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Stepped Approach to Reducing Risk of Suicide in Primary Care (STARRS-PC)

Primary Purpose

Suicidal Ideation, Suicide, Attempted, Suicide Prevention

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Stepped Approach to Reducing Risk of Suicide in Primary Care
Sponsored by
Cynthia Fontanella
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Suicidal Ideation focused on measuring Suicide, STARRS-PC, Adolescent, Risk Assessment, Triage

Eligibility Criteria

12 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria (Youth and Parent): All patients between the ages of 12 - 17 years and their parent/guardian at time of consent who are identified as being at risk for suicide and receive primary care services at one of 16 participating sites are eligible for study inclusion. Youth will be recruited without regard to current or past histories of mental health problems. Youth with comorbid physical illness (e.g., asthma) and those receiving medication treatment for a comorbid physical or psychiatric condition will be eligible to participate provide they otherwise meet study entry criteria. Inclusion Criteria (Provider): Providers must work with patients at one of the participating PCCs. Exclusion Criteria (Youth and Parent): Subjects will be excluded for being: medically or cognitively unable to participate in study procedures without permanent residence or access to a telephone unable to speak English adequately to understand study procedures Exclusion Criteria (Provider): Unable to give consent Unable to speak English adequately to understand study procedures.

Sites / Locations

  • AxessPointe Community Health Centers/Arlington
  • Signature Health
  • Holzer Health System
  • Nationwide Children's Hospital
  • Eastglen PediatricsRecruiting
  • Dayton Children's Hospital - Main
  • Dayton Children's Hospital - NW
  • Holzer Health System
  • Hilliard PediatricsRecruiting
  • Spring Valley Primary Care Center
  • Holzer Health System
  • Kettering Pediatric and Family Care
  • Cornerstone Pediatrics
  • Signature Health
  • Village Square Primary Care Center
  • Franklin Avenue Primary Care Center
  • Signature Health

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Treatment As Usual

STARRS-PC

Arm Description

Treatment as Usual

Intervention consists of implementation of clinical pathway for youth suicide risk

Outcomes

Primary Outcome Measures

Columbia Suicide Severity Rating Scale (C-SSRS) [suicide attempt]
Columbia Suicide Severity Rating Scale (C-SSRS) is a semi-structured interview that tracks suicidal ideation and behavior severity over time.
Pierce Suicide Intent Scale (SIS) [suicide attempt]
Pierce Suicide Intent Scale (SIS) is a questionnaire that assesses behavior and circumstances surrounding the suicide attempt, including plans, preparation, communicative elements, and concept of lethality of the chosen method.

Secondary Outcome Measures

Non-Suicidal Self-Injury (NSSI) [NSSI]
The Non-Suicidal Self-Injury (NSSI) Assessment measures recent and lifetime NSSI.
Suicidal Ideation Questionnaire-JR [Suicidal ideation]
Suicidal Ideation Questionnaire-JR is a 15-item modified version of the SIQ, a 30 item self-report measure of suicidal ideation severity in adolescents, that has been tested in a variety of cultural settings and has been used as an outcome measure in several pediatric treatment studies.
Client Satisfaction Questionnaire-8 (CSQ-8) [Family satisfaction]
Client Satisfaction Questionnaire-8 (CSQ-8) is an 8-item self-report measure with items scored on a 1-4 scale (1=the lowest satisfaction, 4=the highest satisfaction). The CSQ assesses parent and youth perceptions of treatment acceptability and helpfulness.
AIM (Acceptability of Intervention Measure) [Family satisfaction]
AIM (Acceptability of Intervention Measure) is a 4-item measure used to determine the extent the parent and child finds the intervention pathway acceptable.

Full Information

First Posted
August 25, 2023
Last Updated
August 25, 2023
Sponsor
Cynthia Fontanella
Collaborators
National Institute of Mental Health (NIMH), Ohio State University, Holzer Gallipolis, Holzer Jackson, Holzer Athens, Eastglen Pediatrics, Signature Health Ashtabula, Signature Health Willoughby, Signature Health Painesville, AxessPointe - Arlington, Dayton Children's - Main Campus, Dayton Children's - Northwest Campus, Cornerstone Pediatrics, Kettering Pediatric and Family Care, Franklin Avenue Primary Care Center, Village Square Primary Care Center, Spring Valley Primary Care Center
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1. Study Identification

Unique Protocol Identification Number
NCT06018285
Brief Title
Stepped Approach to Reducing Risk of Suicide in Primary Care
Acronym
STARRS-PC
Official Title
Stepped Approach to Reducing Risk of Suicide in Primary Care
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 8, 2023 (Actual)
Primary Completion Date
July 31, 2027 (Anticipated)
Study Completion Date
July 31, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Cynthia Fontanella
Collaborators
National Institute of Mental Health (NIMH), Ohio State University, Holzer Gallipolis, Holzer Jackson, Holzer Athens, Eastglen Pediatrics, Signature Health Ashtabula, Signature Health Willoughby, Signature Health Painesville, AxessPointe - Arlington, Dayton Children's - Main Campus, Dayton Children's - Northwest Campus, Cornerstone Pediatrics, Kettering Pediatric and Family Care, Franklin Avenue Primary Care Center, Village Square Primary Care Center, Spring Valley Primary Care Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Suicide is the second leading cause of death among young people aged 12-17 years in the United States, yet many youth at risk for suicide are not identified or go untreated. Stepped care approaches have been shown to be effective at reducing suicide risk in clinical settings, including primary care. The goal of this hybrid I stepped wedge effectiveness-implementation study is to test the effectiveness of a population-based quality improvement (QI) intervention, entitled STARRS-PC (Stepped Approach to Reducing Risk of Suicide in Primary Care) compared to treatment as usual (TAU), in reducing the risk of suicidal behavior among youth in the pediatric primary care setting. STARRS-PC implements a clinical pathway for youth at elevated risk for suicide in pediatric primary care clinics. Clinical pathways are tools used by health professionals to guide evidence-informed practice. The STARRS-PC pathway consists of three evidence-based suicide clinical care processes: risk detection, assessment and triage, and, if needed, follow-up transitional care. STARRS-PC is guided by the Practical, Robust Implementation, and Sustainability Model (PRISM), which allows for the study of factors that influence effective implementation of the suicide prevention clinical pathway and is focused on scalability. The main questions the study aims to answer are: Will STARRS-PC be more effective than TAU at reducing the rate of suicide attempt at 12 months post-baseline (primary outcome)? Will STARRS-PC be more effective than TAU at reducing suicidal ideation and non-suicidal self-injury, and improving family satisfaction at 12 months post-baseline (secondary outcomes)? What are the barriers and facilitators of effective implementation and sustainability of STARRS-PC?
Detailed Description
This five-year multi-site study consists of the following essential elements: (1) recruitment of 2,324 adolescents ages 12-17 years inclusive at baseline, and their parent/guardian; (2) initial assessment of youth and parent/guardian participants using direct interviews and standardized questionnaires; and (3) follow-up assessments of all participants at 3-months, 6-months, and 1-year post-baseline. To achieve the study objectives, the project will be conducted in 16 pediatric primary care practices. The study consists of three phases of data collection: TAU, intervention, and sustainability. One thousand thirty-three suicidal youth will be enrolled during the TAU phase, and 1,291 suicidal youth will be enrolled during the intervention phase (total number of youth participants = 2,324). Youth and parent participants enrolled in the study will complete multiple questionnaires at four time points (baseline, 3-months, 6-months, and 12-months). Medical record reviews of youth participant files will occur throughout the study and be reviewed by research staff. The intervention phase is followed by a 6-month sustainability phase during which the participating practices will work on maintaining or further improving upon the anticipated gains made during the intervention phase. Phase 1: TAU TAU immediately precedes the intervention phase and ranges in length from 6 to 26 months. During TAU, participants will be treated according to usual and customary care, thus establishing each site's baseline rate of suicide risk screening and detection. Usual care at each participating practice involves screening for depression and suicide risk with the PHQ-9. This baseline rate will serve as the control for subsequent study phases. Phase 2: Intervention The intervention phase will range from 11 to 30 months. During this phase, each site will implement the clinical pathway, which includes universal screening for suicide risk using the Ask Suicide-Screening Questions (ASQ), a four-item questionnaire. Those who screen positive will then be evaluated using the Brief Suicide Safety Assessment (BSSA). The BSSA allows the clinician to assess the level of suicide risk to then choose how to proceed with clinical next steps. Clinicians will triage care based on three categories of risk: low-risk, further evaluation needed, and imminent-risk. The risk assessment will determine the type of care the individual then receives (e.g., mental health referrals, mental health evaluation and safety plan, tele-psychiatry crisis intervention consultation, send to ED). We will also conduct in-depth qualitative interviews with a purposive sample of providers (e.g., physicians, nurses, social workers) at each of the participating sites. Purposive sampling is a way to identify and recruit participants that are especially experienced with or knowledgeable about a phenomenon of interest. Provider participants will complete a series of questionnaires at three separate times: 1) prior to clinical pathway training, 2) after training, and 3) 6 months after training. Provider participants will also be trained on the quality improvement process for implementing the intervention strategy. Some provider participants will be asked to complete up to four qualitative interviews that will focus on the implementation process, barriers and facilitators to successful implementation of the clinical pathway, and lessons learned. Phase 3: Sustainability The intervention phase is followed by a 6-month sustainability phase during which the site will work on maintaining or further improving upon the anticipated gains made during the intervention phase. No participants will be recruited during the sustainability phase and this phase will not be used to evaluate intervention effectiveness. The specific aims include: Aim 1: To implement, study, and improve through a Plan-Do-Study-Act (PDSA) cycle, the STARRS-PC intervention that includes suicide risk detection, assessment and triage, and care management based on risk profile. PDSA is a systematic way to test a change that is implemented by breaking down the implementation process into specific steps, and then evaluating the outcome, improving on it, and testing again. Aim 2: Test the effectiveness of STARRS-PC compared to TAU on the primary patient outcome, suicide attempts, secondary patient outcomes (suicidal ideation, non-suicidal self-injury (NSSI), and family satisfaction) at 12 months post-baseline, as well as mediators and moderators, through a stepped wedge design. Hypotheses: STARRS-PC will significantly reduce the rate of: 1) suicide attempts (nonfatal and fatal) and 2) suicidal ideation, NSSI, and improve family satisfaction during the 12-month post-baseline follow-up period compared with TAU. Exploratory Aim 2a: To examine whether increases in provider knowledge, self-efficacy, and buy-in regarding suicide risk screening, assessment, and management will mediate the intervention effect on patient outcomes. Exploratory Aim 2b: To examine whether organization readiness and practice integration will moderate effects of intervention on patient outcomes. Aim 3: To identify barriers to and facilitators of implementation and sustainability of an intervention designed to improve suicide risk detection and risk management using qualitative interviews and surveys with clinical stakeholders at each study site.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Suicidal Ideation, Suicide, Attempted, Suicide Prevention
Keywords
Suicide, STARRS-PC, Adolescent, Risk Assessment, Triage

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Sequential Assignment
Model Description
Stepped Wedge Design
Masking
None (Open Label)
Allocation
Randomized
Enrollment
4648 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment As Usual
Arm Type
No Intervention
Arm Description
Treatment as Usual
Arm Title
STARRS-PC
Arm Type
Experimental
Arm Description
Intervention consists of implementation of clinical pathway for youth suicide risk
Intervention Type
Behavioral
Intervention Name(s)
Stepped Approach to Reducing Risk of Suicide in Primary Care
Intervention Description
Intervention consists of implementation of clinical pathway for youth suicide risk
Primary Outcome Measure Information:
Title
Columbia Suicide Severity Rating Scale (C-SSRS) [suicide attempt]
Description
Columbia Suicide Severity Rating Scale (C-SSRS) is a semi-structured interview that tracks suicidal ideation and behavior severity over time.
Time Frame
Baseline, 3, 6, 12 Months
Title
Pierce Suicide Intent Scale (SIS) [suicide attempt]
Description
Pierce Suicide Intent Scale (SIS) is a questionnaire that assesses behavior and circumstances surrounding the suicide attempt, including plans, preparation, communicative elements, and concept of lethality of the chosen method.
Time Frame
Based on most recent attempt from CSSRS at baseline, 3, 6 and 12 months
Secondary Outcome Measure Information:
Title
Non-Suicidal Self-Injury (NSSI) [NSSI]
Description
The Non-Suicidal Self-Injury (NSSI) Assessment measures recent and lifetime NSSI.
Time Frame
This measure will be administered to youth only at baseline as well as at 3-, 6-, and 12-months after baseline to track NSSI over time. This is a youth only assessment.
Title
Suicidal Ideation Questionnaire-JR [Suicidal ideation]
Description
Suicidal Ideation Questionnaire-JR is a 15-item modified version of the SIQ, a 30 item self-report measure of suicidal ideation severity in adolescents, that has been tested in a variety of cultural settings and has been used as an outcome measure in several pediatric treatment studies.
Time Frame
Baseline, 3, 6, 12 Months
Title
Client Satisfaction Questionnaire-8 (CSQ-8) [Family satisfaction]
Description
Client Satisfaction Questionnaire-8 (CSQ-8) is an 8-item self-report measure with items scored on a 1-4 scale (1=the lowest satisfaction, 4=the highest satisfaction). The CSQ assesses parent and youth perceptions of treatment acceptability and helpfulness.
Time Frame
Baseline ONLY, Parent and Child receive survey independently.
Title
AIM (Acceptability of Intervention Measure) [Family satisfaction]
Description
AIM (Acceptability of Intervention Measure) is a 4-item measure used to determine the extent the parent and child finds the intervention pathway acceptable.
Time Frame
Baseline ONLY, Parent and Child receive survey independently.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria (Youth and Parent): All patients between the ages of 12 - 17 years and their parent/guardian at time of consent who are identified as being at risk for suicide and receive primary care services at one of 16 participating sites are eligible for study inclusion. Youth will be recruited without regard to current or past histories of mental health problems. Youth with comorbid physical illness (e.g., asthma) and those receiving medication treatment for a comorbid physical or psychiatric condition will be eligible to participate provide they otherwise meet study entry criteria. Inclusion Criteria (Provider): Providers must work with patients at one of the participating PCCs. Exclusion Criteria (Youth and Parent): Subjects will be excluded for being: medically or cognitively unable to participate in study procedures without permanent residence or access to a telephone unable to speak English adequately to understand study procedures Exclusion Criteria (Provider): Unable to give consent Unable to speak English adequately to understand study procedures.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Cynthia Fontanella, PhD
Phone
(614) 938-0323
Email
cynthia.fontanella@nationwidechildrens.org
First Name & Middle Initial & Last Name or Official Title & Degree
Priyanka Desirazu, MSE
Phone
(614) 938-1113
Email
STARRS@nationwidechildrens.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey Bridge, PhD
Organizational Affiliation
Abigail Wexner Research Institute at NCH
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Alex Kemper, MD, MPH, MS
Organizational Affiliation
Abigail Wexner Research Institute at NCH
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Cynthia Fontanella, PhD
Organizational Affiliation
Abigail Wexner Research Institute at NCH
Official's Role
Study Director
Facility Information:
Facility Name
AxessPointe Community Health Centers/Arlington
City
Akron
State/Province
Ohio
ZIP/Postal Code
44333
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Terah Omaits, LPN
Email
tomaits@axesspointe.org
Facility Name
Signature Health
City
Ashtabula
State/Province
Ohio
ZIP/Postal Code
44004
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Libbie Stansifer, MD
Phone
440-992-8552
Email
lstansifer@shinc.org
Facility Name
Holzer Health System
City
Athens
State/Province
Ohio
ZIP/Postal Code
45701
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jonathan Mathis, MD
Phone
740-589-3100
Email
jmathis@Holzer.org
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cynthia Fontanella, PhD
Phone
614-938-0323
Email
cynthia.fontanella@nationwidechildrens.org
First Name & Middle Initial & Last Name & Degree
Priyanka Desirazu, MSE
Phone
(614) 938-1113
Email
STARRS@nationwidechildrens.org
First Name & Middle Initial & Last Name & Degree
Jeffrey Bridge, PhD
First Name & Middle Initial & Last Name & Degree
Alex Kemper, MD, MPH, MS
Facility Name
Eastglen Pediatrics
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43213
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cynthia Black, MD
Phone
614-866-8077
Email
cblack@copcp.com
Facility Name
Dayton Children's Hospital - Main
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45404
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shipla Sangvai, MD,MPH
Email
sangvai@childrensdayton.org
Facility Name
Dayton Children's Hospital - NW
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45404
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shipla Sangvai, MD, MPH
Email
sangvai@childrensdayton.org
Facility Name
Holzer Health System
City
Gallipolis
State/Province
Ohio
ZIP/Postal Code
45613
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jonathan Mathis, MD
Phone
740-446-5937
Email
jmathis@Holzer.org
Facility Name
Hilliard Pediatrics
City
Hilliard
State/Province
Ohio
ZIP/Postal Code
43026
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cathy Homick
Phone
614-777-1800
Email
chomick@hilliardpeds.com
Facility Name
Spring Valley Primary Care Center
City
Holland
State/Province
Ohio
ZIP/Postal Code
43528
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amy Hardy
Email
amy.hardy@nationwidechildrens.org
Facility Name
Holzer Health System
City
Jackson
State/Province
Ohio
ZIP/Postal Code
45640
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jonathan Mathis, MD
Phone
740-395-8801
Email
jmathis@Holzer.org
Facility Name
Kettering Pediatric and Family Care
City
Kettering
State/Province
Ohio
ZIP/Postal Code
45429
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ramzieh Azmeh, MD
Phone
937-293-4168
Email
ramziehazmeh@yahoo.com
Facility Name
Cornerstone Pediatrics
City
Miamisburg
State/Province
Ohio
ZIP/Postal Code
45342
Country
United States
Individual Site Status
Not yet recruiting
Facility Name
Signature Health
City
Painesville
State/Province
Ohio
ZIP/Postal Code
44077
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Libbie Stansifer, MD
Phone
440-853-1501
Email
lstansifer@shinc.org
Facility Name
Village Square Primary Care Center
City
Perrysburg
State/Province
Ohio
ZIP/Postal Code
43551
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amy Hardy
Email
amy.hardy@nationwidechildrens.org
Facility Name
Franklin Avenue Primary Care Center
City
Toledo
State/Province
Ohio
ZIP/Postal Code
43620
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Carla Welsh
Email
carla.welsh@nationwidechildrens.org
Facility Name
Signature Health
City
Willoughby
State/Province
Ohio
ZIP/Postal Code
44094
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Libbie Stansifer, MD
Phone
440-953-9999
Email
lstansifer@shinc.org

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Data will be made available through the National Institute of Mental Health (NIMH) Data Archive (NDA) system.
IPD Sharing Time Frame
We will follow NIMH guidelines for dissemination of study data and related materials.
IPD Sharing Access Criteria
To be provided.
Citations:
Citation
Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. National Center for Injury Prevention and Control. Accessed October 9, 2020. www.cdc.gov/injury/wisqars
Results Reference
background
PubMed Identifier
7498888
Citation
Burns BJ, Costello EJ, Angold A, Tweed D, Stangl D, Farmer EM, Erkanli A. Children's mental health service use across service sectors. Health Aff (Millwood). 1995 Fall;14(3):147-59. doi: 10.1377/hlthaff.14.3.147.
Results Reference
background
PubMed Identifier
15914749
Citation
Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA. 2005 May 25;293(20):2487-95. doi: 10.1001/jama.293.20.2487.
Results Reference
background
PubMed Identifier
12038893
Citation
Rushton J, Bruckman D, Kelleher K. Primary care referral of children with psychosocial problems. Arch Pediatr Adolesc Med. 2002 Jun;156(6):592-8. doi: 10.1001/archpedi.156.6.592.
Results Reference
background
PubMed Identifier
25057539
Citation
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. Available from http://www.ncbi.nlm.nih.gov/books/NBK222274/
Results Reference
background
PubMed Identifier
11726741
Citation
Miller CL, Druss B. Datapoints: suicide and access to care. Psychiatr Serv. 2001 Dec;52(12):1566. doi: 10.1176/appi.ps.52.12.1566. No abstract available.
Results Reference
background
PubMed Identifier
8496115
Citation
Brent DA, Perper JA, Moritz G, Allman C, Friend A, Roth C, Schweers J, Balach L, Baugher M. Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry. 1993 May;32(3):521-9. doi: 10.1097/00004583-199305000-00006.
Results Reference
background
PubMed Identifier
8634012
Citation
Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry. 1996 Apr;53(4):339-48. doi: 10.1001/archpsyc.1996.01830040075012.
Results Reference
background
PubMed Identifier
32817611
Citation
Underwood JM, Brener N, Thornton J, Harris WA, Bryan LN, Shanklin SL, Deputy N, Roberts AM, Queen B, Chyen D, Whittle L, Lim C, Yamakawa Y, Leon-Nguyen M, Kilmer G, Smith-Grant J, Demissie Z, Jones SE, Clayton H, Dittus P. Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2019. MMWR Suppl. 2020 Aug 21;69(1):1-10. doi: 10.15585/mmwr.su6901a1.
Results Reference
background
PubMed Identifier
16816228
Citation
Reinherz HZ, Tanner JL, Berger SR, Beardslee WR, Fitzmaurice GM. Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. Am J Psychiatry. 2006 Jul;163(7):1226-32. doi: 10.1176/ajp.2006.163.7.1226.
Results Reference
background
PubMed Identifier
7806612
Citation
Harrington R, Bredenkamp D, Groothues C, Rutter M, Fudge H, Pickles A. Adult outcomes of childhood and adolescent depression. III. Links with suicidal behaviours. J Child Psychol Psychiatry. 1994 Oct;35(7):1309-19. doi: 10.1111/j.1469-7610.1994.tb01236.x.
Results Reference
background
PubMed Identifier
10665603
Citation
Frankenfield DL, Keyl PM, Gielen A, Wissow LS, Werthamer L, Baker SP. Adolescent patients--healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting. Arch Pediatr Adolesc Med. 2000 Feb;154(2):162-8. doi: 10.1001/archpedi.154.2.162.
Results Reference
background
PubMed Identifier
29483201
Citation
Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK; GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics. 2018 Mar;141(3):e20174082. doi: 10.1542/peds.2017-4082.
Results Reference
background
PubMed Identifier
29483200
Citation
Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics. 2018 Mar;141(3):e20174081. doi: 10.1542/peds.2017-4081.
Results Reference
background
PubMed Identifier
18781118
Citation
Cheung AH, Dewa CS, Levitt AJ, Zuckerbrot RA. Pediatric depressive disorders: management priorities in primary care. Curr Opin Pediatr. 2008 Oct;20(5):551-9. doi: 10.1097/MOP.0b013e32830fe3e3.
Results Reference
background
PubMed Identifier
2741862
Citation
Kelleher KJ, Hohmann AA, Larson DB. Prescription of psychotropics to children in office-based practice. Am J Dis Child. 1989 Jul;143(7):855-9. doi: 10.1001/archpedi.1989.02150190105033.
Results Reference
background
PubMed Identifier
21541796
Citation
Vannoy SD, Tai-Seale M, Duberstein P, Eaton LJ, Cook MA. Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide. J Gen Intern Med. 2011 Sep;26(9):1005-11. doi: 10.1007/s11606-011-1726-5. Epub 2011 May 4.
Results Reference
background
PubMed Identifier
22021884
Citation
Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ Open. 2011 Jan 1;1(2):e000198. doi: 10.1136/bmjopen-2011-000198.
Results Reference
background
PubMed Identifier
22996297
Citation
Schwartz-Lifshitz M, Zalsman G, Giner L, Oquendo MA. Can we really prevent suicide? Curr Psychiatry Rep. 2012 Dec;14(6):624-33. doi: 10.1007/s11920-012-0318-3.
Results Reference
background
PubMed Identifier
23609101
Citation
O'Connor E, Gaynes BN, Burda BU, Soh C, Whitlock EP. Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 May 21;158(10):741-54. doi: 10.7326/0003-4819-158-10-201305210-00642.
Results Reference
background
PubMed Identifier
21709131
Citation
McDowell AK, Lineberry TW, Bostwick JM. Practical suicide-risk management for the busy primary care physician. Mayo Clin Proc. 2011 Aug;86(8):792-800. doi: 10.4065/mcp.2011.0076. Epub 2011 Jun 27.
Results Reference
background
PubMed Identifier
24842417
Citation
LeFevre ML; U.S. Preventive Services Task Force. Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 May 20;160(10):719-26. doi: 10.7326/M14-0589.
Results Reference
background
PubMed Identifier
25030971
Citation
Raue PJ, Ghesquiere AR, Bruce ML. Suicide risk in primary care: identification and management in older adults. Curr Psychiatry Rep. 2014 Sep;16(9):466. doi: 10.1007/s11920-014-0466-8.
Results Reference
background
PubMed Identifier
15630118
Citation
Bower P, Gilbody S. Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. Br J Psychiatry. 2005 Jan;186:11-7. doi: 10.1192/bjp.186.1.11.
Results Reference
background
PubMed Identifier
15657324
Citation
Asarnow JR, Jaycox LH, Duan N, LaBorde AP, Rea MM, Murray P, Anderson M, Landon C, Tang L, Wells KB. Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial. JAMA. 2005 Jan 19;293(3):311-9. doi: 10.1001/jama.293.3.311.
Results Reference
background
PubMed Identifier
25157724
Citation
Richardson LP, Ludman E, McCauley E, Lindenbaum J, Larison C, Zhou C, Clarke G, Brent D, Katon W. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. JAMA. 2014 Aug 27;312(8):809-16. doi: 10.1001/jama.2014.9259.
Results Reference
background
PubMed Identifier
27269026
Citation
Hogan MF, Grumet JG. Suicide Prevention: An Emerging Priority For Health Care. Health Aff (Millwood). 2016 Jun 1;35(6):1084-90. doi: 10.1377/hlthaff.2015.1672.
Results Reference
background
PubMed Identifier
19651711
Citation
Asarnow JR, Jaycox LH, Tang L, Duan N, LaBorde AP, Zeledon LR, Anderson M, Murray PJ, Landon C, Rea MM, Wells KB. Long-term benefits of short-term quality improvement interventions for depressed youths in primary care. Am J Psychiatry. 2009 Sep;166(9):1002-10. doi: 10.1176/appi.ajp.2009.08121909. Epub 2009 Aug 3.
Results Reference
background
PubMed Identifier
10634337
Citation
Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unutzer J, Miranda J, Carney MF, Rubenstein LV. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000 Jan 12;283(2):212-20. doi: 10.1001/jama.283.2.212. Erratum In: JAMA 2000 Jun 28;283(24):3204.
Results Reference
background
PubMed Identifier
15066896
Citation
Wells K, Sherbourne C, Schoenbaum M, Ettner S, Duan N, Miranda J, Unutzer J, Rubenstein L. Five-year impact of quality improvement for depression: results of a group-level randomized controlled trial. Arch Gen Psychiatry. 2004 Apr;61(4):378-86. doi: 10.1001/archpsyc.61.4.378.
Results Reference
background
PubMed Identifier
34099503
Citation
Kemper AR, Hostutler CA, Beck K, Fontanella CA, Bridge JA. Depression and Suicide-Risk Screening Results in Pediatric Primary Care. Pediatrics. 2021 Jul;148(1):e2021049999. doi: 10.1542/peds.2021-049999. Epub 2021 Jun 7.
Results Reference
background
Citation
Improvement IfH. How to Improve. Accessed October 18, 2020. http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
Results Reference
background
PubMed Identifier
23027429
Citation
Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Arch Pediatr Adolesc Med. 2012 Dec;166(12):1170-6. doi: 10.1001/archpediatrics.2012.1276.
Results Reference
background
Citation
Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. Jossey-Bass 2009.
Results Reference
background
PubMed Identifier
26163594
Citation
Crowl A, Sharma A, Sorge L, Sorensen T. Accelerating quality improvement within your organization: Applying the Model for Improvement. J Am Pharm Assoc (2003). 2015 Jul-Aug;55(4):e364-74; quiz e375-6. doi: 10.1331/JAPhA.2015.15533.
Results Reference
background
Citation
Lopreiato JO. Healthcare Simulation Dictionary Agency for Healthcare Research and Quality; 2016.
Results Reference
background
Citation
Harwayne-Gidansky I, Bellis JM, McLaren SH, et al. Mannequin-Based Immersive Simulation Improves Resident Understanding of a Clinical Decision Rule. Simulation & Gaming. 2017;48(5):657-669. doi:10.1177/1046878117719483
Results Reference
background
PubMed Identifier
26002536
Citation
Adams AJ, Wasson EA, Admire JR, Pablo Gomez P, Babayeuski RA, Sako EY, Willis RE. A Comparison of Teaching Modalities and Fidelity of Simulation Levels in Teaching Resuscitation Scenarios. J Surg Educ. 2015 Sep-Oct;72(5):778-85. doi: 10.1016/j.jsurg.2015.04.011. Epub 2015 May 20.
Results Reference
background
PubMed Identifier
25824896
Citation
Fallucco EM, Seago RD, Cuffe SP, Kraemer DF, Wysocki T. Primary care provider training in screening, assessment, and treatment of adolescent depression. Acad Pediatr. 2015 May-Jun;15(3):326-32. doi: 10.1016/j.acap.2014.12.004. Epub 2015 Mar 29.
Results Reference
background
PubMed Identifier
24401917
Citation
Ventre KM, Barry JS, Davis D, Baiamonte VL, Wentworth AC, Pietras M, Coughlin L, Barley G. Using in situ simulation to evaluate operational readiness of a children's hospital-based obstetrics unit. Simul Healthc. 2014 Apr;9(2):102-11. doi: 10.1097/SIH.0000000000000005.
Results Reference
background
PubMed Identifier
27497385
Citation
Yager P, Collins C, Blais C, O'Connor K, Donovan P, Martinez M, Cummings B, Hartnick C, Noviski N. Quality improvement utilizing in-situ simulation for a dual-hospital pediatric code response team. Int J Pediatr Otorhinolaryngol. 2016 Sep;88:42-6. doi: 10.1016/j.ijporl.2016.06.026. Epub 2016 Jun 7.
Results Reference
background
Citation
Wallin K, Kelly F, Sembera K. Building High Reliability Through Simulation. In: Oster CA, Braaten JS, eds. High Reliability Organizations: A Healthcare Handbook for Patient Safety & Quality. 2 ed. Sigma Theta Tau International; 2021.
Results Reference
background
PubMed Identifier
30384966
Citation
Brahmbhatt K, Kurtz BP, Afzal KI, Giles LL, Kowal ED, Johnson KP, Lanzillo E, Pao M, Plioplys S, Horowitz LM; PaCC Workgroup. Suicide Risk Screening in Pediatric Hospitals: Clinical Pathways to Address a Global Health Crisis. Psychosomatics. 2019 Jan-Feb;60(1):1-9. doi: 10.1016/j.psym.2018.09.003. Epub 2018 Sep 22.
Results Reference
background
PubMed Identifier
33310014
Citation
Aguinaldo LD, Sullivant S, Lanzillo EC, Ross A, He JP, Bradley-Ewing A, Bridge JA, Horowitz LM, Wharff EA. Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics. Gen Hosp Psychiatry. 2021 Jan-Feb;68:52-58. doi: 10.1016/j.genhosppsych.2020.11.006. Epub 2020 Nov 13.
Results Reference
background
Citation
PhenX Toolkit: Mental Health Research Core Tier 1 Demographic and Social Environment Measures. RTI International. Accessed October 4, 2020. https://www.phenxtoolkit.org/sub-collections/view/1
Results Reference
background
PubMed Identifier
11556941
Citation
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.
Results Reference
background
PubMed Identifier
18186994
Citation
Cameron IM, Crawford JR, Lawton K, Reid IC. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract. 2008 Jan;58(546):32-6. doi: 10.3399/bjgp08X263794.
Results Reference
background
Citation
Posner K, Brent D, Lucas C, et al. Columbia-Suicide Severity Rating Scale (C-SSRS) New York State Psychiatric Institute https://cssrs.columbia.edu/wp-content/uploads/C-SSRS_Pediatric-SLC_11.14.16.pdf
Results Reference
background
PubMed Identifier
870128
Citation
Pierce DW. Suicidal intent in self-injury. Br J Psychiatry. 1977 Apr;130:377-85. doi: 10.1192/bjp.130.4.377.
Results Reference
background
PubMed Identifier
18314433
Citation
Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, Vitiello B, Ritz L, Iyengar S, Abebe K, Birmaher B, Ryan N, Kennard B, Hughes C, DeBar L, McCracken J, Strober M, Suddath R, Spirito A, Leonard H, Melhem N, Porta G, Onorato M, Zelazny J. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008 Feb 27;299(8):901-913. doi: 10.1001/jama.299.8.901. Erratum In: JAMA. 2019 Nov 5;322(17):1718.
Results Reference
background
PubMed Identifier
15315995
Citation
March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J; Treatment for Adolescents With Depression Study (TADS) Team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004 Aug 18;292(7):807-20. doi: 10.1001/jama.292.7.807.
Results Reference
background
PubMed Identifier
10267258
Citation
Nguyen TD, Attkisson CC, Stegner BL. Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Eval Program Plann. 1983;6(3-4):299-313. doi: 10.1016/0149-7189(83)90010-1.
Results Reference
background
PubMed Identifier
11474056
Citation
Horwitz SM, Hoagwood K, Stiffman AR, Summerfeld T, Weisz JR, Costello EJ, Rost K, Bean DL, Cottler L, Leaf PJ, Roper M, Norquist G. Reliability of the services assessment for children and adolescents. Psychiatr Serv. 2001 Aug;52(8):1088-94. doi: 10.1176/appi.ps.52.8.1088.
Results Reference
background
PubMed Identifier
10939232
Citation
Stiffman AR, Horwitz SM, Hoagwood K, Compton W 3rd, Cottler L, Bean DL, Narrow WE, Weisz JR. The Service Assessment for Children and Adolescents (SACA): adult and child reports. J Am Acad Child Adolesc Psychiatry. 2000 Aug;39(8):1032-9. doi: 10.1097/00004583-200008000-00019.
Results Reference
background
Citation
Association AP. DSM-5-TR Online Assessment Measures. Accessed July 21, 2022. https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
Results Reference
background
Citation
Chorpita BFS, Susan H. Child Depression and Anxiety RCADS 25 Accessed July 22, 2022. https://help.greenspacehealth.com/article/50-child-depression-and-anxiety-rcads-25
Results Reference
background
PubMed Identifier
11577918
Citation
Herron J, Ticehurst H, Appleby L, Perry A, Cordingley L. Attitudes toward suicide prevention in front-line health staff. Suicide Life Threat Behav. 2001 Fall;31(3):342-7. doi: 10.1521/suli.31.3.342.24252.
Results Reference
background
PubMed Identifier
26648231
Citation
Gamarra JM, Luciano MT, Gradus JL, Wiltsey Stirman S. Assessing Variability and Implementation Fidelity of Suicide Prevention Safety Planning in a Regional VA Healthcare System. Crisis. 2015;36(6):433-9. doi: 10.1027/0227-5910/a000345.
Results Reference
background
PubMed Identifier
29191230
Citation
Hoekstra F, van Offenbeek MAG, Dekker R, Hettinga FJ, Hoekstra T, van der Woude LHV, van der Schans CP; ReSpAct group. Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care. Implement Sci. 2017 Dec 1;12(1):143. doi: 10.1186/s13012-017-0667-8.
Results Reference
background
PubMed Identifier
30729511
Citation
Mullin DJ, Hargreaves L, Auxier A, Brennhofer SA, Hitt JR, Kessler RS, Littenberg B, Macchi CR, Martin M, Rose G, Trembath F, van Eeghen C. Measuring the integration of primary care and behavioral health services. Health Serv Res. 2019 Apr;54(2):379-389. doi: 10.1111/1475-6773.13117. Epub 2019 Feb 6.
Results Reference
background
PubMed Identifier
27736110
Citation
Kessler RS, Auxier A, Hitt JR, Macchi CR, Mullin D, van Eeghen C, Littenberg B. Development and validation of a measure of primary care behavioral health integration. Fam Syst Health. 2016 Dec;34(4):342-356. doi: 10.1037/fsh0000227. Epub 2016 Oct 13.
Results Reference
background
PubMed Identifier
24410955
Citation
Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for implementing change: a psychometric assessment of a new measure. Implement Sci. 2014 Jan 10;9:7. doi: 10.1186/1748-5908-9-7.
Results Reference
background
Citation
Armat MR, Assarroudi A, Rad M, Sharifi H, Heydari A. Inductive and Deductive: Ambiguous Labels in Qualitative Content Analysis. The Qualitative Report. 2018;doi:10.46743/2160-3715/2018.2872
Results Reference
background
PubMed Identifier
18468362
Citation
Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf. 2008 Apr;34(4):228-43. doi: 10.1016/s1553-7250(08)34030-6.
Results Reference
background
PubMed Identifier
31170296
Citation
McCreight MS, Rabin BA, Glasgow RE, Ayele RA, Leonard CA, Gilmartin HM, Frank JW, Hess PL, Burke RE, Battaglia CT. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med. 2019 Nov 25;9(6):1002-1011. doi: 10.1093/tbm/ibz085.
Results Reference
background
Citation
Constas MA. Qualitative Analysis as a Public Event: The Documentation of Category Development Procedures. American Educational Research Journal. 1992;29(2):253-266. doi:10.3102/00028312029002253
Results Reference
background
Citation
Crabtree BF, Miller WL. Doing Qualitative Research 2nd ed. Sage Publications Inc; 1999.
Results Reference
background
PubMed Identifier
30658677
Citation
Hemming K, Taljaard M, Grimshaw J. Introducing the new CONSORT extension for stepped-wedge cluster randomised trials. Trials. 2019 Jan 18;20(1):68. doi: 10.1186/s13063-018-3116-3.
Results Reference
background
Citation
Foster ED, Deardorff A. Open Science Framework (OSF). Journal of the Medical Library Association. 2017;105(2)doi:10.5195/jmla.2017.88
Results Reference
background
PubMed Identifier
16829207
Citation
Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007 Feb;28(2):182-91. doi: 10.1016/j.cct.2006.05.007. Epub 2006 Jul 7.
Results Reference
background
Citation
Grambsch PM, Therneau TM. Proportional Hazards Tests and Diagnostics Based on Weighted Residuals. Biometrika. 1994;81(3):515-526. doi:10.2307/2337123
Results Reference
background
Citation
Flury BK, Riedwyl H. Standard Distance in Univariate and Multivariate Analysis. The American Statistician. 1986;40(3):249-251. doi:10.1080/00031305.1986.10475403
Results Reference
background
Citation
Austin PC. Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research. Communications in Statistics - Simulation and Computation. 2009;38(6):1228-1234. doi:10.1080/03610910902859574
Results Reference
background
Citation
Tingley D, Yamamoto T, Hirose K, Keele L, Imai K. mediation: R Package for Causal Mediation Analysis. Journal of Statistical Software. 2014;59(5):1 - 38. doi:10.18637/jss.v059.i05
Results Reference
background
Citation
Sales A. Review: mediation Package in R. Journal of Educational and Behavioral Statistics. 2016;42doi:10.3102/1076998616670371
Results Reference
background
PubMed Identifier
29207961
Citation
Jakobsen JC, Gluud C, Wetterslev J, Winkel P. When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts. BMC Med Res Methodol. 2017 Dec 6;17(1):162. doi: 10.1186/s12874-017-0442-1.
Results Reference
background
PubMed Identifier
30195428
Citation
Xie H, Gao W, Xing B, Heitjan DF, Hedeker D, Yuan C. Measuring the Impact of Nonignorable Missingness Using the R Package isni. Comput Methods Programs Biomed. 2018 Oct;164:207-220. doi: 10.1016/j.cmpb.2018.06.014. Epub 2018 Jul 4.
Results Reference
background
PubMed Identifier
23303463
Citation
Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, Kessler RC. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013 Mar;70(3):300-10. doi: 10.1001/2013.jamapsychiatry.55.
Results Reference
background
PubMed Identifier
26282553
Citation
Baio G, Copas A, Ambler G, Hargreaves J, Beard E, Omar RZ. Sample size calculation for a stepped wedge trial. Trials. 2015 Aug 17;16:354. doi: 10.1186/s13063-015-0840-9.
Results Reference
background
Citation
Agency for Healthcare Research and Quality (AHRQ). https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html#:~:text=The%20Plan%2DDo%2DStudy%2D,on%20it%2C%20and%20testing%20again
Results Reference
background
PubMed Identifier
24193818
Citation
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health. 2015 Sep;42(5):533-44. doi: 10.1007/s10488-013-0528-y.
Results Reference
background

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Stepped Approach to Reducing Risk of Suicide in Primary Care

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