# Exploratory-Project 2

> **NIH NIH P50** · UNIVERSITY OF PENNSYLVANIA · 2024 · $295,155

## Abstract

PROJECT SUMMARY
Suicide is inherently an affectively charged topic and clinicians often experience anxiety and low self-efficacy in 
detecting and intervening with those at risk. This anxiety leads to poor implementation of evidence-based suicide 
screening, assessment, and interventions (SSAIs). Clinician anxiety and low self-efficacy related to SSAI use 
are thus candidate targets for implementation strategy design to optimize SSAI uptake in diverse mental health 
settings. This exploratory 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-level anxiety about SSAI use. We will test the effect of EBIS as an implementation 
strategy to augment Implementation as Usual (IAU) to enhance SSAI implementation in community mental health 
settings. Specifically, Aim 1 will use participatory design methods to develop and refine EBIS in collaboration 
with a stakeholder advisory board of clinicians, administrators, and content experts. In Aim 2, we will further 
iteratively refine EBIS with up to 15 clinicians in a pilot field test, using rapid cycle prototyping, in collaboration 
with the INSPIRE Methods Core. Clinicians in Aim 2 will also provide qualitative feedback on EBIS’ ability to 
mitigate anxiety and increase self-efficacy to deliver SSAIs to optimize our ability to engage target mechanisms 
of clinician anxiety. Aim 3 will test the refined EBIS in a pilot implementation trial in which 40 community mental 
health clinicians will be randomized to receive either IAU or EBIS+IAU. Primary Aim 3 dependent variables are 
EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention 
statistics; this pilot trial is not intended to be powered to detect effects. Secondary outcomes are preliminary 
effectiveness of EBIS on implementation outcomes (SSAI adoption and fidelity), and engagement of target 
implementation mechanisms (clinician anxiety and self-efficacy related to SSAI use), assessed via mixed 
methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). We have two 
exploratory hypotheses, which we will evaluate via mixed methods: (1) EBIS will engage target implementation 
mechanisms by lowering anxiety and increasing self-efficacy better than IAU; (2) Clinicians randomized to EBIS 
will show improved SSAI adoption and fidelity. We also will gather data on other possible implementation 
mechanisms using questionnaires and qualitative interviews to probe for contextual implementation barriers to 
SSAI use not addressed by EBIS to inform augmentation prior to fully powered evaluation.
This project addresses a major gap in the implementation of suicide prevention evidence-based practices by 
developing a novel implementation strategy to augment IAU that targets mutable implementation mechanisms 
unique...

## Key facts

- **NIH application ID:** 10895392
- **Project number:** 5P50MH127511-04
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Maria A Oquendo
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $295,155
- **Award type:** 5
- **Project period:** 2021-09-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10895392

## Citation

> US National Institutes of Health, RePORTER application 10895392, Exploratory-Project 2 (5P50MH127511-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10895392. Licensed CC0.

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