Improving Primary Care Response to Youth Suicidality: A Longitudinal Study of a Large-Scale Workforce Training Program

Objective To evaluate whether an intensive, theory-based workforce retraining program for primary care clinicians (PCCs) improves their knowledge, self-efficacy, and behavioral intentions to assess and manage suicidal ideation and behavior (SIB) in youth. We hypothesized that increases in PCCs’ SIB clinical knowledge and self-efficacy from pre-to post-training would predict sustained improvements in PCCs' interventions and behaviors at 6-month follow-up. Methods We conducted a longitudinal study of 3246 PCCs (pediatricians, family physicians, and nurse practitioners) who participated in a pediatric primary care mental health workforce training program between 2017 and 2024. The program includes a 3-day interactive workshop and 6 months of twice-monthly group case-based coaching. Self-report assessments were collected at baseline (T1), post-workshop (T2), and 6-month follow-up (T3). Measures included SIB-related knowledge, self-efficacy, SIB rating scale use, and self-reported changes in SIB clinical practices. Results Participants across the US and Canada showed significant increases from T1 to T3 in SIB knowledge, self-efficacy, and self-reported practice changes (F range: 5.85–38.04; all P '.0029), with large effects sustained over time. Time 1 to 2 changes in knowledge and self-efficacy significantly predicted self-reported practice changes at T3. Effects were consistent across clinician disciplines. Recent curricular updates (2022–2024) were associated with even greater gains. Conclusions An intensive, theory-based workforce training program can significantly improve and sustain PCCs' preparedness and willingness to assess and manage youth SIB. Embedding suicidality instruction within a broader pediatric primary care mental health retraining framework may offer a scalable strategy to expand first-responder capacity and address the youth suicide crisis.