Integrating the Youth Nominated Support Team (YST) with CBT for Black Youth with Acute Suicide Risk

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Project Abstract Recent data show alarming increases in suicide mortality among Black youth combined with concerning disparities in access to and engagement in outpatient mental health care. Despite this urgent need, there are no well-established psychosocial treatments for suicide risk with demonstrated effectiveness in Black youth. Commonly used approaches (e.g., CBT) tend to focus on intrapersonal factors associated with suicide-related distress, such as cognitive distortions and emotion dysregulation, with limited focus on interpersonal factors (e.g., connectedness, social support), which are recommended as a suicide prevention strategy, and may be specifically protective for Black youth. The Youth Nominated Support Team (YST) was designed to be adjunctive to treatment following an acute suicide crisis, is specifically focused on intrapersonal connections, and has been designated a “promising intervention” by SAMHSA. YST creates a team of youth- nominated adults who receive education and guidance, provide weekly supportive contacts for high-risk youth, and encourage youth participation in treatment. YST is the only individual-level suicide prevention strategy in the U.S. with evidence of association with reduced self-injury mortality; participation in YST is also linked to increased treatment utilization. In response to this urgent need and RFA-MH-22-125, the proposed project will use a community-based participatory research (CBPR) strategy to iteratively develop and pilot test a two- component psychosocial intervention, Cognitive-Behavioral Therapy for Suicide Prevention plus the Youth- Nominated Support Team (CBT-SP+YST) for adolescents, ages 12-17 years, following an ED visit for acute suicide risk. Given the paucity of intervention development research conducted with Black youth, the alarming increases in suicide mortality among Black youth, and the possibility that social support interventions may be particularly protective for Black youth, this initial development of CBT-SP+YST will focus on cultural tailoring for Black youth served by Detroit/Wayne County’s public mental health system. Embedded within a hybrid one effectiveness-implementation framework, we will 1) integrate an innovative scalable computer assisted version of YST (E-YST) with CBT-SP, tailoring intervention components based on input from community stakeholders, 2) conduct a feasibility pilot and 3) conduct a pilot RCT to examine theorized mechanisms of action, youth outcomes, intervention feasibility/acceptability, and barriers to implementation in this population of publicly insured Black youth. Completion of the proposed study is the first step towards a larger-scale effectiveness trial, which will be facilitated by the innovative computer-assisted E -YST platform. The integration and tailoring of these two strategies has the potential to address an urgent public health concern while capitalizing on the inherent strengths found in the families, schools, and community institutions that surround Black youth.