PROJECT SUMMARY Suicide is a significant public health problem with rates in the US general population gradually increasing over time. The burden of suicide is even more pronounced in many American Indian tribes, especially among youth, with average rates estimated to be about four times higher than the US general population. The effects of these deaths are felt throughout communities. Programs aimed at preventing suicide are critically important in these settings and represent one of the top priorities of the National Institute of Mental Health. However, even when we know prevention programs work, sustaining them and their effects has proved challenging. The overall goal of this K01 Mentored Research Career Development Award is to broaden the candidate’s expertise in the science of sustainment. Through coursework, structured mentorship activities and applied learning, the candidate will develop new competencies in (1) Dissemination and Implementation (D&I) science with a focus on sustainment; (2) American Indian health research; (3) use of innovative methodologic approaches, including mixed-methods and systems dynamic approaches; and (4) professional development, to become an independent NIMH-funded investigator. Drs. Joseph Gallo, Shannon Wiltsey-Stirman, and Allison Barlow will provide primary mentorship, and are joined by a team of dedicated and interdisciplinary consultant mentors including Drs. Takeru Igusa, Sonja Schoenwald, Lawrence Palinkas, Lindsey Zimmerman and Teresa Brockie. The research will be conducted by leveraging the NIMH U19 Southwest Suicide Prevention Hub. The candidate will combine mixed-methods and systems dynamic science, to innovatively identify, prioritize and ultimately, test strategies to enhance sustainment of the Celebrating Life youth suicide prevention program as it is disseminated to other tribal contexts. Locally, this research will help our community partners to devise solutions for sustaining effective suicide prevention programs in their settings. More broadly, this study addresses a critical gap in research on sustainment in the Dissemination and Implementation (D&I) science field, and focuses on populations from low-resource and underrepresented groups, representing one of the core values of D&I science.!Results from this study will inform development of an R01 proposal focused on testing systems dynamic approaches as sustainment strategies in an appropriately powered implementation trial. The study goals advance NIMH strategic objective #4 strengthening the public health impact of NIMH supported research by developing and validating “strategies for implementing, sustaining and continuously improving evidence-based practices” (4.2a) and is consistent with NIH’s Priorities for D&I science, focusing on “research testing approaches to scaling up and sustaining effective interventions.”

Project Narrative Despite vast gains in knowledge about what mental and behavioral health programs work, we know very little about how to sustain these programs over time. This is particularly true for critically important prevention programs, including those focused on suicide, with a significant gap in any research focusing on these efforts, especially in settings with less access to funding, capacity and other resource needs. The proposed study titled SuSt-AInS: Sustainment of suicide prevention programs in American Indian Settings, will use a widely generalizable and innovative method, community-based systems dynamic modelling, to prospectively identify, prioritize and test strategies aimed at enhancing sustainability of an evidence-supported youth suicide prevention program in partnership with the White Mountain Apache Tribe and Navajo Nation.