Innovations for peer-delivered and family-engaged brief interventions for youth suicide in Nepal: A pilot hybrid type 2 implementation study

Our proposal aims to co-design and pilot trial the implementation of a package of brief interventions for suicide prevention among youth (12-24 years of age) delivered by Peers (YPFSuPP). YPF-SuPP will contain two evidenced-based interventions tested in South Asia (safety planning and contact follow up) with two core innovations: safety plans delivered through a personalized youth-designed jewelry and protocolized strategies to culturally and safely engage trusted family members to support youth. We will leverage a nationally renowned nongovernmental organization (Social Changemakers and Innovators – SOCHAI) in Nepal and their well-supported Peer Volunteer workforce to deliver YPF-SuPP alongside the existing health system. We establish an implementation system that provides supportive supervision to Peers. Using equity-informed and participatory mixed methods we will establish two advisory boards, a Youth Advisory Board and a Community Advisory Board of local adolescent mental health clinicians, suicide experts, teachers, family members of youth with lived experience of suicide, and youth advocates. We focus our work on a rural municipality of Makwanpur District, focusing on providing care to a broad population (Tamang and Chepang) in Nepal. We will identify successes and improvement based on operationalized benchmarks to move on to a fully powered hybrid type 2 clinical trial. Youth clinical outcomes include suicide-related coping, suicide ideation severity, and mental health service use, among other secondary and mechanistic domains. Implementation outcomes include reach, adoption, acceptability, appropriateness, fidelity, and potential for sustainment. This study will lay the groundwork for a future cluster randomized trial of the YPF-SuPP intervention to evaluate its effectiveness in delivering robust, community level, support for youth at risk for suicide.