Work

Planning for the sustainability of a youth suicide prevention program in Native American contexts: A modeling study

Year: 2025

Type: article

Abstract: Purpose We aimed to identify actionable, effective sustainment strategies for a community-based suicide prevention program implemented in Tribal contexts through a participatory process of system dynamics modeling. Methods Through a series of workshops with teams implementing a suicide prevention program, we prioritized strategies for sustaining implementation and related health outcomes. We used system dynamics modeling and microsimulations to assess the impact of key strategies ( Increased Funding, Enhanced Program Management, and Leadership Development ) on program sustainment outcomes and suicidal behavior among youth. Results Enhanced Program Management impacted sustainment by increasing simulated levels of community trust by 31.9% and partnerships by 10.3%. Increased Funding increased simulated resource availability by 51.2% and staffing levels by 12.8% over the simulated time frame. Among the three simulated sustainment strategies, Enhanced Program Management most effectively mitigated clinical outcomes, decreasing in suicidal ideation by 0.7%, self-harm by 1.4%, and suicide attempts by 1.1%. Conclusions We collaboratively developed a simulation model that assessed the relative impact of stakeholders’ prioritized sustainment strategies. A multifaceted intervention for Enhanced Program Management had the greatest impact on program sustainment outcomes. This approach can benefit Tribal communities considering methods to support vital community-based programs. Keywords (MeSH) System Dynamics; Microsimulation; Community-based participatory research; Native American; Suicide prevention; Surveillance; Sustainability List of abbreviations and acronyms AI/AN, American Indian and Alaskan Native; D&I, Dissemination and implementation; PHPCS, Public Health Program Capacity for Sustainability; PSAT, Program Sustainability Assessment Tool; HIS, Indian Health Service

Source: Annals of Epidemiology

DOI: 10.1016/j.annepidem.2025.10.020