STARRS-PC: A stepped approach to reducing suicide in primary care: Design and methods of a hybrid type 1...

Suicide is the second leading cause of death among youth aged 12-17. Although most at-risk youth receive primary care, routine screening is limited in primary care due to provider discomfort, time constraints, limited training, and inadequate referral sources. Research evaluating and implementing suicide prevention strategies in pediatric primary care is vitally needed.

We aim to test the effectiveness of the Stepped Approach to Reducing Suicide in Primary Care (STARRS-PC), a population-based quality improvement intervention implementing a structured clinical pathway consisting of risk detection, assessment and triage, and follow-up with transitional care.

A stepped wedge cluster randomized design will evaluate the effectiveness of STARRS-PC compared to treatment as usual (TAU) across 16 primary care sites. 2324 adolescents aged 12-17 screening positive for suicide risk will be enrolled (1033 in the TAU phase; 1291 in the intervention phase). Primary outcomes include suicide attempts and deaths. Secondary outcomes are suicidal ideation, non-suicidal self-injury, and family satisfaction. Youth and parents will complete assessments at baseline, 3, 6, and 12 months. Tests of moderation and mediation will be conducted to understand finding generalizability and identify variables that change as a result of the intervention and are associated with suicide attempts/death. Implementation outcomes (reach, adoption, maintenance, feasibility, and acceptability) will be evaluated through provider surveys and qualitative interviews.

This study will provide evidence on the effectiveness and implementation of a quality improvement supported, structured suicide prevention pathway in pediatric primary care, which could transform youth suicide risk identification and management.