Youth Empowerment and Safety Intervention for Systems-involved Sexual and Gender Minority Youth at Risk of Suicide

In the general population, suicide is the second-leading cause of death for ages 10 to 24. Child Welfare (CW) and Juvenile Justice (JJ) involved youth have approximately 3 times greater risk for suicide ideation, attempts, and completions (i.e., self-injurious thoughts and behaviors – SITB) than non-systems-involved youth. Sexual and gender minority (SGM) (i.e. lesbian, gay, bisexual, queer and/or transgender) in the general population have 2-4 times the risk of SITB compared to their heterosexual, cisgender peers. Notably, SGMY are disproportionately overrepresented in CW and JJ, with estimates ranging from 16-32% compared to 2-8% in the general population. In sum, the risk of suicidality for SGMY who are involved with public systems is markedly compounded; however, the unique needs of this population have been largely ignored. Few CW or JJ jurisdictions identifying SGMY identities or providing SGM- affirming care. The proposed quasi-experimental clinical trial study will implement and evaluate the feasibility, acceptability, and initial impact of Peer Support Specialist (PSS) services for public system-involved SGMY at risk of suicide. The goal of this study is to evaluate the feasibility, acceptability, and initial impact of a multi-level intervention, Youth Empowerment & Safety (YES), comprised of two coordinated components: 1) system-level improved identification and referral (I/R) of SGMY at-risk for suicide, and 2) introduction of a SGM- affirming PSS to enhance engagement and support with behavioral health treatment and other support services. The rationale for the YES intervention is that we will improve outcomes for SGMY because our SGM-affirming PSS will strategically address modifiable risk factors (e.g. client-perceived SGM-based provider stigma, mistrust, and internalized queer-phobia) and protective factors (e.g. peer support, SGM-community connection, self-affirming beliefs, and hope) for engagement and SITB among SGMY. To do this, we will first develop and implement standard operating procedures (SOPs) and processes for YES tailored to each setting (JJ & CBMH). This aim will include a full set of protocols and a training and treatment manual (Aim 1). We will then evaluate the feasibility, acceptability, and preliminary impact of YES on system- level targets (Aim 2) and youth-level targets (Aim 3). The proposed research is significant because embedding PSS in the service continuum where SGMY are overrepresented and under- or un-identified is a critical systems innovation. YES has the potential to be a low resource/high impact intervention that could significantly improve service engagement and equity for systems-involved SGMY. This research is in response to the NIMH call for innovative systems-based mental health interventions (PAR 121-083) and it is aligned with the NIH-Wide Minority Health and Health Disparities Strategic Plan 2021-2025. The results of this study will provide information about if and how affirming identification, referral and connection with an affirming PSS is feasible, acceptable and impact SGMY identified at risk of suicide. This information will be used to inform decisions about the need for further research on SGM- affirming interventions designed to improve the impact of mental health services for this high risk and overlooked population, with implications for other populations and service settings.