Fontanella Lab
Cynthia A. Fontanella, PhD, is interested in examining and improving quality of care for children and youth and studying how services are delivered in “real world” clinical settings. Her work primarily focuses on vulnerable children.
The Fontanella Lab’s primary goal is to understand the relationship between suicide and health service use. Its focuses include
- The relationship between youth suicide, service access and quality of care within boundaried settings (e.g., health care settings, Medicaid and child-serving systems).
- Geographic disparities in suicide in the United States and contextual level factors associated with these disparities.
- The epidemiology of youth suicide.
- Suicide prevention interventions within health care settings including hospitals and primary care settings.
Dr. Fontanella receives funding from the National Institute of Mental Health (NIMH) and the American Foundation for Suicide Prevention.
Current Projects
Youth involved with publicly funded systems of care like Medicaid, the child welfare system, the juvenile justice system and behavioral health care represent an especially large and important “boundaried population” at heightened risk of suicide and mental illness compared to youth in the general population.
Unfortunately, despite the large numbers of vulnerable youth in publicly funded programs, little is known about the rates and predictors of suicide for this population. This population-based study, funded by an R01 grant from the National Institutes of Health (NIH), links data across multiple child-serving agencies in Ohio to identify periods of high risk and predictors of youth suicide.
Although reducing suicides and premature mortality among youth with depression is a national priority and an important goal for U.S. health systems, no studies have examined the impact of pediatric depression care meeting quality standards on important patient outcomes such as depression recurrence, deliberate self-harm, suicide and overall mortality in the United States.
This study uses national Medicaid data linked to mortality data for youth 10 to 24 with a new episode of major depression to examine determinants and outcomes of guideline concordant depression care.
In the year prior to death, 80% of youth who die by suicide are seen by their primary care clinicians (PCC), while only 20% have contact with a mental health professional. This indicates pediatric primary care is an ideal service setting for intervention research designed to rapidly reduce suicide and suicidal behaviors among U.S. youth.
Despite the importance of identifying youth at risk for suicidal behavior, most PCC do not routinely screen for suicide. This hybrid 1 clinical effectiveness trial examines the effectiveness of a population-based quality improvement (QI) intervention, STARRS_PC, that implements a clinical pathway for youth identified by screening as being at elevated risk for suicide. The pathway is designed to promote the use of evidence-based suicide clinical care processes and includes three separate components: suicide risk screening, risk assessment and triage, and care management.
Past Projects and Selected Publications
This study, funded by the American Foundation for Suicide Prevention (AFSP), examined the clinical profiles and health service utilization patterns of youth in Medicaid who died by suicide with those who did not die by suicide.
- Mortality and Cause of Death Among Youths Previously Incarcerated in the Juvenile Legal System
- Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disorders
- Association of Timely Outpatient Mental Health Services for Youths After Psychiatric Hospitalization With Risk of Death by Suicide
- Clinical Profiles and Health Services Patterns of Medicaid-Enrolled Youths Who Died by Suicide
- Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016
