Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co- Occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis. Homeless youth have high rates of alcohol and illicit drug use, comorbid mental health conditions, and are at high risk for suicide. However, few preventive interventions have been proven for reducing substance use or addressing suicide among homeless youth. Resolution of youth homelessness through housing and prevention services, often referred to as ?Housing First? (HF), as proposed in the parent HOME study has great potential to reduce opioid use and progression to opioid use disorder (OUD). This Competitive Revision (CR), ?HOME + Suicide Treatment Education and Prevention (STEP),? proposes to collect additional measures of suicide risk and evaluate the secondary benefits of HF combined with preventive interventions to reduce suicidal ideation (SI) and related outcomes over time. Given the anticipated severity of suicide risk in our sample, we will add ?STEP? to the parent study?s preventive interventions targeting opioid use, including additional screening procedures and Cognitive Therapy for Suicide Prevention (CTSP) for those at high risk for suicide. In our prior trial among homeless youth with severe SI, those who received CTSP has a significantly faster decline in SI compared to youth receiving treatment as usual. The Primary Aim of the CR is to determine the effectiveness of HF + STEP, compared to STEP alone, for reducing primary (suicidal ideation) and related (depression symptoms, suicide attempts) outcomes over time. Secondary aims will test whether outcomes differ among those at high risk at baseline (eligible for CTSP), and whether they are mediated through hypothesized primary (housing stability and substance use) and secondary (hopelessness, stress coping) pathways; and will explore CTSP implementation determinants and outcomes (acceptability, appropriateness, feasibility, fidelity, and cost). Methods. The CR will use the parent study?s sample of youth who do not meet criteria for OUD at baseline (n=240). The parent study will deliver manualized preventive interventions to all youth to address opioid use, and 6 months of housing to a random sample (n=120). With the CR, additional screening and CTSP will be delivered to youth in both study groups. CTSP will be delivered to high risk youth via one-on-one therapy sessions with a trained research therapist over 6 months. Primary and secondary outcome measures will be collected at 3-, 6-, 9-, and 12 months. Analyses of aims will be conducted via intention-to-treat and will use latent growth models (LGM) to estimate trajectories of change across assessment points (baseline, 3, 6, 9, and 12 months follow-up). A series of path analysis will test hypothesized mediators and assess implementation context in a Hybrid Type I implementation study. Impact. Identifying effective strategies to deliver evidence-based preventive services to homeless youth with comorbid suicidal ideation and substance use can inform national models of HF and is important to the goal of reducing loss of life.
Suicide is the leading cause of death among homeless youth, but few suicide prevention interventions have been tested with youth. Therefore, this study seeks to address this gap by identifying an effective combination of strategies to prevent suicide ideation in this population. Specifically, we will add assessment and a preventive cognitive therapy for suicide to a parent study examining Housing First in a randomized trial for homeless youth.
