Southwest Hub for American Indian Youth Suicide Prevention Research

美国印第安人青少年自杀预防研究西南中心

• 批准号: 10166935
• 负责人: Mary Cwik
• 金额: $ 54.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-20 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10166935
• 关键词: Address; Adolescent; Aftercare; Age; Alaska Native; American Indians; Apache; Apache Tribe; Caring; Case Management; Cherokee Indian; Communities; Continuity of Patient Care; Data; Early identification; Elderly; Enrollment; Event; Feeling hopeless; Feeling suicidal; Foundations; Goals; Health; Health system; Heterogeneity; Hualapai; Impulsivity; Informal Social Control; Intervention; Mediator of activation protein; Mental Depression; Mental Health; Mental Health Services; Modality; Modeling; Navajo; Participant; Prevention Research; Research; Resources; Risk; Risk Factors; Risk Reduction; Safety; Self-Injurious Behavior; Sequential Multiple Assignment Randomized Trial; Suicide; Suicide attempt; Suicide prevention; System; Testing; Training; Trauma; Treatment Effectiveness; Tribes; Ursidae Family; White Mountain Apache; Work; Youth; acceptability and feasibility; base; behavioral health; brief intervention; c new; design; emotion regulation; evidence base; follow-up; healing; ideation; improved; indexing; native youth; preference; prevent; primary outcome; protective factors; psychoeducation; reducing suicide; resilience; secondary outcome; self esteem; service providers; skills; substance use; suicidal behavior; suicidal risk; suicide rate; therapy development; trial design

PROJECT ABSTRACT The research component of the Southwest Hub will identify effective, feasible and sustainable interventions to prevent suicide and promote resilience among American Indian (AI) youth building on 20+ years of partnership between the Johns Hopkins Center for American Indian Health (CAIH), the White Mountain Apache Tribe (WMAT) and Navajo Nation (NN). The foundation of these partnerships is tribally-mandated surveillance for early identification, and follow-up and case management to connect at-risk youth to treatment after a recent suicide attempt, ideation or binge substance use episode. In addition, we have been designing and piloting brief interventions informed by local tribal data. Two such interventions were selected to be evaluated in sequence by our Suicide Prevention Study. Both employ Native paraprofessionals as a means of task-shifting much-needed psychoeducation and promoting continuity of care in under-resourced communities. The first intervention, New Hope (NH), is an evidence-based first-stage strategy delivered by paraprofessional community mental health workers (CMHWs) focused on reducing immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections. The second, the Elder’s Resilience (ER) intervention, is a longer-term strategy delivered by Elders with support from CMHWs to promote resilience by increasing youth’s connectedness, self-esteem and cultural identity and values. Our Primary Aim is: to use a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate which of four sequences of New Hope (NH), Elders Resilience (ER) and Case Management (CM) has the greater effect on immediate and longer-term suicidal ideation (primary outcome) and resilience (secondary outcome) among AI adolescents ages 10-24 identified at risk for suicide. We hypothesize that: a) New Hope vs. Case Management alone will significantly reduce participant suicidal ideation; b) Elders Resilience vs. Case Management alone will significantly improve participant resilience; c) New Hope followed by Elders Resilience will have the strongest effects on suicidal ideation and resilience; and d) Case Management alone will have the weakest effects of all combinations. Our Secondary Aims are: 1) to examine mediators and moderators of treatment effectiveness and sequencing in order to determine which types and sequence of interventions is best suited for which youth; and 2) to assess the acceptability, feasibility and capacity for sustainability of the Hub’s key intervention components with core and satellite partners, the Navajo, San Carlos Apache, Hualapai, and Cherokee nations. Due to heterogeneity of suicide risk factors generally and among AIAN youth, not all youth require the same type of interventions. Generating evidence for what works, when it works and for whom is even more paramount to AI suicide prevention efforts, where rates are currently high and resources are limited.

项目摘要 西南中心的研究部分将确定有效、可行和可持续的 预防自杀并提高美洲印第安人 (AI) 青年复原力的干预措施 约翰霍普金斯大学美洲印第安人健康中心 (CAIH)、 白山阿帕奇部落 (WMAT) 和纳瓦霍族 (NN)。这些伙伴关系的基础是 部落授权的监测，以实现早期识别、后续行动和案件管理，以建立联系 最近有自杀企图、意念或滥用药物事件后需要接受治疗的高危青少年。在 此外，我们一直在根据当地部落数据设计和试点简短的干预措施。两个这样的 我们的自杀预防研究选择了干预措施并按顺序进行评估。两者都雇用 本地专业人员辅助人员作为急需的任务转移和心理教育的手段 资源贫乏社区的持续护理。第一个干预措施是 New Hope (NH) 由专业社区心理卫生工作者提供的基于证据的第一阶段策略 (CMHW) 致力于通过安全规划、情绪调节技能、 并促进护理联系。第二个是老年人复原力 (ER) 干预，是一项长期干预措施 由长者在 CMHW 的支持下实施的战略，通过提高青年人的 连通性、自尊以及文化认同和价值观。我们的主要目标是：使用顺序 多重分配随机试验（SMART）设计评估四个序列中的哪一个是新的 希望 (NH)、老年人复原力 (ER) 和个案管理 (CM) 对即时和 人工智能的长期自杀意念（主要结果）和复原力（次要结果） 10-24 岁的青少年被确定有自杀风险。我们假设： a) New Hope 与 Case 仅管理就可以显着减少参与者的自杀意念； b) 长者的复原力与案例 仅靠管理就能显着提高参与者的适应能力； c) 新希望继之以长老 复原力将对自杀意念和复原力产生最强的影响； d) 案件管理 单独使用的效果是所有组合中最弱的。我们的次要目标是：1）检查 治疗效果和排序的调节因素和调节因素，以确定哪些 干预措施的类型和顺序最适合哪些青年； 2）评估可接受性， 中心关键干预措施的可行性和可持续性的能力，包括核心和 卫星合作伙伴包括纳瓦霍族、圣卡洛斯阿帕奇族、瓦拉派族和切罗基族。由于 自杀危险因素总体上存在异质性，并且在 AIAN 青年中，并非所有青年都需要相同的 干预措施的类型。为什么有效、何时有效以及对谁有效提供证据 对于人工智能自杀预防工作至关重要，目前自杀率很高且资源有限。