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: 10672887
• 负责人: Cheryl A. King
• 金额: $ 106.77万
• 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/10672887
• 关键词: Accident and Emergency department; Address; Administrator; Adolescent; Advisory Committees; Age; Attitude; Black race; Caregivers; Caring; Communities; Cost Effectiveness Analysis; Detection; Development; Effectiveness; Emergency Situation; Emergency department visit; Emergency medical service; Enrollment; Equity; Family; Feeling suicidal; Goals; Hospitalization; Hospitals; Intervention; Knowledge; Male Adolescents; Manuals; Mediating; Mediator; 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; Recommendation; Reporting; Research; Risk; School-Age Population; Self Efficacy; Services; Suicide; Suicide attempt; Suicide prevention; Surveys; System; Technology; Testing; Text Messaging; Training; Work; Youth; acceptability and feasibility; boys; care systems; computerized; effectiveness clinical trial; effectiveness evaluation; effectiveness trial; evidence base; experience; follow-up; gender minority; high risk; high school; implementation facilitation; implementation framework; implementation science; improved; intervention refinement; prevent; psychologic; reducing suicide; screening; sex; sexual minority; suicidal; suicidal adolescent; suicidal behavior; suicidal risk; user-friendly; Accident and Emergency department; Address; Administrator; Adolescent; Advisory Committees; Age; Attitude; Black race; Caregivers; Caring; Communities; Cost Effectiveness Analysis; Detection; Development; Effectiveness; Emergency Situation; Emergency department visit; Emergency medical service; Enrollment; Equity; Family; Feeling suicidal; Goals; Hospitalization; Hospitals; Intervention; Knowledge; Male Adolescents; Manuals; Mediating; Mediator; 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; Recommendation; Reporting; Research; Risk; School-Age Population; Self Efficacy; Services; Suicide; Suicide attempt; Suicide prevention; Surveys; System; Technology; Testing; Text Messaging; Training; Work; Youth; acceptability and feasibility; boys; care systems; computerized; effectiveness clinical trial; effectiveness evaluation; effectiveness trial; evidence base; experience; follow-up; gender minority; high risk; high school; implementation facilitation; implementation framework; implementation science; improved; intervention refinement; prevent; psychologic; reducing suicide; screening; sex; sexual minority; suicidal; suicidal adolescent; 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.

项目摘要 在黑人青少年中，自杀企图增加了73％，自杀企图 在1991年之间，黑人青春期男孩的需要增加了122％ - 2017年。许多自杀的黑人青年都身份不明，只有不到一半的人参考治疗 急诊科访问之后，许多转介的青年不遵守治疗。 然而，先前的研究尚未研究黑人青年的护理系统的有效性 将自杀风险筛查与干预措施结合在一起，以增强与优质心理健康的联系 服务。我们的目标是增加风险识别，治疗转诊和参与，并在 转弯，减少黑人青年的自杀念头和行为，为此解决NIMH目标 RFA，更广泛地是针对青年自杀的国家行动联盟目标。该研究的目的 为：1）告知并促进对有风险的黑人青年的护理体系 自杀者通过评估多个利益相关者的自杀（青年，父母，临床医生， 支持人员，管理员）关于Wecare护理体系的观点。我们将使用 已建立的实施科学框架：a）确定障碍，促进者和 建议对Wecare进行改编，然后进行审判期间，期间和之后； b）确定Wecare 可接受性和可行性； c）生产训练的Wecare实施软件包 通过用户友好的手册，培训，Wecare护理系统中的现有临床医生 协议和保真度评估，以及2）进行随机临床有效性试验 2,200名黑人青年有自杀风险检查Wecare的有效性。大约 4,257名12至17岁的年轻人从纽约市的两家医院ED招收，将是 评估与自杀有关的风险评估，中度/高风险年轻人将是 随机分配给Wecare与通常的服务。调查评估将在3--， 和6个月的随访，并在12个月内进行病历审查。作为探索目的，我们 a）考试Wecare的影响是否受青年性，性或性别的调节 少数族裔身份，年龄（12-14、15-17岁）和自杀的基线风险； b）进行费用 有效分析以告知实施，c）了解自杀风险的水平 （通过CASSY评估）与那些年轻人的治疗参与有关 分配给Wecare。