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

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.