Table 1.

Community-partnered adaptations to the suicide risk management protocol

Initial SRMP design
Components of SRMP detailed in study grant	Community feedback	Partnered solution
Completion of outreach calls within 24 hours of initial endorsement of suicidality.	A delayed response may be insufficient for emergent suicidality.	Completion of outreach calls by study clinicians within 30 minutes whenever possible.
Study participants with suicidal ideation would receive a list of referrals to local emergency rooms, community mental health clinics, and counseling centers.	Participants may face barriers in accessing care, including fear and stigma; unfamiliarity with how to navigate referral clinics; and challenges getting an expedited appointment in a busy safety-net system.	Written agreements were developed with local mental health and primary care clinics to provide facilitated referrals through a “warm handoff,” with appointments in 1-2 business days. Participants already in treatment were coached on how to discuss suicidal ideation with their current providers.
Low threshold for study clinicians to contact 911 or the Los Angeles County Psychiatric Mobile Response Team (PMRT) for further evaluation of suicidality.	Due to historical relationships, study communities may be distrustful of local law enforcement and fearful of the possibility of involuntary detainment or hospitalization.	911 and/or PMRT would be contacted by study clinicians only if, on detailed assessment, there was concern for imminent threat of self-harm and there were no other reasonable options for ensuring study participant safety.
Mid-study SRMP modification
Original SRMP component	Research staff feedback	Partnered solution
Direct outreach by a study clinician to every participant with a positive suicidality screen on the MINI (at baseline) or PHQ-9 (on six- and 12-month surveys).	Positive suicidality screening was very common, leading to a heavy burden of outreach calls on clinical staff. Despite frequency of suicidality, no participants were assessed by study clinicians to be at imminent risk of self-harm.	To study participants screening positive via the MINI or PHQ-9 suicide item, survey staff posed an additional question: “Are these thoughts bothering you now?” based on the approach initially used by clinicians in their follow-up telephone contacts. Study clinician outreach was limited to participants who responded affirmatively to this “current suicidality” follow-up question.