Most adolescence-onset mental disorders persist well into adulthood. Health promotion is a core competency of the Advanced Practice Registered Nurse (APRN) role to prevent unhealthy behaviors, which start in puberty and increase the disease burden later in life (Das et al., 2016). In youth, poor mental health is linked to adverse outcomes such as fights, juvenile delinquency, and suicide (Das et al., 2016).
Related interventions are designed to target specific groups and at-risk individuals across different settings, including schools. Most recently, suicide prevention is delivered digitally in addition to a face-to-face format (King, Arango, & Ewell, 2018). In this paper, a proposed mental health initiative to meet the challenges of at-risk youth is discussed using the PDSA model and related evidence-based strategies based on IHI indicators included.
Development of a Health Promotion Program
The at-risk groups for youth suicide prevention interventions are school/college youth and adolescents. According to Das et al. (2016), the suicide rate in the 15-19 age bracket is high, at 9.1%. Thus, adolescent mental health stands out as an unmet need that requires integrated strategies to reduce the incidence of adverse outcomes and access barriers. Caregivers, including APRNs, are called upon to extend their scope of practice to care for pediatric and youth mental health challenges (van Cleve, Hawkins-Walsh, & Shafer, 2013).
Therefore, at the community level, effective, evidence-based programs should be developed and implemented to improve their outcomes. At the national level, policy analysis is required to describe the problem, identify solutions, and determine appropriate courses of action (Teitelbaum & Wilensky, 2018). The approach could result in modifications of laws against substance abuse, a critical risk factor in adolescent suicide.
A three-pronged Youth Suicide Prevention (YSP) that combines online resources, support, and youth cafés is proposed. In the first case, a reliable mental health information site and support services will be created. Access to the program will be through the YSP website and online psychotherapy for at-risk individuals. The site will contain a broad range of information on interpersonal trauma and substance abuse.
According to Das et al. (2016), major depressive disorder is a leading cause of suicide in youth. Other risk factors include illicit drug use and traumatic experiences. The user-friendly website will give advice on stress, anxiety, bullying, exams, sexuality, depression, and drugs. The content will be delivered as email factsheets to subscribers, videos, and podcasts. A question-and-answer section will be included to allow users to seek further clarifications.
Content for YSP will be developed in collaboration with mental health organizations. Registered students will also access online support services through links that lead them to counselors. Specifically, users can ask a psychotherapist a question and receive a response, book an online counseling session, and join discussion boards or self-help programs. For those not in out-of-school settings, local youth mental health projects (youth cafés) will be created to foster positive mental health and help at-risk individuals.
Participatory policy analysis is ideal for developing procedures and guidelines for these initiatives, as it grounded in deliberative democracy and inclusion (Teitelbaum & Wilensky, 2018). Volunteers and staff at these facilities will work to reduce the suicide risk through support, referrals to further assessment, and giving them informational resources.
The PDSA Model Steps for Change
Effective implementation of an intervention must be grounded in a change framework. The PDSA model includes four stages, i.e., plan, do, study, and act, which are designed to improve an aspect of customer-defined quality or launch a new program (Minnesota Department of Health (MDH), 2019). YSP will seek to establish a safety-oriented culture among youth in educational and non-academic settings.
Survivors will be involved in the planning phase of the YSP program. The specific action steps of stage one of the PDSA model entails the recruitment of a team to lead the change, the creation of an aim statement, description of the current context, development of a problem statement, and identification of causes and alternatives (MDH, 2019). Practical ways to plan the YSP are assessing the present awareness levels of suicide behavior problems and available information to adolescents.
Suicide-related data will help prioritize schools or regions with the highest need. Additionally, training of psychotherapists on suicide screening, needs assessment, alternative medications or care pathways, and follow-up will help prepare the team for the program (Renaud et al., 2014). Content for the YSP website and youth cafés will be developed in collaboration with professional during the planning stage. Recruitment of volunteer staff (psychotherapists) will also occur at this time. The action plan aims to reduce suicide rates among the youth through enhanced access and utilization of support services and informational resources in the community.
The “Do” stage follows the planning phase of the PDSA model. The implementation of the action plan occurs at this point (MDH, 2019). Data on the execution challenges and general observations should be recorded to help in the next stage. For the YSP, information resources and youth cafés will be made available to young people both in educational and non-academic settings. Each suicidal person will be enrolled in a pathway to care that is tailored to individual needs. Access to the services will be ensured by establishing 24-hour support for at-risk youth. Peers and families will also be engaged in this program as additional support sources.
The third stage of the PDSA model is “Study”. In this step, the aim statement formulated earlier and data collected are used to evaluate improvement, return on investment, new trends, and unintended side effects of the program (MDH, 2019). The pre- and post-YSP suicide rates, the number of online users accessing the YSP informational resources and support services, and youth cafés attendance rate are the metrics for assessing the success of the intervention.
The final step of the PDSA model is “Act”. According to the MDH (2019), this stage encompasses reflecting on the plan and its outcomes. If the YSP intervention is evaluated as a success, it will be standardized and replicated in more regions or facilities. Returning to phase one will help improve the plan even more.
Integration of Evidence-based Strategies Using IHI Indicators
The health promotion objectives for YSP program are to improve awareness of suicide as a preventable adverse mental health outcome, create broad-range online support, and provide informational resources to at-risk groups, such as those diagnosed with major depressive disorder (Das et al., 2016). Realizing these goals would require a multi-pronged approach that includes evidence-based interventions that target the youth. Educational initiatives delivered through workshops, mass media, and digital platforms are effective in reducing suicidal ideation and attempt (King et al., 2018). YSP will adapt evidence-based activities to create awareness in the youthful population. Suicide and self-harm data will be collected to help improve the intervention continually.
The evaluation of the program will be based on validated measures. The Institute for Health Improvement’s (2019) triple aim gives metrics for three improvement dimensions: population health, patient experience, and per capita cost. For the first domain, the specific measures include health status, risk level, disease burden, and mortality. Screening of adolescents for psychological or substance use disorders will give the pre-YSP functional status of the target population. A comparison of pre-implementation risk level, disease burden, and mortality due to suicide and post-implementation scores will indicate the success rate of the program.
Another of IHI’s triple aims is the patient experience. Satisfaction scores of service users as determined through surveys are a measure of quality. The adolescents/youth using YSP’s informational resources, support services, and youth cafés will rate the program before, during, and after implementation. An additional metric will be the likelihood to recommend YSP online resources, support, or youth café. A high score would indicate that the program is of high quality and address the unmet mental health needs of the young people.
Per capita cost is another domain included in IHI’s triple aims. Suicide prevention initiatives have been shown to be cost-effective. Significant cost savings can be made from deterred suicide-related mortality, disability due to depression, and reduced emergency department utilization rate (IHI, 2019). Multi-modal programs such as YSP could yield a higher return since they involve a broad range of interventions to target population subgroups.
Conclusion
Youth suicide can be attributed to mental health or substance use disorders. The YSP program will seek to increase awareness of suicide risk among adolescents. It involves a three-pronged approach to tackling this problem: online support, website informational resources, and youth café. To achieve implementation success, the PDSA model and IHI indicators of population health, patient experience, and per capita cost will be adopted.
References
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Institute for Health Improvement (IHI). (2019). IHI triple aim measures. Web.
King, C. A., Arango, A., Ewell, F. C. (2018). Emerging trends in adolescent suicide prevention research. Current Opinion on Psychology, 22, 89-94. Web.
Minnesota Department of Health (MDH). (2019). PDSA: Plan-do-study-act. Web.
Renaud, J., Séguin, M., Lesage, A., Marquette, C., Choo, B., & Turecki, G. (2014). Service use and unmet needs in youth suicide: A study of trajectories. Canadian Journal of Psychiatry, 59(10), 523-530. Web.
Teitelbaum, J. B., & Wilensky, S. E. (2018). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
van Cleve, S. N., Hawkins-Walsh, E., & Shafer, S. (2013). Nurse practitioners: Integrating mental health in pediatric primary care. The Journal for Nurse Practitioners, 9(4), 243-248. Web.