SAFETY-A for Promoting Equity in Suicide Prevention Outcomes in Schools

SAFETY-A 促进学校自杀预防成果的公平

• 批准号: 10677768
• 负责人: ANNA Shan-Lai LAU
• 金额: $ 23.63万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677768
• 关键词: Accident and Emergency department; Acute; Address; Administrator; Adolescent; Age; American; Asian Americans; Caregivers; Caring; Case Series; Characteristics; Clinical; Cluster randomized trial; Coercion; Cognitive Therapy; Collaborations; Communication; Continuity of Patient Care; Data; Death Rate; Detection; Disparity; Distress; Emergency department visit; Emotions; Equity; Ethnic Population; Family; Feedback; Feeling suicidal; Funding; Hospitalization; Hybrids; Intervention; Investigation; Latina; Latinx; Low income; Mental Health; Mental Health Services; Methods; Not Hispanic or Latino; Outcome; Parents; Perception; Persons; Phase; Policies; Prevention; Protocols documentation; Provider; Randomized; Reporting; Research; Resource-limited setting; Resources; Risk; Risk Assessment; Schools; Structure; Students; Suicide attempt; Suicide prevention; Symptoms; Teenagers; Testing; Time; Training; Trust; United States National Institutes of Health; Youth; acceptability and feasibility; design; disparity reduction; effectiveness/implementation trial; emotional distress; ethnic disparity; ethnic minority; ethnic minority population; evidence base; follow-up; health service use; human centered design; hybrid type 1 trial; implementation barriers; implementation evaluation; implementation outcomes; implementation science; implementation strategy; improved; internalized stigma; medical specialties; minority children; minority student; peer; pilot trial; primary outcome; prototype; provider adherence; racial disparity; racial minority population; racial population; randomized trial; response; school district; secondary outcome; service providers; skills training; social stigma; suicidal; suicidal adolescent; suicidal behavior; suicidal morbidity; suicidal risk; therapy development; workforce needs

PROJECT SUMMARY Ethnic minority adolescents, including Asian American and Latinx adolescents are at increased risk for suicidal thoughts and attempts compared to their Non-Hispanic White (NHW) peers, yet they are less likely to receive mental health services (MHS) after their suicide risk is identified. Although school-based MHS reduce access barriers, racial disparities persist within suicide prevention efforts in schools. The proposed study will adapt Safe Alternatives For Teens and Youth – Acute (SAFETY-A) for implementation in low-resourced school districts to target putative mechanisms underlying disparities in MHS use following youth suicide risk detection. SAFETY-A will be adapted to reduce mistrust of MHS, internalized stigma, and concealment of youth emotional distress that drive poor engagement in MHS among Asian American and Latinx students and families. Furthermore, SAFETY-A delivery parameters and implementation strategies will be adapted to fit the organizational context of school district policies and protocols, resource constraints, and workforce needs. The proposed intervention development study will include three phases. First, stakeholders will be engaged to design adaptations to the intervention and implementation strategy. Provider, youth and caregiver input will be gathered using human-centered design approaches to adapting the SAFETY-A intervention content to address disparities mechanisms. School district leaders, school administrators, and MHS providers will help to develop a tailored implementation strategy to fit local training and support needs across a range of district contexts. Second, a prototyping case series will inform iterative refinements of SAFETY-A in one school district. Third, a pilot controlled trial will randomize school districts to the timing of implementation to provide preliminary data on the impact of SAFETY-A on proposed mechanisms of action (trust in MHS, stigma, youth emotion communication) and the primary outcome of MHS utilization and the secondary outcome of suicidal thoughts and behaviors across racial/ethnic groups. Mixed methods will be used to assess implementation outcomes of provider adherence, and perceptions of feasibility, acceptability and fit. The proposed project will provide preliminary data on feasibility and potential impacts on putative mechanisms to propose a definitive Hybrid Type 1 trial to test SAFETY-A as an intervention to reduce racial/ethnic disparities in MHS utilization among suicidal youth.

项目摘要 少数民族青少年，包括亚裔美国人和拉丁裔青少年， 与非西班牙裔白色（NHW）同龄人相比，他们的自杀想法和企图，但他们不太可能 在确定自杀风险后接受心理健康服务（MHS）。虽然学校的MHS减少了 在学校的自杀预防工作中，存在着入学障碍和种族差异。拟定的研究将 调整青少年安全替代方案-急性（CUSY-A），以便在资源匮乏的学校实施 地区，以针对假定的机制，在青年自杀风险检测后，MHS使用的差异。 CUSY-A将被修改，以减少对MHS的不信任，内化的耻辱，以及对青年的隐瞒 情绪困扰导致亚裔美国人和拉丁裔学生对MHS的参与度很低， 家庭此外，CUSY-A交付参数和实施战略将进行调整，以适应 学区政策和协议的组织背景，资源限制和劳动力需求。 建议的干预发展研究将分三个阶段进行。首先，利益攸关方将参与 设计适应干预和实施战略的措施。提供者、青少年和照顾者的投入将 使用以人为本的设计方法收集，以适应CUSY-A干预内容， 解决差异机制。学区领导、学校管理人员和MHS提供者将帮助 制定量身定制的实施战略，以满足一系列地区的当地培训和支持需求 contexts.其次，一个原型案例系列将为一所学校的CUSY-A的迭代改进提供信息 区的第三，将试点控制试验随机化学区，以提供实施的时机 关于CUSY-A对拟议行动机制影响的初步数据（对MHS的信任、污名、青年 情感交流）和MHS利用的主要结局以及自杀的次要结局 种族/民族群体的思想和行为。将采用混合方法评估执行情况 提供者依从性的结果，以及对可行性、可接受性和适合性的看法。拟议项目将 提供关于可行性和对假定机制的潜在影响的初步数据， 测试CUSY-A作为减少MHS使用中种族/民族差异的干预措施的混合1型试验 自杀的年轻人。