CAMS for Teens (CAMS-4Teens) in School-Based Health Centers

About This Grant

PROJECT ABSTRACT Suicide is a leading cause of death among adolescents in the U.S., and increasing youth access to effective interventions is a critical aspect of suicide prevention. To address this public health concern, many schools have adopted suicide prevention and intervention policies that include plans for identifying and responding to adolescents with risk, creating high demand for easily accessible evidence-based treatments for diverse youth with suicide risk in school and community settings. However, the limited implementation of evidence-based suicide interventions outside of specialty psychiatric settings is a major barrier to effective adolescent suicide prevention, especially for youth in areas with mental health professional shortages. As a network of publicly funded integrated health care clinics located on K-12 school campuses, school-based health centers (SBHCs) are well positioned to receive and treat youth whose risk of suicide is identified in schools, regardless of their insurance status or their ability to pay. SBHCs can increase youth access to evidence-based treatments for mental health problems and are crucial partners of comprehensive adolescent suicide prevention and care plans in schools. The Collaborative Assessment and Management of Suicidality for Teens (CAMS-4Teens, C4T), adapted from CAMS for adults, has reduced suicide risk in adolescents in an open trial conducted in clinical settings. The successful implementation of C4T in SBHCs is important for increasing youth access to evidence-based suicide intervention. Thus, we propose a Hybrid 1 implementation-effectiveness trial that will examine the feasibility and potential effectiveness of implementing C4T in Oregon SBHCs. First, we will engage partner perspectives for deploying C4T training and practices in SBHC settings. We will hold formative interviews with personnel from 11 SBHCs, 5 medical sponsor administrators, and 5 school personnel to assess the barriers and drivers of implementing C4T. We will also invite partners to join a Network Improvement Community to monitor and inform the planning and implementation of C4T. Second, we will conduct a case study with one SBHC site to test the acceptability, feasibility and appropriateness of the implementation strategies and iteratively refine C4T implementation over three patients. Third, we will implement a Hybrid 1 trial of C4T in 10 SBHCs to evaluate its potential effectiveness on patient (ages 12-17) outcomes, while also assessing implementation factors and clinician outcomes, targeting suicidal thoughts and behaviors and possible mechanisms of action: hopelessness and suicide cognitions. This mixed methods study will result in a R01 proposal to conduct a fully powered implementation trial of C4T in Oregon SBHCs. Together, this work will help increase youth access to evidence-based suicide interventions in geographically diverse settings.