While youth at all juvenile justice (JJ) processing points are at increased risk for suicidal behavior (SB) and associated behavioral health (BH) issues, those supervised in community settings (e.g., probation), may be at greatest risk: (a) protocols for identification and service referral are far more common in secure settings, (b) national policy increasingly favors community supervision/diversion over incarceration, (c) youth supervised in the community have far more access to means and opportunity than do those in secure settings, and (d) the multi- system coordination challenges to accessing BH care for community JJ youth are far greater than for those secure care. We propose to adapt and test the utility of a multi-level service delivery model that increases identification of SB and related BH problems, guides targeted referral, trains staff and structures interagency collaboration to increase uptake of BH services by youth on probation; and document the organizational elements required to widely-implement this model in juvenile probation and community treatment settings. The model is based on our earlier, evidence-based linkage protocols from Project Connect, and capitalizes on technological advances unavailable at Connect?s 2007 development, so as to address earlier implementation issues. Working in 9 NYS counties, project specific aims are (1) to develop a technologically advanced cross-system identification/linkage service model that trains staff, formalizes interagency collaboration and referral decision-making and uses a mobile application to seamlessly combine (a) screening for SB and related BH problems, (b) classification of clinical need and (c) county-specific streamlined referral plans for BH services; (2) to examine the degree to which, compared to Baseline, e- Connect improves (a) intermediary PO practice outcomes (service need identification, cross-system referral) and increasing (b) youth BH service use (access, engagement); and (3) to elucidate multi-level factors (e.g., staff, organizational, youth/family, community,) that influence implementation (feasibility, acceptability, sustainability) of e-Connect across various probation department processing categories (e.g. status offenders, diversion cases) to inform comprehensive scale-up. The theoretically based mechanisms (e.g., changes in staff knowledge and self-efficacy; agency structural characteristics) by which PO practice change affects BH service use will also be examined. Guided by the GPM and CFIR framework, this 5-year study will comprise 4 project phases: (1) Development, (2) Baseline data collection, (3) Implementation, and (4) Sustainment. After development, counties are randomized to one of 4 Waves to begin implementation of e-Connect at 4-month intervals in a stepped-wedge design. Implementation activities continue for 18m and sites? use of e-Connect protocols after 18m will be an indication of sustainability. This initiative is one of the first to address SB and advance JJ youth enrollment in BH treatment. Because we propose addressing risk and acute SB, this study has the likelihood of identifying and linking to services high-risk, high need youth that are often overlooked.
Youth in all types of justice settings are at substantive risk for suicidal behavior (SB) and correlated poor outcomes, yet protocols for identification and service delivery, while common for those in secure care, are rare for those in community settings (e.g., probation). Addressing the SB risk in probation youth is critical, because compared to those in secure care, there are 8 times as many JJ youth managed in their communities, where they have far more access to means and opportunity for SB, and where the service system coordination challenges are far greater. e-Connect, by training probation officers and providing them with mobile technology that will allow them to identify SB and make rapid and targeted referral decisions, will increase access to behavioral health service use and reduce SB in this highly vulnerable population.
