NATIVE RISE-Risk Identification for Suicide and Enhanced care for Native Americans

项目摘要 约翰霍普金斯美洲印第安人健康中心及其合作伙伴，白色山地阿帕奇部落和 纳瓦霍民族是独特的定位，并准备通过推进自杀预防科学， 资助机会”用于识别、预防和治疗面临风险的个人的服务就绪工具 自杀”（RFA-MH-21-110）。美洲原住民的自杀率要高得多， 是所有种族中增长最快的这些差异是殖民化遗留下来的， 种族灭绝未遂，历史创伤和持续的不公正，包括医疗保健长期资金不足 和心理健康服务。尽管存在这些不利因素，但NAs仍行使部落主权， 最具创新性、实用性和有效性的自杀预防方法。其中一个模型是 庆祝生命计划（CL），一个以社区为基础的自杀监测和病例管理系统， 最初由白色山地阿帕奇部落（WMAT）开发，并显示有助于减少 自杀企图和死亡率CL计划现在正在通过西南枢纽进行扩展， 青少年自杀预防（U19 MH 113136）。随着该计划的扩大，我们的试点工作暴露了障碍， 执行方面的困难，包括：1）风险识别方面的挑战，2）难以与个人的 这一风险对以证据为基础的干预措施作为提高稀缺资源效率的一种手段产生了负面影响。来帮助克服 为了克服这些实施障碍，NIMH资助我们的团队开发和试点测试NATIVE-RISE （U19MH113136-02S3）。NATIVE-RISE是一种系统级策略，利用预测分析， 加强风险识别，整合并提高当地NA案例管理人员的效率， 简短的接触干预。拟议的项目将利用我们团队与印度卫生部的历史性谅解备忘录 服务（IHS）和与部落合作伙伴长达数十年的信任关系，以测试NATIVE-RISE及其集成 通过混合III型阶梯楔形集群与三个NA服务医疗机构合作 随机实施试验具体而言，该项目旨在1）优化NATIVE的实施- RISE在三个NA服务的医疗保健机构中进行，2）确定NATIVE-RISE在以下方面的有效性： 提高循证自杀预防服务的覆盖面，以及3）描述与自杀相关的成本。 实施NATIVE-RISE，为扩大规模和可持续性提供信息。我们的应用程序解决了关键优先事项 这是国家精神卫生研究所（NOT-MH-21-090）的目标，符合国家精神卫生研究所的战略计划目标4.3。如果结果 实现后，NATIVE-RISE将成为一种有效和可扩展的方法，可以改善服务， NA人群中的自杀，并推进我们对如何实施预测分析的理解， 更个性化的自杀预防护理。

PROJECT SUMMARY The Johns Hopkins Center for American Indian Health and its partners, the White Mountain Apache Tribe and Navajo Nation are uniquely positioned and prepared to advance suicide prevention science through the funding opportunity “Service-Ready Tools for Identification, Prevention and Treatment of Individuals at Risk for Suicide” (RFA-MH-21-110). Native American populations experience substantially higher rates of suicide and the sharpest increases over time of any racial group. These disparities are the legacy of colonization, attempted genocide, historical trauma, and ongoing injustices, including chronic underfunding of health care and mental health services. Despite these adversities, NAs have exercised tribal sovereignty to support some of the most innovative, practical, and effective approaches to suicide prevention. One such model, the Celebrating Life program (CL), a community-based suicide surveillance and case management system, developed originally by the White Mountain Apache Tribe (WMAT) and shown to help contribute to reductions in suicide attempts and deaths over time. The CL program is now being scaled through the Southwest Hub for Youth Suicide Prevention (U19MH113136). As this program has scaled, our pilot work has revealed barriers to implementation, including 1) challenges to risk identification, and 2) difficulties matching individuals’ level of risk to evidence-based interventions as a means to improve scarce resource efficiencies. To help overcome these barriers to implementation, NIMH funded our team to develop and pilot test NATIVE-RISE (U19MH113136-02S3). NATIVE-RISE is a systems-level strategy that leverages predictive analytics to enhance risk identification and integrates and improves the efficiency of local NA case managers who deliver brief contact interventions. The proposed project will leverage our team’s historic MOU with Indian Health Service (IHS) and decades-long trust-relationships with tribal partners to test NATIVE-RISE and its integration in partnership with three NA-serving health care settings through a Hybrid Type III stepped-wedge cluster randomized implementation trial. Specifically, this project aims to 1) optimize the implementation of NATIVE- RISE across three NA-serving health care settings, 2) determine the effectiveness of NATIVE-RISE at improving the reach of evidence-based suicide prevention services, and 3) describe the costs associated with implementing NATIVE-RISE to inform scale-up and sustainability. Our application address key priority populations for NIMH (NOT-MH-21-090) and is in line with NIMH’s strategic plan Objective 4.3. If results are achieved, NATIVE-RISE will become an effective and scalable approach that improves services to prevent suicide among NA populations and advances our understanding of how to implement predictive analytics and more personalized care for suicide prevention.