (i.e., youth, caregivers, peers, BH providers and probation officers) workgroups to create Peer-Connect (Aim 1); (2) conduct a pilot-test of Peer-Connect and implementation evaluation via a quasi-experimental, pre-post pilot-trial with n=60 youth on probation (Aims 2 and 3). Given the exploratory nature of our aims, a quasi-experimental design is sufficient to meet the objectives of our study and will inform a larger effectiveness trial, using a stepped-wedge design. H1 primary outcomes) and b) reduced SIB/BH symptoms after 3 months/probation exit (H2, secondary outcome) compared to pre- Peer-Connect (e-Connect only) youth. We will also examine changes in family engagement as a potential mechanism of action (Aim 2). Finally, we will investigate the implementation of Peer-Connect (i.e., feasibility, fidelity, acceptability, sustainability of the program) and the acceptability and feasibility of planned implementation strategies, examining the role of EPIS/GPM factors (e.g., staff/peer characteristics, family enabling and predisposing factors; inner and outer context), to inform a blueprint for scale-up of Peer-Connect in probation (Aim 3). This pilot-test lays the groundwork for a fully powered R01 Peer-Connect Type II effectiveness-implementation trial.
