Project Summary/Abstract The objective of this proposal is to develop and pilot a systems-level strategy in pediatric primary care to enhance identification and management of suicidal ideation and behavior in Latinx youth, particularly those in immigrant families with parents who have limited English proficiency (LEP). We will focus on the use of trained community health workers (CHWs) to increase clinic capacity and quality of suicide risk screening and early intervention, with a focus on safety planning, parent psychoeducation and care coordination. Our specific aims are 1: To develop site-specific implementation protocols for the integration of CHWs into SIB screening and safety planning for Latinx youth and their families; 2: To pilot the implementation of the program in a six-month open trial in four pediatric primary care practices representing a range of usual practice settings; and 3: To engage a stakeholder network to explore barriers and facilitators, including costs and billing strategies, to implementation of this approach across a broad range of pediatric primary care settings. In Aim 1, we will use Implementation Mapping, a systematic process incorporating the perspectives of users (e.g., families), implementers (e.g., clinic staff), adopters (e.g. clinic administrators) and sustainers (e.g. healthcare service delivery experts and payors) to guide development of strategies to adopt, implement and maintain an evidence-based intervention in the four participating pediatric practices. In Aim 2, we will assess feasibility, acceptability, and impact on organizational (e.g., increase in screening and CHW referral, engagement in follow-up mental health visits) and patient-level outcomes (e.g., improved family functioning, parenting self-efficacy). Quantitative data (e.g., changes in rates of screening) will be examined using an interrupted time series analysis. In Aim 3, we will conduct semi-structured interviews with stakeholders and convene the stakeholder network to develop an implementation plan for a larger trial. We will then integrate pilot trial and qualitative data using mixed methods analysis to assess feasibility and acceptability at the organizational, provider, and patient levels and convene to develop an implementation plan for a larger trial. Successful completion of this deployment-focused pilot study would prepare us for a future multi-site cluster randomized controlled trial assessing the effectiveness of the implementation of suicide prevention interventions delivered by CHWs in health care settings on rates of suicidal ideation and behavior for Latinx youth in pediatric primary care, with the long- term goal of addressing mental health service disparities and preventing youth suicide.

Project Narrative The integration of evidence-based screening and suicide prevention delivered by community health workers into pediatric primary care has the potential to address mental health service gaps experienced by Latinx youth and their families, reduce suicidal ideation and behavior, and prevent youth suicide. Systems-level approaches to the identification and management of suicidal ideation and behavior developed in this study may be broadly generalizable to populations of underserved youth from families with limited English proficiency and in settings with limited mental health service workforce capacity.