Prevention and Assessment of Risk in Teens (PART) Longitudinal Study

青少年的自杀率急剧上升，特别是黑人青年。大多数 自杀死者最后一次与医生接触是在基层护理。因此，PPC设置对于识别 和治疗自杀青年，但在识别，干预和治疗方面存在挑战。 实施.使用自我报告进行抑郁症的年度筛查可能会错过识别许多高危青年， 因为许多自杀者，特别是黑人青年，在他们的自杀行为之前没有报告想法， 年轻人的自杀危机会迅速发展。第二个挑战是，一旦确定了高危青年，PPC 提供者缺乏可靠的服务提供战略，无法有效地治疗这些青年。第三个挑战是， 识别或干预有自杀风险的黑人青年的许多障碍。我们的签名R 01地址 这些挑战如下：在R 01的第一部分，我们将开发一个预测分析平台， PPC基于电子健康记录（EHR）、移动的传感、生态瞬时活动（EMA） 评估情绪和自杀想法和行为以及自我报告，以确定谁有风险，何时有风险 他们面临自杀相关事件的紧迫风险。为了实现这一目标，我们将从PPC招募2000名青年， 为那些自杀风险高的人富集，样本将是35%的黑人。这些年轻人将被 基线后1、3和6个月的访谈和自我报告，并将获得来自移动的的6个月数据 以及日线和周线EMA。我们将：（1）开发一个预测算法，使用电子病历的青少年在PPC （2）识别移动的感知和EMA措施的动态变化，预测自杀的迫在眉睫的风险- 相关事件;（3）开发结合移动的传感、EMA、自我报告和EHR的数据融合算法， 改进预测;（4）测试和优化其在黑人青年中的表现。在第二部分中，我们 将对该队列的一个子集，即900名自杀风险高的青年进行随机临床试验（RCT）。 我们将把常规治疗（TAU）与当前项目期间开发的一套工具进行比较，以指导 儿科医生评估自杀风险，提出治疗建议，制定安全计划， 加载到患者的智能手机上，并启动自动短信干预，以增加治疗 订婚根据我们以前的工作，我们假设这种联合干预，综合护理， 帮助高危青少年（iCHART）将减少自杀事件（导致自杀的自杀行为或想法）， 紧急转诊）减少50%，效果将通过转诊，治疗参与， 安全规划。我们将使用实施科学的方法来评估障碍，促进者，可行性， PART预测分析和iCHART干预的可接受性，为未来的实施工作提供信息 促进健康公平，确保我们的识别和干预方法有效， 黑人青年可以接受。这项研究可以提高识别和监测青少年的风险，减少自杀 活动，并促进黑人青年的健康公平。

Suicide rates among adolescents have increased dramatically, particularly for Black youth. The majority of suicide decedents have their last clinical contact in primary care. Thus, PPC settings are critical for identifying and treating suicidal youth, but there are challenges with respect to identification, intervention, and implementation. Annual screening for depression using self-report may miss identifying many high-risk youth, as many suicide attempters, particular Black youth, do not report ideation prior to their suicidal behavior and suicidal crises in youth can develop quickly. A second challenge is that once high-risk youth are identified, PPC providers lack a reliable service delivery strategy to effectively treat these youth. A third challenge is that are many barriers for identifying or intervening with Black youth at risk for suicide. Our Signature R01 addresses these challenges as follows: In the first component of the R01, we will develop a predictive analytic platform for PPC based on the electronic health record (EHR), mobile sensing, ecological momentary activity (EMA) assessments of mood and suicidal thoughts and behaviors and self-reports to identify who is at risk and when they are at imminent risk for suicide-related events. To accomplish this, we will recruit 2000 youth from PPC, enriched for those at high suicidal risk, and the sample will be 35% Black. These youth will be followed with interviews and self-reports at 1, 3, and 6 months following baseline and will have 6 months of data from mobile sensing and daily and weekly EMA. We will: (1) develop a predictive algorithm using EHR of adolescents in PPC settings; (2) identify dynamic changes in mobile sensing and EMA measures predicting imminent risk for suicide- related events; (3) develop a data-fusion algorithm combining mobile sensing, EMA, self-reports, and EHR to improve prediction; and (4) test and optimize its performance among Black youth. In the 2nd component, we will conduct a randomized clinical trial (RCT) on a subset of this cohort, namely 900 youth at high suicidal risk. We will compare treatment as usual (TAU) to a suite of tools developed in the current project period to guide the pediatric provider in assessing suicidal risk, making a treatment recommendation, generating a safety plan that is loaded on the patient’s smartphone, and launching an automated texting intervention to increase treatment engagement. Based on our previous work, we hypothesize that this combined intervention, integrated Care to Help At-Risk Teens (iCHART) will decrease suicidal events (suicidal behavior or ideation that results in an emergency referral) by 50%, and the effects will be mediated by increases in referrals, treatment engagement, and safety planning. We will use implementation science methods to assess barriers, facilitators, feasibility, and acceptability of PART predictive analytics and the iCHART intervention to inform future implementation efforts and to promote health equity and ensure that our methods of identification and intervention will be effective and acceptable to Black youth. This study can improve identification and monitoring of youth at risk, reduce suicidal events, and advance health equity for Black youth.