Developing Effective Proximal Care to Prevent Rural Alaska Native Youth Suicide

美国印第安人/阿拉斯加原住民（AI/AN）15-19岁青年的年自杀死亡率可能是所有美国青年的18倍。大多数AI/AN青少年从未接受过行为健康护理，即使表现出焦虑，愤怒，抑郁或其他精神痛苦的迹象，以及主动自杀。在我们的研究区域，这种服务通常只在危机期间使用，只有在同龄人和家庭成员耗尽他们的社会储备之后，其中包括家庭和朋友的非正式社交网络，大多数人在危难时依赖这些网络。以前的研究表明，需要建立在文化上敏感的专业自杀预防实践，并扩大社区支持，特别是在美国印第安人和阿拉斯加原住民（AI/AN）的农村社区。我们的部落工作组在过去三年中开发了PC-CARES。通过这种干预，我们的目标是建立一个公共卫生系统，降低自杀风险，并加强部落社区的保护因素。PC-CARES将加强土著准专业人员和非土著专业心理健康提供者之间的合作，减少心理健康求助的耻辱感，并促进提供者和社区成员之间的早期互动，以更好地满足土著青年的需求。土著村庄顾问和非土著临床医生将接受培训，以促进社区外联会议，将文化/地方知识和临床专业知识结合起来。这种做法将促进提供者之间以及提供者与社区成员之间的知识交流和关系建设。参与AN村庄的相对封闭的系统，再加上我们与该地区唯一的部落社会和卫生保健组织15年以上的研究伙伴关系，提供了一个前所未有的机会来记录和跟踪寻求帮助的村级模式和为青年提供服务，并描述这些支持系统如何反映和互动与正式的健康和心理健康服务。我们提出了一种创新，而不是专注于个人层面的变化，以加强，扩大和跟踪系统的青年支持在社区和机构层面，这将减少青年自杀行为。目标1：描述可以用来预防青少年自杀的机构和社区支持系统;确定实施PC-CARES后发生的变化。目标二：测试PC-CARES的可行性和初步成果，这是一种帮助提供者和社区成员合作预防土著青年自杀的干预措施。影响：心理健康服务和家庭/同伴对有自杀风险的土著青年的支持之间存在重大差距。PC-CARES将整合这些资源，激励支持者，并提供有意义的，以社区为基础的帮助。这种方法可以用于其他服务不足的农村社区。自1990年以来，自杀跟踪系统在研究区域运行，我们将能够在这项试点研究中记录我们的干预措施对转诊行为的影响。我们将在下一阶段的研究中记录PC-CARES对自杀行为的影响。

DESCRIPTION (provided by applicant): The annual suicide death rate can be 18 times higher for American Indian/Alaska Native (AI/AN) youth ages 15-19 than for all American youth. The majority of AI/AN youth never receive behavioral health care, even when showing signs of anxiety, anger, depression, or other mental distress and when actively suicidal. In our study region, such services typically are utilized exclusively during crises, and only after peers and family members have depleted their social reserves, which include the informal social networks of family and friends upon which most rely in times of distress. Previous research indicates a need for culturally-responsive professional suicide prevention practice that builds on and extends community support, particularly in rural American Indian and Alaska Native (AI/AN) communities. Our tribal working group developed PC-CARES over the last three years. With this intervention, we aim to develop a public health system that decreases suicide risk and bolsters protective factors in tribal communities. PC-CARES will enhance collaborations among Native paraprofessional and non-Native professional mental health providers, reduce stigma for mental health help-seeking, and promote earlier interactions between providers and community members to better meet the needs of Native youth. Native village counselors and non-Native clinicians will be trained to facilitate the community outreach sessions that will bring together cultural/local knowledge and clinical expertise. This approach will promote knowledge exchange and relationship-building among providers and between them and community members. The relatively closed systems of participating AN villages, coupled with our 15+ years of research partnerships with the only tribal social and health care organization in the region, offer an unprecedented opportunity to document and track village-level patterns of help-seeking and caregiving for youth, and to describe how these support systems reflect and interact with formal health and mental health services. Instead of focusing on individual-level change, we propose an innovation to strengthen, expand, and track the systems of youth support at community and institutional levels, which will reduce youth suicidal behavior. Aim 1: Characterize the Institutional and Community Support Systems that can be Harnessed to Prevent Youth Suicide; Identify Changes that Occur after Implementation of PC-CARES. Aim 2: Test the Feasibility and Preliminary Outcomes of PC-CARES, an Intervention to Help Providers and Community Members Collaborate in Preventing Suicide in Native Youth. IMPACT: There is a significant gap between mental health services and family/peer support for Native youth at risk for suicide. PC-CARES will align these resources, galvanize supporters, and offer meaningful, community-based help. This approach can be used with other underserved, rural communities. With a suicide tracking system operational in the study region since 1990, we will be able to document our intervention's effect on referral behavior in this pilot study. We will document the impact of PC-CARES on suicidal behavior in the next stage of research.