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

项目概要 少数族裔青少年，包括亚裔美国人和拉丁裔青少年，患此病的风险更高 与非西班牙裔白人 (NHW) 同龄人相比，他们有自杀念头和尝试，但自杀的可能性较小 在确定自杀风险后接受心理健康服务 (MHS)。尽管校本 MHS 减少了 学校预防自杀工作中仍然存在入学障碍和种族差异。拟议的研究将 调整青少年和青少年的安全替代方案 - 急性 (SAFETY-A)，以便在资源匮乏的学校实施 各地区针对青少年自杀风险检测后 MHS 使用差异的推定机制。 SAFETY-A 将进行调整，以减少对 MHS 的不信任、内在的耻辱和对青少年的隐瞒 情绪困扰导致亚裔美国人和拉丁裔学生对 MHS 的参与度较差， 家庭。此外，SAFETY-A 交付参数和实施策略将进行调整以适应 学区政策和协议、资源限制和劳动力需求的组织背景。 拟议的干预开发研究将包括三个阶段。首先，利益相关者将参与其中 设计干预和实施策略的调整。提供者、青少年和护理人员的投入将 使用以人为本的设计方法来收集，以适应 SAFETY-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，以满足各地区的当地培训和支持需求 上下文。其次，原型案例系列将为一所学校的 SAFETY-A 迭代改进提供信息 区。第三，试点对照试验将随机分配学区以提供实施时间 关于 SAFETY-A 对拟议行动机制影响的初步数据（对 MHS 的信任、耻辱、青年 情绪沟通）以及 MHS 使用的主要结果和自杀的次要结果 跨种族/族裔群体的思想和行为。将使用混合方法来评估实施情况 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。拟议的项目将 提供有关可行性和对假定机制的潜在影响的初步数据，以提出明确的建议 混合 1 型试验，测试 SAFETY-A 作为减少 MHS 使用方面种族/民族差异的干预措施 在有自杀倾向的青少年中。

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.