Pittsburgh Foundation — ETUDES Pilot Program
With the generous support of The Pittsburgh Foundation and matching funds from the Department of Psychiatry at the University of Pittsburgh, the ETUDES Center funded proposals to support pilot projects for early career scientists relevant to youth suicide.
This research innovation program is a multifaceted approach to tackling the complex issue of adolescent suicide. By leveraging innovative research methods such as predictive algorithms, digital health interventions, and implementation science strategies, the program aims to develop effective interventions tailored to the unique needs of at-risk youth. Additionally, the program's emphasis on mentorship and training for early career scientists ensures a sustainable pipeline of researchers dedicated to advancing suicide prevention and health equity.
Funded Projects 2024-2026
Adaptation and Implementation of Flourish within Schools: Strengthening Suicide Prevention services for Adolescents Experiencing Online Victimization — Candice Biernesser, PhD.
This study will address this major need through Flourish, a text messaging program tailored for underserved youth designed to augment services within schools by adaptively responding to online victimization (OV) events to reduce suicide risk. Flourish’s development was driven by qualitative interviews with youth (N=40, 75% underserved), their caregivers (N=21), and school and mental health professionals (N=39), an online survey with youth (N>1,500), and codesign processes in which underserved youth (N=63) worked as equal partners. Flourish launches with a questionnaire of online experiences and responds with education and coping skills tailored for underserved youth that are aligned with suicide prevention best practices. Flourish focuses on targets important for suicide prevention among youth experiencing OV: augmenting distressing internal states (distress tolerance), bolstering engagement in help seeking after OV (motivation for help-seeking), and aiding response to OV using adaptive coping strategies (social problem-solving). Flourish was evaluated through usability testing, yielding excellent perceived usability scores, an open trial and ongoing RCT. Across these studies, Flourish has met anticipated engagement targets averaging 2.1 times weekly use.
The specific aims of the study are to:
Use human centered design methods to iteratively adapt the structure and planned rollout of imHere4U with school personnel (N=8) and underserved youth advisors (N=8).
Adaptation of Flourish will yield a revised program and rollout plan that has high satisfaction and usability.
Examine the feasibility and preliminary efficacy of Flourish among middle and high-school students (ages 11-17), experiencing OV and suicide risk. H1a. Feasibility will be evidenced by recruitment/retention rates > 80% and > weekly Flourish use in > 80% of youth.
Youth will report improved psychological distress and suicidal ideation over the 3-month follow-up period.
Understand barriers and facilitators to adoption of Flourish within schools.
Exit interviews and brief surveys with school personnel will elucidate strategies for implementing Flourish in schools.
Together, these aims are designed to provide the pilot data necessary for a future trial adequately powered to test effectiveness and implementation outcomes. This project will fill a critical gap in services by adapting Flourish for rollout within schools, an important venue for increasing access to services among underserved youth, thereby meaningfully advancing suicide prevention.
Candice Biernesser, PhD, LCSW, MPH
Evaluation of recruitment & retention for an ETUDES Center clinical trial targeting youth suicide prevention — Rachel Vaughn-Coaxum, PhD.
There has been crucial and due emphasis on community engagement strategies to address differences in mental health research including supports for designing and implementing research with a lens to address differences across all youth (e.g., NIH Clinical Translational Science Institutes, NIH Pragmatic Trials Collaboratory, and grassroots efforts by individual research teams). Yet, there is no framework to evaluate the effectiveness of these strategies for enhancing representation of the most vulnerable youth in clinical research, and this gap may impede NIMH’s research priorities aimed at reducing health differences. It is critical to carefully examine the effectiveness of clinical trials in reaching and retaining high-risk, vulnerable youth in suicide prevention research. Enhancing both enrollment and retention of youth may require strategically different approaches based on the stage where attrition occurs and the reasons for attrition.
The objective of this proposal is to refine the proposed retention in clinical trials framework (REACT framework) in evaluation of equity in enrollment and retention of youth representative of the pediatric primary care samples recruited in ETUDES clinics. The first goal is to test and refine REACT in iCHART, quantifying equity in screening, consent, assessment, and treatment across youth demographic categories. This includes quantitative and qualitative methods to obtain feedback from youth and caregivers at each possible exit point from the study. The second goal is to develop an adaptive REACT methodology—applicable across trials and populations—to identify barriers to enrollment and retention equity across studies.
Rachel A Vaughn-Coaxum, PhD