Implementing the Zero Suicide Framework in a Statewide Youth Behavioral Health System: A Qualitative Study

Background The health-care system is an important point of intervention for youth suicide, and the Zero Suicide framework offers a comprehensive, evidence-informed approach to suicide prevention within health-care systems. Researchers evaluated implementation of the Zero Suicide framework within the New Jersey Department of Children and Families’ Children’s System of Care, a statewide youth-serving behavioral health system of care.Objective This study evaluates the statewide implementation of the Zero Suicide framework across a youth behavioral health system.Methods Researchers conducted semi-structured, in-depth interviews with 32 staff members to investigate strengths and challenges of deploying the framework, and necessary adaptations to tailor it for youth-serving providers across clinical and non-clinical behavioral health service contexts.Results Providers perceived the framework improved staff awareness and confidence in addressing youth suicide and increased systematic screening for suicide risk. Participants identified adapting the framework to youth-specific contexts includes a need for tailored communication and engagement strategies to effectively navigate family dynamics. Staffing shortages and high turnover were barriers, with participants advocating for more training, tools, and workflows to streamline the framework into agency operations.Conclusions Findings indicate that the Zero Suicide framework can be feasibly applied within youth-specific behavioral health contexts with moderate adaptation. Applying this framework at scale in these contexts may help reduce youth suicide in the US.