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Abstract Background Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation. Methods We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). Discussion Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS’ effect on implementation and patient outcomes. Trial registration Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021.

The current study examines trajectories of treatment outcomes 6 months after completion of a peer parent program, "NAMI Basics." Fifty-two caregivers who were part of a larger trial completed questionnaires prior to, immediately after, and 6 months after completing "NAMI Basics." Growth curve models were used to examine trajectories of caregiver ratings of parent activation and engagement, parent help-seeking intentions, child symptoms, outpatient service use, and parent stress at 6 months after completion of the program. Prior improvements to the outcomes of parent activation and engagement ([beta] = 2.31, p < 0.001, d = 1.35), parent help-seeking intentions ([beta] = 1.94, p = 0.017, d = 0.69), and child intrapersonal distress ([beta] = -3.93, p = 0.046, d = 0.58) were maintained at 6 months, while help-seeking intentions was not ([beta] = 1.31, p = 0.222, d = 0.47). Though no changes were observed immediately post-class, caregivers reported significant increases in outpatient services use ([beta] = -1.51, p = 0.030, d = 0.68) and reductions in parenting stress ([beta] = - 4.99, p = 0.009, d = 0.75) and overall child symptoms ([beta] = -19.67, p = 0.001, d = 0.90) at 6 month follow-up. These results suggest that many of the positive impacts of the "NAMI Basics" program are sustained 6 months after the intervention. Additionally, these results suggest that some positive outcomes of the program may not emerge until several months after taking the class. Implications and future directions are discussed.