Answering the Alarm: A System of Care for Black Youth at Risk for Suicide

响应警报：针对有自杀风险的黑人青少年的护理系统

• 批准号: 10440864
• 负责人: Cheryl A. King
• 金额: $ 132.46万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440864
• 关键词: Accident and Emergency department; Address; Administrator; Adolescent; Age; Americas; Attitude; Black race; Caregivers; Communities; Cost Effectiveness Analysis; Detection; Development; Effectiveness; Emergency Situation; Emergency department visit; Emergency medical service; Enrollment; Family; Feeling suicidal; Goals; Hospitalization; Hospitals; Intervention; Knowledge; Male Adolescents; Manuals; Mediating; Mediator of activation protein; Medical Records; Mental Health; Mental Health Services; National Institute of Mental Health; New York City; Parents; Perception; Policies; Population; Prevention; Prevention strategy; Probability; Protocols documentation; Psyche structure; Randomized; Reporting; Research; Risk; School-Age Population; Self Efficacy; Services; Suicide; Suicide attempt; Suicide prevention; Surveys; System; Testing; Text Messaging; Training; Work; Youth; acceptability and feasibility; adolescent suicide; boys; care systems; computerized; effectiveness clinical trial; effectiveness trial; evidence base; experience; follow-up; gender minority; high risk; high school; implementation facilitation; implementation framework; implementation science; improved; intervention refinement; prevent; psychologic; screening; sex; sexual minority; suicidal; suicidal behavior; suicidal risk; user-friendly

PROJECT SUMMARY Suicide attempts increased by 73% among Black adolescents, and suicide attempts requiring hospitalization increased by 122% for Black adolescent boys between the years 1991- 2017. Many suicidal Black youth are unidentified, fewer than half are referred to treatment following an emergency department visit, and many referred youth do not adhere to treatment. Yet, prior research has not examined the effectiveness of a system of care for Black youth that combines suicide risk screening with an intervention to enhance linkage to quality mental health services. Our goal is to increase risk identification, treatment referral and engagement, and, in turn, reduce suicidal ideation and behavior among Black youth, addressing NIMH goals for this RFA and, more broadly, the National Action Alliance goals for youth suicide. The study’s aims are to: 1) Inform and facilitate implementation of a system of care for Black youth at risk for suicide who present to the ED by assessing multiple stakeholders’ (youth, parents, clinicians, support staff, administrators) perspectives regarding the WeCare system of care. We will use established implementation science frameworks to: a) determine barriers, facilitators, and recommended adaptations to WeCare before, during, and after the trial; b) ascertain WeCare acceptability and feasibility; and c) produce a WeCare implementation package that trains existing clinicians in the WeCare system of care through a user-friendly manual, training protocol, and fidelity assessment, and 2) Conduct a randomized clinical effectiveness trial with 2,200 Black Youth at risk for suicide to examine the effectiveness of WeCare. Approximately 4,257 youth, ages 12 to 17 years, enrolled from two hospital EDs in New York City, will be assessed on enrollment for risks associated with suicide, and moderate/high risk youth will be randomly assigned to WeCare vs. usual services. Survey assessments will be conducted at 3-, and 6-month follow-up, with medical record review through 12 months. As exploratory aims, we will a) examine whether impacts of WeCare are moderated by youth sex, sexual or gender minority status, age (12-14, 15-17 years), and baseline risk for suicidality; b) conduct a cost effectiveness analysis to inform implementation, and c) understand how level of suicide risk (assessed via the CASSY) is associated with treatment engagement among those youth assigned to WeCare.

项目概要 黑人青少年的自杀企图增加了 73% 1991 年至 1991 年间，黑人男孩需要住院治疗的人数增加了 122% 2017 年。许多有自杀倾向的黑人青年身份不明，不到一半被转介接受治疗 在急诊科就诊后，许多被转介的青少年没有坚持治疗。 然而，先前的研究尚未检验黑人青少年护理系统的有效性，该系统 将自杀风险筛查与干预措施相结合，以增强与优质心理健康的联系 我们的目标是增加风险识别、治疗转诊和参与。 转变，减少黑人青年的自杀意念和行为，实现 NIMH 的目标 RFA 以及更广泛的国家行动联盟针对青少年自杀的目标。 的目的是： 1) 为面临以下风险的黑人青年提供照料制度并促进其实施： 自杀者通过评估多个利益相关者（青少年、父母、 我们将使用有关 WeCare 护理系统的支持人员、管理人员的观点。 建立实施科学框架，以： a) 确定障碍、促进因素和 在试验之前、期间和之后建议对 WeCare 进行调整 b) 确定 WeCare； 可接受性和可行性；以及 c) 制定可培训的 WeCare 实施包 WeCare 护理系统中的现有人群通过用户友好的手册、培训 方案和保真度评估，以及 2) 进行随机临床有效性试验 约 2,200 名有自杀风险的黑人青少年检查 WeCare 的有效性。 纽约市两家医院急诊室的 4,257 名 12 至 17 岁青少年将参加 对入学情况进行与自杀相关的风险评估，中度/高风险青少年将接受 随机分配到 WeCare 与常规服务的调查评估将在 3 点进行。 作为探索性目标，我们进行了 6 个月的随访，并审查了 12 个月的病历。 a) 检查 WeCare 的影响是否受到青少年性别、性别或社会性别的调节 b) 评估少数民族身份、年龄（12-14 岁、15-17 岁）和自杀基线风险； 有效性分析为实施提供信息，c) 了解自杀风险水平 （通过 CASSY 评估）与这些青少年的治疗参与度相关 分配给 WeCare。