Exploratory-Project 3

自杀是10-24岁青少年的第二大死因，自杀率正在上升。近期 研究表明，在过去的30年里，黑人青年和 在黑人高中生中自我报告的自杀企图中。黑人青年比白人青年更不可能 因自杀念头或行为而接受治疗，自杀后不太可能接受住院或门诊治疗 尝试。黑人青年开始心理健康治疗的障碍包括缺乏感知的需求、耻辱和不信任 提供者和治疗方面的困难，实际获得服务的困难，以及提供者缺乏文化 能力。患者导航提供了一种灵活的模型，可以解决其中的许多障碍，并且可以 为特定人群和需求量身定做的，但没有很好地研究用于有自杀倾向的青少年。对……的干预 黑人青年可能需要适应，因为许多干预措施没有解决与文化相关的问题 黑人病人。这项探索性研究将改编并试点测试一种患者导航干预措施，即自杀青少年 获取治疗(STAT-ED)，以增加其与10-18岁黑人青年的相关性和有效性 多年来向急诊科(ED)提出自杀念头或行为以增加自杀意念或行为 在心理健康治疗方面。我们将使用Adapt-ITT模型系统地调整患者的要素 导航模型。首先，我们将对青少年和照顾者进行定性访谈。第二，我们将呈现 统计-ED到一个咨询小组，该小组将审查干预措施并提供关于选择组件的意见 需要调整的干预措施。适应将针对儿童和家庭文化因素，如文化 耻辱，对治疗效果的负面看法，以及通过在文化上提供 相关的心理教育和进行动机访谈，以解决治疗偏好和 感知。此外，干预措施将解决资源不足人群中常见的后勤障碍。 其中黑人青年的比例过高。我们将在50 Black的小型RCT中测试自适应干预 出现自杀念头或行为的青少年及其照顾者。参与者，随机到 适应的患者导航干预或常规强化治疗将在基线、2和 六个月。我们将审查实施成果(可行性、可接受性、保真度) 干预。我们还将检查对主要结果(心理健康治疗启动率、时间)的影响 治疗次数)、二次结局(自杀意念)和潜在的中介因素(心理健康 治疗动机)。来自这项探索性研究的信息将为心理健康提供新的知识 为有自杀倾向的黑人青年启动护理，并将通知NIMH应用程序，以测试患者导航干预 动力十足的RCT。

Suicide is the second leading cause of death among 10-24 year olds and suicide rates are increasing. Recent research has shown disturbing and significant increases over the last 3 decades in suicides in Black youth and in self-reported suicide attempts among Black high school students. Black youth are less likely than White youth to be treated for suicidal ideation or behaviors, and less likely to receive inpatient or outpatient care after a suicide attempt. Barriers to Black youth starting mental health treatment include lack of perceived need, stigma, mistrust of providers and treatment, difficulties in physically accessing available services, and providers’ lack of cultural competence. Patient navigation offers a flexible model that can address many of these barriers, and can be tailored to specific populations and needs, but are not well studied for use with suicidal youth. An intervention for Black youth would likely require adaptation, as many interventions do not address culturally relevant issues for Black patients. This exploratory study will adapt and pilot test a patient navigation intervention, Suicidal Teens Accessing Treatment (STAT-ED), to increase its relevance to and effectiveness with Black youth ages 10-18 years presenting to the Emergency Department (ED) with suicidal ideation or behaviors to increase their initiation in mental health treatment. We will use the ADAPT-ITT model to systematically adapt elements of a patient navigation model. First, we will conduct qualitative interviews with youth and caregivers. Second, we will present STAT-ED to an advisory group, which will review the intervention and provide input on the selection components of the intervention to be adapted. The adaptation will target child and family cultural factors, such as cultural stigma, negative perceptions of treatment effectiveness, and problem identification, by providing culturally relevant psychoeducation and conducting motivational interviewing to address treatment preferences and perceptions. Additionally, the intervention will address logistical barriers common in under-resourced populations in which Black youth are overrepresented. We will test the adapted intervention in a small RCT with 50 Black youth presenting in the ED with suicidal ideation or behaviors and their caregivers. Participants, randomized to the adapted patient navigation intervention or enhanced treatment as usual, will be assessed at baseline, 2, and 6 months. We will examine implementation outcomes (feasibility, acceptability, fidelity) of the adapted intervention. We also will examine impact on primary outcome (rates of mental health treatment initiation, time to treatment, number of sessions), secondary outcome (suicidal ideation), and potential mediators (mental health treatment motivation). Information from this exploratory study will contribute new knowledge for mental health care initiation for suicidal Black youth and will inform a NIMH application to test patient navigation intervention in a fully-powered RCT.