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For much of the past decade, suicide has been the second leading cause of death for adolescents in the United States, and suicide rates among adolescents have been rising for the last 15 years. Suicidal thoughts and behaviors among adolescents were common before COVID-19 and have become an increasing public health priority in the pandemic's wake. In this "Social Policy Report," we review evidence for suicide prevention strategies designed to address these rising trends. We make recommendations for federal, state, and local policymakers and practitioners; program developers in organizations that design and implement programming for youth; and academic and nonacademic researchers. Where research evidence is strong, we suggest legislation, funding, and implementation. In areas where gaps exist: (a) research on economic policies for adolescents is nonexistent; (b) while mental health care access is a barrier, we do not know how to reduce youth suicide rates via changing care access; (c) data on crisis lines are encouraging but descriptive; and (d) school personnel training increases knowledge and confidence but not adolescent help-seeking, we recommend program development and research.

Background: Poverty-related disparities in school readiness are well documented (Dreyer, 2020). Increasing cognitively stimulating parenting practices can contribute greatly to addressing such disparities, and therefore represent a key modifiable target for preventive interventions beginning early in life (Brooks-Gunn & Markman, 2005). Purpose/Objective/RQ: Smart Beginnings (SB) is an innovative, risk-stratified intervention designed to address poverty-related disparities in child development through two tiers -- its health-care based universal component (VIP; Mendelsohn et al., 2005) and its targeted, selective prevention component through home visiting (the FCU; Dishion & Stormshak, 2007). SB focuses on increasing positive parenting with the goal of improving children's school readiness (Shaw et al., 2021). Research has documented the efficacy of SB in improving cognitively stimulating parenting practices (Miller et al., 2023; Roby et al., 2021). The current study has two primary aims: 1) to test the direct impact of the SB model on children's early language and literacy skills at child age 4; and 2) to test the indirect effects of SB by examining whether improvements in children's school readiness are mediated by increases in cognitively stimulating parenting at child age 2. Research Design: This study was part of the single-blind, two-site RCT of SB in NYC and in Pittsburgh, PA, which enrolled mothers and infants in postpartum hospital units. All families randomly assigned to the treatment condition were offered the VIP component of SB. In addition, treatment families were assessed for eligibility for the FCU through annual screening. Participants: The SB sample was composed of 403 mothers with low incomes. The majority of mothers in NYC were Latinx (84%), whereas in Pittsburgh they were predominantly Black/African-American (81%). There were no significant differences on baseline characteristics between treatment and control groups. Measures: The primary outcomes were literacy skills as assessed by the Woodcock-Johnson (WJ) IV LetterWord Identification test (Schrank et al., 2014) and language skills as assessed by the Receptive One-Word Picture Vocabulary Test (ROWPVT-4; Martin & Brownell, 2010). The mediator of interest was parental support of cognitive stimulation, which was assessed in two ways -- survey measures and observations of parent-child interactions. Data Analysis: A latent variable of parental support of cognitive stimulation was created from the survey-reported and observed cognitive stimulation. To evaluate direct effects of the SB intervention on child early language and literacy skills and indirect effects through this latent variable of cognitive stimulation, path analysis was then conducted to estimate mediation models for each outcome separately. Findings: As shown in Figure 1, a mediational model examining direct and indirect paths to children's letter-word identification was tested and provided a good fit to the data (X[superscript 2] = 21.99, p = 0.19, CFI > 0.99, RMSEA = 0.03). There was a significant path between the SB intervention and the latent variable of parental support of cognitive stimulation ([alpha] = 0.14, p < 0.05). In addition, there was a significant path from parental support of cognitive stimulation and the early literacy outcome of letter-word identification ([beta] = 0.25, p < 0.01). Finally, there was a significant indirect effect of 0.03 (p = 0.05) between the SB intervention and the early literacy outcome of letter-word identification, and this effect was completely mediated through the latent parental support of cognitive stimulation. A similar mediational model examining direct and indirect paths to children's receptive vocabulary was tested and, as above, also provided a good fit to the data (X[superscript 2] = 20.40, p = 0.25, CFI > 0.99, RMSEA = 0.02). As shown in Figure 2, there was a significant path between the SB intervention and the latent variable of parental support of cognitive stimulation ([alpha] = 0.14, p < 0.05). In addition, there was a significant path from parental support of cognitive stimulation to the early language outcome of receptive vocabulary ([beta] = 0.34, p < 0.01). Finally, as for letter-word recognition above, there was a significant indirect effect of 0.05 (p < 0.05) between the SB intervention and the early language outcome of receptive vocabulary, and this effect was again completely mediated through the latent parental support of cognitive stimulation. Conclusions: Although there were no direct effects of the SB intervention on child language and literacy outcomes, the SB intervention impacted children's letter-word identification and receptive language entirely via increases in cognitively stimulating parent-child interactions. These findings provide support for the theory of change of the SB model and insight into core components of interventions.