Exploratory-Project 3

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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.