Veterans with criminal-legal system involvement (VCLI) are a vital group requiring special attention in suicide-prevention efforts. Notably, there is significant overlap between risk factors for legal system involvement and suicide, particularly criminogenic needs and posttraumatic stress symptoms. To identify patterns of co-occurrence among these factors, latent profile analysis was conducted in a subgroup of VCLI from an epidemiological sample of adults in the community (N = 522). Based on six criminogenic needs and four posttraumatic stress symptom indicators, results supported five unique subgroups of VCLI characterized by lowest endorsement across indicators ("low" profile, 55.4%); high endorsement of avoidance symptoms ("avoidant" profile, 23.6%); high endorsement across all posttraumatic stress symptom criteria and low-to-moderate endorsement of criminogenic needs ("posttraumatic stress symptoms" profile, 11.7%); high endorsement of hyperarousal/reactivity symptoms and elevated endorsement of intrusion/re-experiencing symptoms, education/employment difficulties, antisocial attitudes/orientation, and antisocial personality/behavior ("threat-reactivity" profile, 5.2%); and highest endorsement across nearly all posttraumatic stress symptoms and criminogenic needs, particularly characterized by high antisocial attitudes/orientation, antisocial personality/behavior, and substance abuse ("high" profile, 4.2%). A logistic regression analysis supported a significant relationship between profile membership and a history of suicide attempt for the "high" and "posttraumatic stress symptoms" profiles, corresponding to elevated rates of endorsement for these groups. The current findings suggest that the identification of subgroups of VCLI may be helpful in identifying which VCLI are especially important to address in suicide-prevention efforts and recidivism risk prevention efforts. Practice and policy implications of the present study's results are discussed, and future directions for research are proposed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Burnout is a pervasive challenge in the mental health field, particularly among practitioners treating serious mental illness. Although skills-based training may reduce burnout, many programs are not equipped to support continued engagement. Recent advances suggest artificial intelligence (AI) may address these limitations. This study compared provider burnout after receiving standard web-based didactic training (treatment as usual [TAU]) to TAU plus an AI-supported training platform (TAU + AI) that included immediate feedback. Participants were frontline behavioral health providers working with clients with serious mental illness, where burnout was assessed at baseline and 3-month follow-up. Across groups, burnout significantly increased from pre- to posttraining, t(95) = 3.72, p < .001, Cohen's d = 0.38. There were no significant differences in burnout change between the TAU + AI and TAU conditions, suggesting brief AI-supported interventions may be insufficient to alleviate burnout. Secondary analyses revealed no association between frequency of practice and burnout change. However, there was a significant negative relationship between posttraining burnout and the proportion of practices that met fidelity benchmarks. A significant interaction effect also indicated that meeting fidelity benchmarks predicted lower burnout only when those exercises were completed at a high level of proficiency. Together, these findings suggest that training may impact burnout only if learners successfully acquire new skills, potentially improving confidence and self-efficacy. While training alone may not be sufficient to reduce burnout, integrating AI-based feedback and skill assessment into training may allow systems to better verify and support provider skill acquisition and ultimately reduce burnout. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Moral injury is a topic of rapidly increasing scholarly interest, and it presents unique challenges and opportunities for clinical intervention because of its overlapping psychological, spiritual, and relational dimensions. This article (a) describes the development, implementation, and iterative refinement of a collaborative acceptance and commitment therapy group intervention for moral injury that is cofacilitated by a mental health professional and a chaplain and (b) presents preliminary outcomes derived from a retrospective, uncontrolled pre-post analysis of clinical data collected over several years of implementation in a Veterans Health Administration setting. Preliminary pre-post data (n = 102) demonstrate improvement in outcome measures (posttraumatic stress disorder, depression, psychosocial functioning, psychological inflexibility/experiential avoidance). The group was implemented 22 times during a 7-year period, including during the COVID-19 pandemic, in both in-person and virtual formats. Future research and clinical quality improvement endeavors can help answer important questions about efficacy. To our knowledge, this study is one of the first to report outcomes using one of the recently developed, robust moral injury measures (Moral Injury Outcome Scale), making this a particularly novel contribution to the literature. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The transdiagnostic intervention for sleep and circadian dysfunction (TranS-C) was adapted to fit community mental health centers (CMHCs), resulting in an adapted version of TranS-C. Prior research suggests that providers commonly make ad hoc adaptations, but the effects of such adaptations are unclear. The aim of this study was to compare adapted versus standard TranS-C on ad hoc adaptations and examine their effect on implementation and patient outcomes. CMHC providers (N = 125) were trained to deliver TranS-C to CMHC patients diagnosed with serious mental illness (N = 396). Assessments were conducted at provider posttraining, patient pretreatment, and provider and patient posttreatment. Outcomes were provider ratings of treatment fit and patient utilization, sleep, and psychiatric symptoms. Condition (adapted vs. standard TranS-C) was not associated with ratings of fit or ad hoc adaptations. In both conditions, fit was strong, and providers reported approaching a moderate extent of ad hoc adaptations, which were not associated with changes in provider ratings of fit or patient outcomes. Modular and transdiagnostic treatment can be perceived as fitting well within CMHCs by providers. Importantly, ad hoc adaptations did not negatively impact outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Research has reported high rates of mental disorder and symptoms among youth in the juvenile justice (JJ) system and the racial disparities that these youth are in in secure settings. However, most studies were conducted in only secure settings, and they are dated. The United States has undergone extensive JJ reforms since then, including a widespread push toward diversion for youth with mental health concerns. This study compared Massachusetts Youth Screening Instrument-Version 2 screening results in JJ settings from 1997 to 2003 with a postreform sample of Massachusetts Youth Screening Instrument-Version 2 from 2015 to early 2020 (n = 62,482) in five states to examine differences in the presence of self-reported mental health symptoms in secure versus probation settings and by race/ethnicity. Rates of significant mental health concerns among JJ youth decreased by only 5% from pre- to postreform overall; however, there were significant decreases in rates of significant mental health symptoms within secure settings and fewer racial/ethnic disparities. These decreases were most notable for Latinx youth. Given the concomitant increase in youth mental health concerns in the general population during this timeframe, increases in the use of early mental health screening (at probation intake), the push toward diversion and against confinement for youth with mental health concerns, and strategies for reducing racial/ethnic disparities may have improved court decisions. These initiatives should continue. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
This study examines perceptions of access to military sexual trauma-focused group therapy among veteran men with histories of military sexual trauma at a mental health clinic within the Veteran Affairs Greater Los Angeles Health Care System, a large and heterogeneous health care facility. Drawing on veteran data (n = 134) collected from January 2019 to April 2025, we used thematic qualitative analysis to examine veterans' perceptions of an MST-focused group therapy to which they had been referred. This study found that veteran men expressed varying perceptions of MST-focused group therapy that functioned as either barriers or facilitators to engagement. Perceived barriers included: concerns about the group format (privacy, trust, safety, efficacy), interpersonal challenges (peer judgment, fear of vulnerability, social interaction), and intrapersonal concerns (avoidance, shame, fear of retraumatization). Facilitators included: trust in referring veteran affairs providers, motivation for trauma recovery and personal growth, and interest in social connection, including reducing isolation and learning from peers. These findings offer clinical, programmatic, and systems-level implications for enhancing referral conversations and improving access to MST-focused group therapy for veteran men. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
There is a recognized need for efforts that promote utilization and completion of trauma-focused evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). Patients referred to PTSD specialty clinics are often reluctant to engage in EBPs, especially if they are treatment-naive or had prior negative treatment experiences. To address this reluctance, we implemented PTSD101, a psychoeducation group led by peer specialists offered in a specialty PTSD clinic for veterans considering new PTSD services. This present study aimed to conduct a program evaluation of PTSD101 using pre-post data. The structured group consisted of seven 90-min sessions addressing: (a) civilian readjustment; (b) effects of trauma; (c) trust, safety, and self-care; (d) coping/healing; (e) survival strategies and relationships; (d) substance use and medication; and (f) PTSD treatment. Data were collected from 34 veterans across multiple group cohorts. Following completion of the group, over half of the veterans (n = 18) initiated a new behavioral health treatment service, including trauma-focused EBPs (n = 11). Significant improvements were also noted in measures of PTSD symptoms, depression symptoms, and illness management strategies and recovery outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Burnout and occupational stress among mental health providers within the U.S. Veterans Health Administration are of critical concern, particularly for clinicians providing trauma-focused evidence-based psychotherapies. Burnout has been defined and measured in different ways across studies. In this article, burnout is conceptualized as a work-related syndrome involving emotional exhaustion, cynicism, and reduced professional efficacy, while recognizing that other constructs such as secondary traumatic stress and moral distress may also affect provider well-being. This article describes the Intensive Virtual Evidence-Based Psychotherapy Team at the Veterans Affairs Pacific Islands Health Care System, a fully virtual 2- to 4-week program that delivers massed prolonged exposure therapy or the Unified Protocol with Whole Health integration. Although the Intensive Virtual Evidence-Based Psychotherapy Team was developed as a clinical care model for Veterans, it was also intentionally structured in ways that support provider well-being at the service-delivery, team, and individual levels. Preliminary local program evaluation findings are presented. In a small retrospective pre-post evaluation, staff reported greater perceived support and lower burnout, secondary traumatic stress, and moral distress after joining the Intensive Virtual Evidence-Based Psychotherapy Team. A second 8-week Employee Whole Health initiative showed favorable descriptive trends and positive qualitative feedback regarding job satisfaction, collegial support, and accountability for personal wellness goals. Findings should be interpreted as preliminary given the nature of the small program evaluation. This article highlights one approach to promote provider well-being and embed sustainable practices into clinical program design in Veterans Health Administration mental health settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
While research has documented the beneficial effects of greater formal as well as informal mindfulness practice in mindfulness training programs, it is less clear what drives informal practice engagement. In a high-stakes occupational context like the military, where performance is paramount, leader behaviors that support mindfulness training may influence individuals' engagement in informal practice. In a study assessing a combined mindfulness training and yoga intervention, 813 soldiers attending 10 weeks of basic combat training were surveyed at two time points about their informal practice of mindfulness and their perceptions of leader support for mindfulness training. More than one third of participants reported engaging in informal practice at least 3 days per week (343 [48.0%] at 4 weeks and 249 [36.9%] at 9 weeks); participants most frequently reported informally practicing when they felt stressed in training or in the barracks. Individuals reporting higher levels of leadership support for mindfulness training were more likely to report engaging in informal practice compared to those with lower levels of leadership support. This analysis controlled for sex, rank, previous mindfulness experience, and overall leadership ratings. The relationship between leader support for mindfulness and informal mindfulness practice was also found when examined in terms of specific practice contexts (e.g., engaging in a task, getting stressed). Exploratory models assessing group-level ratings of leadership resulted in similar findings. Future implementation efforts should further examine the influence of leader support for mindfulness training in the military and other high-stakes occupational contexts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The U.S. Veterans Health Administration launched a national mentoring program for posttraumatic stress disorder (PTSD) in 2008 to support the delivery of evidence-based psychotherapies by bridging mental health operations and frontline clinical care. This article describes the program's evolution and indicators of its success. Program leadership clarified roles and responsibilities for involved staff, developed a unified set of expectations for high-quality PTSD specialty care, leveraged administrative data to support context-specific data monitoring and feedback systems, and partnered with researchers to identify and evaluate implementation strategies that were subsequently integrated into program operations. These changes were associated with an increase in the mean (SD) proportion of psychotherapy patients receiving an evidence-based psychotherapy for PTSD within PTSD clinical teams from 26.5% (SD = 15.6%) to 40.5% (SD = 14.1%), a reduction in the proportion of PTSD teams with low evidence-based psychotherapy reach from 29% (33/113) to <2% (2/119), and an increase in the median and interquartile range level of measurement-based care from 22% (interquartile range = 27%) to 36% (interquartile range = 22%). Bridging programs that adopt tailored implementation strategies may provide the support needed to ensure uptake of evidence-based practices and sustainment of changes over time. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Mental health care providers face heightened risk for burnout, posttraumatic stress disorder, and other mental health problems due to workplace violence exposure and chronic stressors, exacerbated by postpandemic workforce challenges. Little evidence exists to guide interventions to reduce workplace trauma and burnout in psychiatric hospitals or to establish a baseline for evaluating implementation efforts. We consulted with 28 cross-sector stakeholders to share research and generate actions, then elicited further suggestions and feedback from 120 participants, producing 12 detailed recommended strategies to address workplace violence, burnout, and trauma. We then conducted a preimplementation survey of hospital leaders (N = 22) and union representatives (N = 18) at Canadian hospitals with inpatient mental health beds. Participants ranked their top priorities (i.e., most important, valuable, and urgent) and rated the perceived barriers and facilitators to implementing the recommended strategies at their hospital. Recommendations rated the highest priority concerned proactive strategies: preventing workplace critical events, creating psychologically healthy workplaces, and strengthening staff's ability to prevent and safely respond to critical events. However, hospitals were most likely to have engaged responses at the postexposure phase, including operational debriefing and trauma prevention for exposed staff. Capacity-building recommendations were the least likely to be undertaken. Current practices were related to ratings of familiarity and feasibility rather than agreement with the recommendation. Hospital and union representatives had similar priorities. These findings highlight the need for collaboration among hospital leadership, employee associations, government agencies, and other stakeholders to prevent workplace burnout and trauma. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Women who identify as Black, Indigenous, and women of color (BIWOC) in Canada face additional mental health challenges due to racism, discrimination, and social inequalities, as well as disparities in accessing and benefiting from mental health care due to a lack of culturally informed services. This needs assessment was conducted to identify the mental health barriers and needs of BIWOC in Ottawa, Canada, and to generate recommendations on responsively designing and adapting mental health services. Using a mixed methods, community-based participatory action research design, we surveyed 130 BIWOC in the Ottawa region and conducted in-depth qualitative interviews with representatives from four community agencies representing diverse groups of BIWOC. Survey data were descriptively analyzed, and qualitative data were analyzed via reflexive thematic analysis. Findings highlighted the presence of both systems-level (e.g., financial and language barriers, difficulty navigating mental health systems, lack of culturally appropriate services) and psychosocial (e.g., stigma) barriers. BIWOC's mental health needs included stress, worry, depression, and racism-related stress. Culturally informed, community-based care was emphasized as crucial to meeting diverse needs. A comprehensive list of recommendations is provided, which outlines strategies for mental health programs in Canada to improve service provision to best meet the needs of BIWOC. Recommendations include building strong partnerships with existing community organizations, offering flexible and responsive mental health services in safe community spaces, prioritizing training in culturally responsive care for clinicians, and implementing BIWOC-specific services that address unmet mental health needs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Veterans with substance use disorder frequently experience cognitive difficulties that interfere with treatment engagement and everyday functioning. When designing telehealth-delivered research involving cognitively demanding interventions, study procedures and intervention materials must align with veterans' cognitive needs and contexts. This brief report describes how veteran-informed preparatory design work can be conducted to inform research procedures for feasibility and acceptability testing of a telehealth-delivered cognitive rehabilitation intervention within a Veteran Affairs health care system. Veteran input was obtained through consultation with an established veteran engagement group, whose members serve in an advisory role for Veteran Affairs research. During a structured consultation, veterans reviewed recruitment materials and components of the telehealth-delivered intervention. Veteran engagement activities were considered alongside operational data sources, including recruitment activity logs and telehealth workflow documentation, to inform research decisions related to recruitment materials, telehealth workflows, and intervention delivery. Data were analyzed using directed content analysis, with implementation frameworks applied pragmatically to organize design-relevant observations and document refinements. Key themes included cognitive burden and accessibility, language and recovery orientation, relational and contextual factors in recruitment, telehealth usability and cognitive load, and telehealth-compatible intervention delivery. Findings highlight the value of integrating veteran perspectives with operational realities during early research planning to strengthen accessibility and acceptability of telehealth-delivered cognitive rehabilitation programs in Veteran Affairs and similar organized care settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Demand for pediatric mental and behavioral health (MBH) services continues to rise, yet access to clinicians delivering evidence-based practices remains limited. Less effective treatment prolongs care episodes, restricts access, and contributes to provider burnout and turnover. This article describes a case example of collaboration between an academic medical center and a community MBH organization within the Pediatric Improvement Network for Quality. Using improvement science and implementation practice strategies (training, consultation, and quality improvement), the partnership executed a system-wide rollout of measurement-based care training. We outline quality improvement processes for setting organization-specific aims, designing interventions, and tracking outcomes; detail the development of expert case consultation groups; and summarize the MBH organization's quality improvement journey from identifying priorities to implementing targeted strategies. Core interventions included provider training, integration of the Brief Outcome Survey into treatment, weekly expert case consultation, and efforts to mitigate provider burnout. Outcomes demonstrated increased provider self-efficacy and adherence to measurement-based care, improved caregiver engagement and satisfaction, shorter treatment durations, and reduced provider turnover. This case example demonstrates the significant impact that a coordinated academic-community partnership can have on expanding access to high-quality pediatric MBH care. The findings underscore the potential of scalable, cross-sector implementation strategies to address the nationwide shortage of effective pediatric MBH services. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Among veterans with borderline personality disorder (BPD), comorbidity with posttraumatic stress disorder (PTSD) is frequent. Clinicians are often hesitant to treat PTSD symptoms among this population, given the chronically elevated suicide risk. We examined the real-world effectiveness of an intensive outpatient program (IOP) with combined dialectical behavior therapy (DBT) and trauma-focused prolonged exposure (PE). Twelve weeks of full-model DBT was provided with PE administered simultaneously for approximately 6 weeks. Most veterans met criteria for both full-threshold PTSD (89%) and BPD (74%). Among the 180 veterans enrolled, 134 finished the protocol (74%). We observed large pre-posttreatment effect sizes for decreases in self-reported PTSD symptoms (d = 1.46), borderline symptomatology (d = 0.92), depression (d = 0.95), and anxiety (d = 0.81) as well as increases in DBT skills (d = -0.91). Medium effect sizes were found for decreases in subjective stress (d = 0.71), suicidal ideation and planning behaviors (d = 0.54), and dysfunctional coping (d = 0.68). On average across all clinical outcome measures, 52% of veterans experienced at least a partial response to treatment (≥30% score reduction), 49% demonstrated reliable changes, and 46% finished the program in at least partial remission (i.e., normative or subthreshold scores). These results are evidence for the effectiveness of DBT PE-style interventions, which can be delivered in IOPs for higher risk veterans with serious presentations of comorbid PTSD and BPD symptoms. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Social support can be important for individuals experiencing homelessness who often have fragile or absent social networks. However, there is limited research on interventions to improve social support or interpersonal effectiveness in this population. A scoping review was conducted, in accordance with Joanna Briggs Institute methodology and with a protocol registered with the Open Science Framework, of qualitative and quantitative studies that reported outcomes of interventions focused on improving social support in homeless populations. The initial search yielded 5,534 studies, and 19 studies met full inclusion criteria. Ten of the included studies reported results from interventions designed to treat an adult parent-child relationship; there were no studies of interventions targeting adult parent-adult child relationships. The remaining nine studies evaluated interventions targeting social skills of homeless or unstably housed adults or families. In terms of study design, seven studies were randomized trials, one was a nonrandomized trial, three were qualitative, four were quantitative/pre-post designs, one was mixed methods, two were descriptive/observational, and one was a case study. All 19 studies evaluated a different social support or family therapy intervention. Family functioning or general social skills were often secondary to outcomes of treatment compliance and housing stability. These findings offer insights into general social skills building in homeless populations, but future research is needed on interventions that target rebuilding estranged adult relationships, which might serve as a buffer against housing instability. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Intimate partner violence (IPV) occurs at elevated rates among Veterans, with recent meta-analyses estimating 31.8% of Veterans use IPV and 24.3% of Veterans experience IPV. While Johnson's (2008) typology distinguishes IPV types based on control patterns, limited research has applied latent class analysis to identify IPV typologies that incorporate measures of coercive control. This study used latent class analysis to examine patterns of IPV use and experience among Veterans in primary care, focusing on coercive control dynamics and their associations to mental health outcomes. Cross-sectional survey data were collected from 299 Veterans in romantic relationships receiving care at 20 community-based outpatient clinics in Western and Central New York. Measures included the Conflict Tactics Scale-Revised, Women's Experience with Battering scale, Proximal Antecedents of Violent Episodes, and correlated mental health assessments. Latent class analysis identified four distinct IPV typologies based on use and experience patterns: low-to-no conflict (26%), psychological IPV with negotiation (36%), high psychological/low physical without control (26%), and multitype IPV with control (13%). Veterans in the multitype class with coercive control showed significantly higher rates of depression, posttraumatic stress disorder symptoms, alcohol misuse, and suicidal ideation compared to other classes. Over half (51%) of Veterans in this sample reported propensity for using violence to control their partner. Results demonstrate heterogeneous IPV patterns among Veterans, with coercive control dynamics associated with severe mental health comorbidity. Findings support the need for differentiated screening and intervention approaches in Veterans Health Administration settings, with particular attention to coercive control assessment for comprehensive IPV evaluation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The primary aim of the present study was to examine the initial impact and implementation of the Pain Coach app within a real-world Veterans Affairs Primary Care Mental Health Integration clinic. Specifically, this study represents a real-world trial of advancing the use of the Pain Coach app into a Brief Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) group among veterans with chronic pain being managed in primary care. A secondary aim was to determine participation characteristics of veterans who utilized the Pain Coach app, with a tertiary aim of providing a narrative review of how the Pain Coach app was integrated at our site. This was a retrospective chart review study in which outcomes were evaluated by comparing rates of app usage as defined by assessments completed at either pre- and/or posttreatment via the Pain Coach app. Veterans who used the Pain Coach app attended significantly more sessions of the Brief CBT-CP group than veterans who did not use it. Early engagement with the app predicted number of sessions of Brief CBT-CP completed, suggesting that early incorporation of the app may be beneficial for reducing attrition. Certain participant characteristics were associated with Pain Coach app use, such that women, those with a history of military sexual trauma, and no previous mental health diagnosis were more likely to use the app. Age was not associated with app use, indicating that older adults were just as likely to use the app as their younger counterparts. Though it was released in 2024, research on the Pain Coach app is limited. Current findings from the initial phase of dissemination and implementation of the Pain Coach app within a Brief CBT-CP group provide support for the feasibility and effectiveness of integrating mobile-assisted technology in a real-world Veterans Affairs Primary Care Mental Health Integration clinic. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Veterans with serious mental illness (SMI) smoke at disproportionately high rates but receive smoking cessation treatment at disproportionately low rates. Mental health providers have strong relationships with veterans with SMI but often do not treat smoking. Knowledge, attitudes, and self-efficacy are related to smoking treatment delivery, but their interactions have yet to be explored in qualitative data for providers working with veterans with SMI. Guided by the theory of planned behavior, this project explored how knowledge, attitudes, self-efficacy, and emerging themes impeded or facilitated smoking cessation treatment delivery in SMI clinics at a Veterans Affairs medical center. Semistructured interviews were conducted with 20 multidisciplinary providers. Data were analyzed qualitatively using an inductive-deductive approach, and the number of providers endorsing themes was quantified. Many providers had knowledge of high smoking rates among veterans with SMI and smoking harms. Though most (60%) providers asked about smoking, only 20% followed up about smoking. Medical record prompts to ask about smoking facilitated smoking treatment delivery. Providers held various attitudes toward smoking, such as viewing smoking as enjoyable for veterans and smoking discussions as a potential threat to rapport, that were related to feelings of guilt and frustration. Low self-efficacy due to limited training in smoking cessation exacerbated discomfort. Half of providers expressed motivation to increase smoking discussions. Knowledge, attitudes, emotions, and self-efficacy may interact with one another as providers decide how to treat smoking. Intensive implementation strategies designed to improve provider delivery of tobacco treatment should make sure to address all these barriers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Lesbian, gay, bisexual, transgender, two spirit, queer or questioning, intersex, and asexual (LGBTQIA+) individuals experience disproportionately high rates of suicidal ideation, attempts, and deaths compared to the general population. These disparities are fueled by systemic inequities, discrimination, and minority stress. Gatekeeper trainings such as Question, Persuade, Refer and SafeTALK have been shown to improve knowledge, skills, and self-efficacy in suicide prevention. Despite ongoing advancements in suicide prevention efforts, a significant need remains for approaches that move beyond general adaptation toward full integration of LGBTQIA+-specific factors. This gap leaves gatekeepers underprepared to recognize LGBTQIA+-specific risk factors and provide affirming support. To address this gap, we introduce BELONG, a conceptual framework for an LGBTQIA+-inclusive suicide prevention gatekeeper training. BELONG integrates minority stress theory, sociopolitical development theory, and intersectionality into the four established domains of gatekeeper training knowledge, attitudes, skill development, and self-efficacy. BELONG incorporates practical strategies such as LGBTQIA+-specific role-plays, affirming communication practice, tailored referral resources, and advocacy tools. These components are designed to strengthen gatekeepers' intervention confidence while expanding their capacity to address systemic barriers that exacerbate suicide risk. A distinguishing feature of BELONG is the positioning of advocacy as a cross-cutting construct. Rather than focusing exclusively on individual-level crisis intervention, the model emphasizes the role of gatekeepers in fostering affirming environments and promoting structural change. By embedding affirmation, belonging, and critical consciousness into a structured training framework, BELONG advances the field of suicide prevention through a culturally grounded model tailored to LGBTQIA+ populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
