NIMH Clinical Pathway in Rural Appalachian School-based Health Clinics

Review of patient records for the number of patients that were asked about suicidal thoughts and/or behaviors during their visit. Review will occur for a total of 3 months during the Treatment as Usual Period.

Review of patient records for the number of patients that were asked about suicidal thoughts and/or behaviors during their visit. Review will occur for a total of 6 months during the Treatment as Usual Period.

Review of patient records for the number of patients that reported having suicidal thoughts and/or behaviors. Review will occur for a total of 12 months during the Intervention Period.

Review of patient records for the number of patients that reported having suicidal thoughts and/or behaviors. Review will occur for a total of 12 months during the Interventional Period

Number of at-risk patients that the providers documented safety planning was completed.

Number of at-risk patients that the providers documented safety planning was completed.

Number of at-risk patients that the providers documented safety planning was completed.

Number of at-risk patients that the providers documented safety planning was completed.

Percentage of at-risk patients that the providers documented safety planning was completed.

Percentage of at-risk patients that the providers documented safety planning was completed.

Percentage of at-risk patients that the providers documented safety planning was completed.

Percentage of at-risk patients that the providers documented safety planning was completed.

Number of at-risk patients that documentation confirms providers conducted follow-up appointments to re-assess suicidal symptoms.

Number of at-risk patients that documentation confirms providers conducted follow-up appointments to re-assess suicidal symptoms.

Suicidal Ideation Questionnaire (SIQ-Jr) will be administered to participants at the initial visit and 3 months follow up. The SIQ-Jr is a 15-item self-report questionnaire that measures suicidal thoughts on a 7-point scale ("0- I never had this thought" to "6- I have this thought every day"). Scores range from 0-90, SIQ-Jr scores of 23 and above indicate severe suicidal ideation and the need for clinical intervention.

Suicidal Ideation Questionnaire (SIQ-Jr) will be administered to participants at the initial visit and 3 months follow up. The SIQ-Jr is a 15-item self-report questionnaire that measures suicidal thoughts on a 7-point scale ("0- I never had this thought" to "6- I have this thought every day"). Scores range from 0-90, SIQ-Jr scores of 23 and above indicate severe suicidal ideation and the need for clinical intervention.

Suicidal Ideation Questionnaire (SIQ-Jr) will be administered to participants at the initial visit and 3 months follow up. The SIQ-Jr is a 15-item self-report questionnaire that measures suicidal thoughts on a 7-point scale ("0- I never had this thought" to "6- I have this thought every day"). Scores range from 0-90, SIQ-Jr scores of 23 and above indicate severe suicidal ideation and the need for clinical intervention.

Suicidal Ideation Questionnaire (SIQ-Jr) will be administered to participants at the initial visit and 3 months follow up. The SIQ-Jr is a 15-item self-report questionnaire that measures suicidal thoughts on a 7-point scale ("0- I never had this thought" to "6- I have this thought every day"). Scores range from 0-90, SIQ-Jr scores of 23 and above indicate severe suicidal ideation and the need for clinical intervention.

The Center for Epidemiological Studies Depression Scale (CES-D) will be administered to the participant at the initial visit and the 3 month follow up. The CES-D is a self-report measure with 10 items asking about the frequency with which individuals have experienced various symptoms of depression within the last week. Each item is rated on a Likert scale, typically ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Total scores range is from 0-30, with higher scores indicating higher levels of depression.

The Center for Epidemiological Studies Depression Scale (CES-D) will be administered to the participant at the initial visit and the 3 month follow up. The CES-D is a self-report measure with 10 items asking about the frequency with which individuals have experienced various symptoms of depression within the last week. Each item is rated on a Likert scale, typically ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Total scores range is from 0-30, with higher scores indicating higher levels of depression.

The Center for Epidemiological Studies Depression Scale (CES-D) will be administered to the participant at the initial visit and the 3 month follow up. The CES-D is a self-report measure with 10 items asking about the frequency with which individuals have experienced various symptoms of depression within the last week. Each item is rated on a Likert scale, typically ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Total scores range is from 0-30, with higher scores indicating higher levels of depression.

The Center for Epidemiological Studies Depression Scale (CES-D) will be administered to the participant at the initial visit and the 3 month follow up. The CES-D is a self-report measure with 10 items asking about the frequency with which individuals have experienced various symptoms of depression within the last week. Each item is rated on a Likert scale, typically ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Total scores range is from 0-30, with higher scores indicating higher levels of depression.

Number of participants who indicate "yes" as per the following: Providers will administer the brief version of the Columbia Suicide-Severity Rating Scale (C-SSRS). The C-SSRS is a screening tool that asks two initial questions about suicidal ideation. For participants who state "yes" to either of these questions, they are asked additional questions about suicidal intent, plans, and behavior. Investigators will measure suicidal behavior as a dichotomous "yes"/"no" variable. A participant will be considered a "yes" for this measure if they answer "yes" to the final question about engaging in suicidal preparation and/or attempts on the C-SSRS and to the question asking whether or not they have done so in the past 3 months.

Number of participants who indicate "yes" as per the following: Providers will administer the brief version of the Columbia Suicide-Severity Rating Scale (C-SSRS). The C-SSRS is a screening tool that asks two initial questions about suicidal ideation. For participants who state "yes" to either of these questions, they are asked additional questions about suicidal intent, plans, and behavior. Investigators will measure suicidal behavior as a dichotomous "yes"/"no" variable. A participant will be considered a "yes" for this measure if they answer "yes" to the final question about engaging in suicidal preparation and/or attempts on the C-SSRS and to the question asking whether or not they have done so in the past 3 months.

Percentage of participants who indicate "yes" as per the following: Providers will administer the brief version of the Columbia Suicide-Severity Rating Scale (C-SSRS). The C-SSRS is a screening tool that asks two initial questions about suicidal ideation. For participants who state "yes" to either of these questions, they are asked additional questions about suicidal intent, plans, and behavior. Investigators will measure suicidal behavior as a dichotomous "yes"/"no" variable. A participant will be considered a "yes" for this measure if they answer "yes" to the final question about engaging in suicidal preparation and/or attempts on the C-SSRS and to the question asking whether or not they have done so in the past 3 months.

Percentage of participants who indicate "yes" as per the following: Providers will administer the brief version of the Columbia Suicide-Severity Rating Scale (C-SSRS). The C-SSRS is a screening tool that asks two initial questions about suicidal ideation. For participants who state "yes" to either of these questions, they are asked additional questions about suicidal intent, plans, and behavior. Investigators will measure suicidal behavior as a dichotomous "yes"/"no" variable. A participant will be considered a "yes" for this measure if they answer "yes" to the final question about engaging in suicidal preparation and/or attempts on the C-SSRS and to the question asking whether or not they have done so in the past 3 months.

Number of participants who screen positive for suicide risk during the initial visit reporting use of the safety plan developed for the participant.

Number of participants who screen positive for suicide risk during the initial visit reporting use of the safety plan developed for the participant.

Percentage of participants who screen positive for suicide risk during the initial visit reporting use of the safety plan developed for the participant.

Percentage of participants who screen positive for suicide risk during the initial visit reporting use of the safety plan developed for the participant.

Number of parents whose child screened positive for suicide risk during the initial visit reporting the use of the safety plan that was developed for the participant (child).

Number of parents whose child screened positive for suicide risk during the initial visit reporting the use of the safety plan that was developed for the participant (child).

Percentage of parents whose child screened positive for suicide risk during the initial visit reporting the use of the safety plan that was developed for the participant (child).

Percentage of parents whose child screened positive for suicide risk during the initial visit reporting the use of the safety plan that was developed for the participant (child).

Number of participants who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Number of participants who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Percentage of participants who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Percentage of participants who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Number of parents who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Number of parents who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Percentage of parents who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Percentage of parents who endorse each category related to Safety Plan Usage. Measured on a Likert Type scale with a range of 1-5 ("1-all the time," "2-often," "3-sometimes," "4-almost never," or "5-never") with 1 being more frequent usage and 5 being less frequent usage.

Number of participants who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Number of participants who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Percentage of participants who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Percentage of participants who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Number of parents who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Number of parents who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Percentage of parents who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Percentage of parents who endorse each category related to Safety Plan Helpfulness. Measured on a Likert Type scale with a range of 1-4 ("1-very helpful," "2-helpful," "3-a little helpful," or "4-not at all helpful.") with 1 being most helpful and 4 being least helpful.

Number of participants who report acute care was utilized for help with suicidal symptoms between the initial visit and the 3 month follow up visit per participant report.

Number of participants who reported acute care was utilized for help with suicidal symptoms between the initial visit and the 3 month follow up visit per participant report.

Percentage of participants that reported acute care was utilized for help with suicidal symptoms between the initial visit and the 3 month follow up visit.

Percentage of participants that reported acute care was utilized for help with suicidal symptoms between the initial visit and the 3 month follow up visit.

Number of parents who report a participant utilized acute care for help with suicidal symptoms between the initial visit and the 3 month follow up visit as per reported by the parent.

Number of parents who report a participant utilized acute care for help with suicidal symptoms between the initial visit and the 3 month follow up visit as per reported by the parent.

Percentage of parents that reported acute care was utilized for help with participant suicidal symptoms between the initial visit and the 3 month follow up visit.

Percentage of parents that reported acute care was utilized for help with participant suicidal symptoms between the initial visit and the 3 month follow up visit.