Stepped-Care for Suicidal Youth and Children

Change from Baseline in Suicidal Thoughts and Behaviors (STB) as measured by the Columbia-Suicide Severity Rating Scale (C-SSRS).

This primary outcome measure assesses the change in the severity of suicidal thoughts and behaviors (STB) among participants over time, relative to their initial state at baseline. Data for this measure will be collected using the Columbia-Suicide Severity Rating Scale (C-SSRS). The C-SSRS is a standardized, clinician-administered tool that consists of a series of questions designed to identify, classify, and quantify the severity of a person's suicidal thoughts and behaviors. The scale addresses five types of suicidal ideation (e.g., thoughts of suicide without a plan or intent) and six types of suicidal behaviors (e.g., actual suicide attempts). The assessment is conducted at multiple time points. The change in C-SSRS scores between these time points will be used to compare the intervention group with the control group, determining whether the new treatment is more effective in reducing suicidal risk in children and adolescents.

Feasibility of SSC Model Integration

This measure evaluates the feasibility and fidelity of implementing the Stratified-Stepped-Care (SSC) model into the existing clinic workflow. Feasibility will be measured by calculating the percentage of adherence to the study protocol for both providers and participants (e.g., percentage of sessions completed, percentage of core protocol elements delivered). Fidelity will also be assessed via direct observation and completion of a standardized Protocol Adherence Checklist. Higher percentages indicate greater feasibility and fidelity to the SSC model and a better outcome.

Depression: Measured by the Mood and Feelings Questionnaire (MFQ).

This outcome measure assesses the change in depression levels among participants over time, relative to their initial state at baseline. Depression is measured using a standardized self-report questionnaire called the Mood and Feelings Questionnaire (MFQ). The MFQ is a standard tool for measuring the severity of depressive symptoms in children and adolescents. Participants are asked to rate the frequency of various depressive symptoms (such as feeling sad, hopeless, or losing interest in activities) on a rating scale. A higher score on the questionnaire indicates greater depression severity. The assessment is conducted at multiple time pointsץ

Total Cost of Mental Health Service Delivery per Participant

Costs in US Dollars will include direct service costs (e.g., provider salaries, training, supervision, facility costs) and indirect costs (e.g., costs associated with hospitalizations or emergency room visits related to STB). These components will be aggregated to provide a single value for the total cost of care for the study period. Lower total costs indicate greater economic efficiency and a better outcome.

Time (in Days) from Initial Intake to First Therapeutic Session

The waiting time will be measured as the number of days from a participant's initial intake at the clinic to their first therapeutic session. This data will be collected for both the SSC group and the Care as Usual (CAU) group and will be compared to demonstrate whether the new model improves access. From Initial Intake (Day 1) through the start of the first therapeutic session for each participant. A lower number of days indicates reduced waiting time and a better outcome for access to care.

Change from Baseline in Anxiety Symptoms as measured by the Screen for Child Anxiety Related Emotional Disorders (SCARED).

his outcome measure assesses the change in anxiety levels among participants over time, relative to their initial state at baseline. Anxiety is measured using a standardized self-report questionnaire called the Screen for Child Anxiety Related Emotional Disorders (SCARED). The SCARED is a standardized questionnaire that screens for five main types of anxiety disorders: panic disorder, generalized anxiety disorder, separation anxiety disorder, social anxiety, and school avoidance. Participants are asked to rate how true specific symptoms have been for them in the last three months, using a rating scale. A higher score on the questionnaire indicates greater anxiety severity.