Suicidal ideation, plans, and attempts among adolescents are far more common than many realize, and these suicide antecedents are likely to be exacerbated in the wake of COVID-19. Yet, the prevailing suicide prevention paradigm entails identification and treatment within the formal mental health system, largely disconnected from the places and people where youth spend most of their time (e.g., schools, trusted extended family, peers, social media).
ARCADIA for Suicide Prevention takes a developmentally-informed, population-health approach to adolescent suicide. With the prediction of adolescent suicide barely better than chance, we focus on the places where adolescents already are (schools, primary care) and leverage trusted sources of support (peers, parents, trusted adults). With attention to the unique developmental needs of adolescent autonomy and identity, and guided by the ideas of youth themselves and those with lived experience, we draw on innovations from diverse disciplines (e.g., neuroscience, behavioral economics, implementation science, public health, communications) for our Center. Our focus is to strengthen bridges, integrating prevention and intervention, within and across the places where youth are situated, drawing from the “Swiss cheese model” for industrial accidents (recognizing that each place has gaps but their layering can support more kids at risk than when each exists on its own). We approach our work as a partnership between academia and public agencies, for seamless integration into practice, and to reach all youth, at population-scale. Through our transdisciplinary, cross-sector work, we aim to generate actionable solutions for youth suicide, while simultaneously addressing disparities facing marginalized BIPOC and LGBTQI+ youth, and meet National Action Alliance goals.
Examples of our current work, include:
1. Examining trends in adolescent suicidal behaviors by place, cohort, time, and policy. By leveraging administrative data at national, state, and district levels, we seek to identify trends in suicidal behaviors, factors that contribute to these trends, and policy levers for altering them. To date, research on youth suicide trends has primarily examined differences across demographic groups (race/ethnicity, gender, age) with less attention to the contexts and generational cohorts in which adolescents develop. We ask how neighborhood density and inequality are associated with suicide rates, and how policies, at the school- and community- levels, can make a difference. We prioritize analyses that can provide timely and actionable information to policymakers as well as school leaders at the local level to strengthen suicide prevention efforts. Currently, we are launching a study to examine generational effects on suicide trends and another to examine the impact of COVID-19 on suicide attempts among low-income children and teens, so city and state agencies can target post-pandemic efforts.
2. Evaluation of a novel school-based mental health/suicide prevention program that can be a catalyst for school- and community-wide suicide prevention. In Directing Change, a program “disguised as a film contest,” students create 30- and 60-second films in mental health/suicide prevention and disseminate them to the larger school community. Consistent with developmental theory and a disparities perspective, Directing Change focuses on peers - including those marginalized - in recognizing signs and encouraging help seeking, and in centering youth voice in positive, action-oriented messaging. Directing Change is unique in its arts-based approach, its reliance on the application of knowledge for understanding, its fostering of youth leadership in prevention, and its potential for school-wide transformation by offering a “foot in the door” into a school setting often ill-equipped for suicide prevention. The program has an eight-year history serving largely Latinx youth in California (CA) in partnership with the CA Department of Education, is part of a CA statewide mental health initiative, and meets the state mandate for suicide prevention programming. A possible embedded study will examine the film contest messages across racial/ethnic and sexual minority/majority groups for effective, targeted public health messaging strategies that can be utilized nationwide.
3. Identifying ways to strengthen the capacity of schools and links between schools and the formal mental health system. The dominant suicide prevention paradigm cannot meet the needs of many marginalized youth given barriers to identification, access, and quality mental health care. By strengthening schools, the natural social networks in which youth are embedded, and links between schools and the formal mental health system, we aim to address youth suicide for marginalized groups (BIPOC, LGBTQI+). As part of this work, we are adapting one of the few evidence-based school suicide prevention programs, Sources of Strength (SoS), which trains peer leaders to send messages of healthy coping and empowerment through natural peer networks to include an adjunctive “indicated” component for high risk youth. Sub-projects extend SoS approaches to a broader array of places where youth are, such as a) schools with linked mental health supports and b) community-based, informal settings, like barber shops and church groups; other models for high risk youth in schools are being considered. This work lays the groundwork for a NIMH P50 Suicide Prevention Research Center grant.
Why the name ARCADIA?
Arcadia, the name of a Tom Stoppard play, is the story of a girl named Thomasina who explores the relationship between math and nature. Four themes from Arcadia are highlighted in this Center’s work:
- This Center is aimed at uncovering the mystery of suicide prevention that has long eluded prevention scientists and medical professionals just as the play presents a historical mystery of Thomasina’s life.
- In Chaos Theory (also known as the “butterfly effect”), order is found in disorder, much the way that any study of suicide prevention must make sense of what has heretofore been a topic that has raised as many questions as answers.
- Thomasina brings together math with nature - enlightenment with romanticism - in much the same way that progress on suicide likely requires innovations across disciplines to fully understand suicide as part of the human condition.
- The story (and its title) alludes to tragedy, which is ultimately only addressable if we acknowledge its presence.