Adolescent suicide rates have risen over the past decade, prompting significant national, community, and school-based suicide prevention efforts. Schools, as central settings for youth development, provide unique opportunities to address suicide risk through interventions that transform norms and foster help-seeking behaviors. This study develops a theory of change based on student and staff experience of Directing Change, an innovative school-based program where students create and disseminate short films on mental health and suicide prevention that adhere to safe messaging guidelines. The program, grounded in a diffusion of innovation framework, aims to reduce stigma, shift school-wide norms, and promote help-seeking behaviors. Qualitative interviews were conducted with a convenience sample of 17 program champions (10 adult advisors and 7 youth) to garner their perspectives on the program’s theory of change. Themes in the interviews aligned with the program’s intended goals, as well as new themes such as personal growth, youth leadership development, gateways to support, and a sense of belonging and connection within school communities. These findings position Directing Change as an upstream prevention model worthy of testing in a rigorous randomized controlled trial. Moreover, the themes articulated offer intriguing new targets for testing in other youth suicide prevention strategies.

While researchers, physicians, and public officials have highlighted rising rates of adolescent suicide, one group has been largely ignored in public discourse, intervention development, and research: liminal youth. Here, we bring attention to youth with identities outside binary race, ethnic, sexual orientation, or gender categorizations and develop a unified theory explaining their greater risk of suicide. Our work is grounded in the concept of liminality, and we draw on developmental theory regarding identity development, narrative identity, and belonging to detail the stressors experienced by liminal adolescents and their related intrapersonal costs that impede these developmental milestones. We aim to seed a new body of research on adolescent suicide prevention, mental health promotion, and developmental research, writ large, on liminal youth.

Introduced in the context of developmental psychopathology by Cicchetti and Rogosh in the Journal, the current paper incorporates the principles of equifinality and multifinality to support the use of tiered models to prevent the development of emerging child psychopathology and promote school readiness in early childhood. We use the principles of equifinality and multifinality to describe the limitations of applying one intervention model to address all children presenting with different types of risk for early problem behavior. We then describe the potential benefits of applying a tiered model for having impacts at the population level and two initial applications of this approach during early childhood. The first of these tiered models, Smart Beginnings, integrates the use of two evidenced-based preventive interventions, Video Interaction Project, a universal parenting program, and Family Check-Up, a selective parenting program. Building on the strengths of Smart Beginnings, the second trial, The Pittsburgh Study includes Video Interaction Project and Family Check-Up, and other more and less-intensive programs to address the spectrum of challenges facing parents of young children. Findings from these two projects are discussed with their implications for developing tiered models to support children’s early development and mental health.

For much of the past decade, suicide has been the second leading cause of death for adolescents in the United States, and suicide rates among adolescents have been rising for the last 15 years. Suicidal thoughts and behaviors among adolescents were common before COVID-19 and have become an increasing public health priority in the pandemic′s wake. In this Social Policy Report, we review evidence for suicide prevention strategies designed to address these rising trends. We make recommendations for federal, state, and local policymakers and practitioners; program developers in organizations that design and implement programming for youth; and academic and nonacademic researchers. Where research evidence is strong, we suggest legislation, funding, and implementation. In areas where gaps in evidence exist, we recommend program development and research. Our recommendations follow the order in a taxonomy adapted from the Centers for Disease Control and Prevention, beginning with strategies that change the structural conditions in which adolescents live and concluding with strategies that support adolescents following a suicide (i.e., postvention). We find strong evidence for, and recommend policy implementation of: restricting access to lethal means; LGBTQ+ affirming policies; screening for suicide risk in medical settings; and community-wide investments via the Garrett Lee Smith Memorial Act. In schools, we find benefits of, and recommend funding and implementation of, youth-focused programs. Even so, gaps exist: (a) research on economic policies for adolescents is nonexistent; (b) while mental health care access is a barrier, we do not know how to reduce youth suicide rates via changing care access; (c) data on crisis lines are encouraging but descriptive; and (d) school personnel training increases knowledge and confidence but not adolescent help-seeking. Finally, guidelines for response following a suicide loss focus on immediate support and are based on limited research; this is an area for program development and research.

Purpose: This study is a cluster randomized controlled trial (RCT) designed to test the impact of a novel school-based mental health/suicide prevention program “disguised as a film contest”—Directing Change—among high school students in California. Directing Change has been implemented in hundreds of schools across California for over a decade, but the program has not been rigorously evaluated to date. Through quantitative student surveys, we will examine 1) impacts on the students who participate directly in the filmmaking component of the program in the following areas: knowledge, self-efficacy, perceived norms/stigma, school connectedness, help-seeking, and suicidal thoughts and behaviors, overall and in particular for Latine and LGBTQ+ youth; and 2) impacts on other students' (in the same school, but who do not participate directing in the film contest) knowledge, self-efficacy, perceived norms/stigma, school connectedness, and help-seeking. This is a mixed-method study (utilizing quantitative surveys and qualitative interviews; for the purposes of this registration, only the quantitative methods will be formally registered).

This study examined whether a two-tiered parenting program, which provides universal primary prevention along with targeted secondary prevention only for families with increased needs, would have mutually beneficial impacts on attendance across two program components. A secondary analysis of the Smart Beginnings (SB) randomized controlled trial was conducted. SB takes place from birth to age 3 and combines universal delivery of the Video Interaction Project (VIP) with targeted delivery of the Family Check-Up (FCU) for families identified as having increased risks following yearly screening. The current study analyzed whether attendance in VIP in the first six months was associated with FCU attendance for eligible families at six months, and whether FCU attendance at six and 18 months was associated with subsequent VIP attendance. Analyses included logistic and mixed-effects Poisson regression, as well as group-based trajectory analysis. VIP attendance predicted later FCU attendance (AOR = 5.43, p < .01), and FCU attendance predicted later VIP attendance (IRR = 1.35, p < .01) and a high-stable VIP attendance trajectory (AOR=14.98, p < .01). Findings provide strong support for the ability of tiered models to engage parents, to promote effective and efficient service delivery to reduce disparities in school readiness, and their potential to overcome common barriers to attendance and scaling by addressing the heterogeneity of risk among low-income families.

Study aim to test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6 to 24 months across infancy and toddlerhood. Result: Smart Beginnings positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation.

This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.

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