PROJECT SUMMARY The Johns Hopkins Center for American Indian Health and its partners, the White Mountain Apache Tribe and Navajo Nation are uniquely positioned and prepared to advance suicide prevention science through the funding opportunity “Service-Ready Tools for Identification, Prevention and Treatment of Individuals at Risk for Suicide” (RFA-MH-21-110). Native American populations experience substantially higher rates of suicide and the sharpest increases over time of any racial group. These disparities are the legacy of colonization, attempted genocide, historical trauma, and ongoing injustices, including chronic underfunding of health care and mental health services. Despite these adversities, NAs have exercised tribal sovereignty to support some of the most innovative, practical, and effective approaches to suicide prevention. One such model, the Celebrating Life program (CL), a community-based suicide surveillance and case management system, developed originally by the White Mountain Apache Tribe (WMAT) and shown to help contribute to reductions in suicide attempts and deaths over time. The CL program is now being scaled through the Southwest Hub for Youth Suicide Prevention (U19MH113136). As this program has scaled, our pilot work has revealed barriers to implementation, including 1) challenges to risk identification, and 2) difficulties matching individuals’ level of risk to evidence-based interventions as a means to improve scarce resource efficiencies. To help overcome these barriers to implementation, NIMH funded our team to develop and pilot test NATIVE-RISE (U19MH113136-02S3). NATIVE-RISE is a systems-level strategy that leverages predictive analytics to enhance risk identification and integrates and improves the efficiency of local NA case managers who deliver brief contact interventions. The proposed project will leverage our team’s historic MOU with Indian Health Service (IHS) and decades-long trust-relationships with tribal partners to test NATIVE-RISE and its integration in partnership with three NA-serving health care settings through a Hybrid Type III stepped-wedge cluster randomized implementation trial. Specifically, this project aims to 1) optimize the implementation of NATIVE- RISE across three NA-serving health care settings, 2) determine the effectiveness of NATIVE-RISE at improving the reach of evidence-based suicide prevention services, and 3) describe the costs associated with implementing NATIVE-RISE to inform scale-up and sustainability. Our application address key priority populations for NIMH (NOT-MH-21-090) and is in line with NIMH’s strategic plan Objective 4.3. If results are achieved, NATIVE-RISE will become an effective and scalable approach that improves services to prevent suicide among NA populations and advances our understanding of how to implement predictive analytics and more personalized care for suicide prevention.

PROJECT NARRATIVE Longtime tribal-academic research partners will optimize and evaluate NATIVE-RISE, a systems level strategy to suicide prevention that combines service-ready tools based on predictive analytics with risk-stratified evidence-based care for Native American adults. They will use a Hybrid Type-III stepped wedge cluster randomized trial and mixed methods to improve the reach of Brief Contact Interventions, evidence-based suicide prevention approaches shown to reduce suicide attempts and deaths. Implementing predictive analytics and risk-stratified care to help extend the reach of evidence-based suicide prevention programs to communities with the highest needs is paramount to reducing related health disparities.