Project 3

Project 3 Abstract The overall Project 3 goal is to advance science and clinical care for preventing suicide and self-harm and strengthen knowledge for reaching our national objectives of reducing suicide deaths and attempts.22 Within the context of the Center treatment model, “Screening and Treatment for Anxiety and Depression” (STAND), Project 3 extends the clinical targets of STAND to reducing suicide and self-harm risk with the goals of enhancing STAND effectiveness and benefits, and offering a scalable suicide/self-harm prevention model for community colleges. Recognizing disparities in mental health outcomes and access to evidence-based care, we focus on East Los Angeles Community College (ELAC), a community college site in a diverse, low-income area in Los Angeles. Using the Signature Project sample (N=1000) and methods, Project 3 seeks to: 1) enhance risk detection through developing/evaluating algorithms for identifying indicators of “SU/SH risk states” that emerge prior to the onset of suicidal/self-harm (SU/SH) behavior, and provide opportunities to deliver “just-in-time” interventions to prevent suicidal/self-harm episodes; 2) evaluate the effectiveness of STAND with treatment tier/level assigned and adapted based on data-driven algorithms, as compared to symptom severity, on suicide/self-harm outcomes; and 3) enhance the effectiveness of STAND for suicide/self-harm prevention by augmenting STAND with a technology-enhanced suicide prevention intervention (TE-SPI) that combines intervention components with demonstrated benefits in prior research. These include: safety planning; a digital intervention (BRITE app) that prompts safety plan use, skills, and hope; and caring contacts. The TE-SPI will be pre-tested and adapted for the Center population during Years 1 & 2, providing data on safety, feasibility, acceptability, and intervention effects. In Years 3-5, 420 students selected for need (STAND Tiers III or II) will be randomly assigned to either the TE-SPI plus STAND with Usual Risk Management (URM), or STAND with URM. We test the hypothesis that the TE-SPI group, relative to URM, will show: increased treatment engagement/contacts (i.e. app, STAND); lower risk of suicide/self-harm events; greater improvement in severity of suicidality; lower levels of suicide/self- harm related adverse events (e.g. hospitalizations, ED visits); and that increased treatment engagement leads to improved suicide/self-harm outcomes. Primary and secondary outcomes respectively are: suicide/self-harm events (including suicide attempts, unclear and nonsuicidal self-harm/NSSI); and an ordinal suicidality scale with categories of none, ideation, intent/plan, suicidal behavior, suicide attempts.