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

青少年的自杀率大幅上升，特别是黑人青年。大多数人 自杀死者的最后一次临床接触是在初级保健中心。因此，PPC设置对于识别 和治疗有自杀倾向的青少年，但在识别、干预和 实施。使用自我报告的年度抑郁症筛查可能会错过许多高危青年的识别， 由于许多自杀未遂者，特别是黑人青年，在自杀行为之前没有报告自己的想法， 年轻人中的自杀危机可能会迅速发展。第二个挑战是，一旦发现高危青年，购买力平价 服务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 在识别或干预有自杀风险的黑人青年方面存在许多障碍。我们的签名R01地址 这些挑战如下：在R01的第一个组件中，我们将为 基于电子健康记录(EHR)、移动传感、生态瞬时活动(EMA)的PPC 对情绪、自杀念头和行为的评估以及自我报告，以确定谁处于危险之中以及何时处于危险之中 他们面临与自杀相关的事件的迫在眉睫的风险。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补充，样本将是35%的黑色。这些年轻人之后将会有 在基准后1个月、3个月和6个月进行访谈和自我报告，并从移动设备获得6个月的数据 感应和日均和周均均线。我们将：(1)开发一种预测算法，利用PPC中青少年的EHR 环境；(2)确定移动感知和EMA措施的动态变化，预测迫在眉睫的自杀风险- (3)开发了一种结合移动感知、EMA、自我报告和EHR的数据融合算法 提高预测性；(4)在黑人青年中测试和优化其表现。在第二个组件中，我们 将对这一队列的一部分进行随机临床试验，即900名自杀风险较高的青年。 我们将把照常处理(TAU)与在当前项目期开发的一套工具进行比较，以指导 儿科提供者在评估自杀风险、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。基于我们之前的工作，我们假设这种联合干预，综合护理到 帮助高危青少年(ICHART)将减少自杀事件(导致 紧急转诊)减少50%，其影响将通过转诊、治疗参与度、 和安全规划。我们将使用实施科学方法来评估障碍、促进者、可行性和 部分预测分析和iCHART干预的可接受性，为未来的实施工作提供信息 以及促进健康公平，并确保我们的识别和干预方法将是有效和 黑人青年可以接受。这项研究可以改善对高危青少年的识别和监测，减少自杀 活动，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.