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

项目总结 少数族裔青少年，包括亚裔美国人和拉丁裔青少年患癌症的风险增加 与他们的非西班牙裔白人(NHW)同龄人相比，他们有自杀想法和自杀企图，但他们不太可能 在确定自杀风险后，接受精神健康服务(MHS)。虽然以学校为基础的卫生保健服务减少了 尽管存在获取障碍，但在学校预防自杀的努力中，种族差距依然存在。拟议的研究将 采用适合青少年的安全替代方案-急性(安全-A)在资源不足的学校实施 在青少年自杀风险检测后，地区针对潜在的MHS使用差异的假定机制。 将对安全-A进行调整，以减少对MHS的不信任、内化的耻辱和青年的掩饰 导致亚裔美国人和拉丁裔学生在MHS中参与度不高的情绪困扰 家人。此外，将调整安全-A交付参数和实施战略，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。 拟议的干预发展研究将包括三个阶段。首先，利益相关者将参与进来 设计与干预和实施战略相适应的方案。提供者、青年和照顾者的投入将 采用以人为本的设计方法收集，以适应安全-A干预内容 解决差异机制。学区领导、学校管理人员和医疗保健服务提供者将帮助 制定量身定制的实施策略，以满足多个地区的本地培训和支持需求 上下文。其次，一个原型案例系列将告知一所学校的安全-A的迭代改进 地区。第三，试点对照试验将随机化学区的实施时间，以提供 关于安全-A对拟议行动机制的影响的初步数据(对卫生保健制度、耻辱、青年的信任 情感交流)和使用MHS的主要结果和自杀的次要结果 跨种族/民族群体的思想和行为。将使用混合方法来评估实施情况 供应商遵守的结果，以及对可行性、可接受性和适合性的看法。拟议的项目将 提供关于可行性和对假定机制的潜在影响的初步数据，以提出一个明确的 一种混合型试验，以测试安全性-A作为减少卫生保健服务使用中种族/民族差异的干预措施 在有自杀倾向的年轻人中。

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.