Anna Ratzliff

The authors sought to determine whether augmenting usual suicide care with follow-up in the form of instrumental support calls (ISC) or two-way Caring Contacts texts (CC) works best to reduce suicidal ideation and behavior (SI/SB) in adolescents and adults. The Suicide Prevention Among Recipients of Care (SPARC) Trial is a pragmatic comparative effectiveness randomized clinical trial stratified by age, with participants randomized in a 1:1 ratio to ISC or CC. Participants were adolescents (12-17 years, N=723) and adults (18+ years, N=797) who screened at risk for suicide in emergency departments (N=9) and primary care clinics (N=36) between May 2021 and July 2022; primary data collection was completed in August 2023. Outcomes included Columbia-Suicide Severity Rating Scale SI/SB score at 6 months (primary) and 12 months (secondary). Adolescents (N=723; mean age, 14.9 years [SD=1.6]) were mostly female (75%), White (84.1%), and non-Hispanic (84.2%). Adults (N=797; mean age, 38.3 years [SD=15.9]) were mostly female (70%), White (89.1%), and non-Hispanic (90%). At 6 months, outcomes were similar by condition among adolescents, but among adults, SI/SB scores were significantly higher among those receiving CC compared to those receiving ISC (adjusted difference in means [ADM]=0.50, 95% CI=0.12, 0.88). At 12 months, adolescents' SI/SB scores were significantly lower in the CC compared with the ISC condition (ADM=-0.64, 95% CI=-1.11, -0.18), but outcomes were similar by condition among adults. The best suicide prevention follow-up care may vary by age, with adolescents benefiting most from longer-term connection-focused two-way CC and adults benefiting most from more intensive early instrumental support through ISC.

We systematically assessed the presence and distribution of state-level policies, specifically statutes and regulations that were in effect as of July 1, 2022, related to training any occupational groups in suicide prevention. Utilizing legal epidemiology methods, we conducted a cross-sectional assessment of all 50 states and the District of Columbia. We identified 824 policies in our initial search and retained 477 in our final policy database. Policies were distributed across 5 occupational settings: educational (n = 142), behavioral health (n = 130), carceral (n = 111), primary and specialty care (n = 60), and other (n = 58). Fourteen policies pertained to multiple settings. On average, each state had 9.4 policies and covered 3 occupational settings. All states had at least 1 policy (minimum: 1; maximum: 42). Training occupational groups in suicide prevention is a widespread strategy, but significant variation exists across states, occupational settings, and specific occupational groups. Further research is necessary to determine whether this is an effective suicide prevention strategy at the population level. ( Am J Public Health. Published online ahead of print July 31, 2025:e1–e11. https://doi.org/10.2105/AJPH.2025.308193 )

Integrating behavioral health in primary care improves quality of care and outcomes for patients with comorbid conditions. Shortage of a trained behavioral health workforce limits adoption. Professional psychology training programs contribute to recruitment, retention, and development of skilled providers, who value and deliver behavioral health services in primary care. This study interviewed a cohort of established psychology training programs in real-world, state-wide clinical primary care settings and identified their strategies and challenges with teaching practices and program resources that impact the robust quality of training. Between December 2020 and March 2021, we conducted semistructured interviews with 12 licensed psychologists who oversaw nine integrated primary care psychology training programs at the internship and postdoctoral levels across Washington State. Data were analyzed using a thematic approach. Programs taught psychology trainees about integrated primary care via extensive onboarding, modeling and shadowing, structured learning environment, interprofessional education opportunities, flexible and cross-disciplinary supervision, and a psychologically safe space. Teaching challenges included balancing scheduled and curbside supervision, pivoting to telehealth, and aligning trainee expectations and program requirements. Training programs were funded through different and multiple sources, but most lacked a stable funding mechanism, compounded by barriers for psychology trainees to bill for services, a lack of control over organization's budgeting decisions, and instability in funding renewal. Synergistic support from program, organization, and system/policy levels are needed to align teaching activities with clinical practice environments and invest in the growth and sustainability of psychology training programs on integrated primary care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).