Southwest Hub for American Indian Youth Suicide Prevention Research

项目摘要 西南枢纽的研究部分将确定有效、可行和可持续的 预防自杀和提高美国印第安人(AI)青年复原力的干预措施 约翰霍普金斯美国印第安人健康中心(CAIH)与 白山阿帕奇部落(WMAT)和纳瓦霍民族(NN)。这些伙伴关系的基础是 部落授权的监测以进行早期识别，并进行后续行动和病例管理 高危青年在最近一次自杀未遂、构思或暴饮暴食后接受治疗。在……里面 此外，我们一直在根据当地部落数据设计和试行简短的干预措施。两个这样的人 通过我们的自杀预防研究，我们选择了干预措施进行顺序评估。两人都有员工 本土辅助专业人员作为转移任务的手段亟需的心理教育和促进 在资源不足的社区继续提供护理。第一个干预，新希望(NH)，是一个 准职业社区精神卫生工作者提供循证的第一阶段策略 (CMHW)专注于通过安全规划、情绪调节技能、 并促进了护理联系。第二种是老年人的弹性(ER)干预，这是一种更长期的干预 长者在儿童健康中心的支持下提出的策略，以增加青少年的适应力 连通性、自尊以及文化认同和价值观。我们的主要目标是：使用序列 多任务随机试验(SMART)设计，评估四个新序列中的哪一个 希望(NH)、老年人复原力(ER)和案例管理(CM)对即刻和 人工智能中的长期自杀意念(主要结果)和复原力(次要结果) 10-24岁的青少年被认为有自杀的风险。我们假设：a)新希望与案例 仅管理本身就会显著减少参与者的自杀意念；b)老年人的复原力与案例 管理本身将显著提高参与者的复原力；c)长辈跟随新希望 复原力对自杀意念和复原力的影响最大；和d)病例管理 在所有组合中，单独使用将产生最弱的影响。我们的次要目标是：1)审查 治疗有效性和排序的调解人和主持人，以确定哪些 干预的类型和顺序最适合哪种青年；以及2)评估可接受性， 中心核心和核心关键干预组件的可行性和可持续性能力 卫星合作伙伴，纳瓦霍人、圣卡洛斯·阿帕奇人、瓦拉派人和切诺基人。由于 自杀危险因素的异质性总体上和在AIAN青年中，并不是所有的青年都需要相同的 干预措施的类型。为什么管用、什么时候管用以及为谁提供证据就更重要了 人工智能自杀预防工作至关重要，目前自杀发生率很高，资源有限。

PROJECT ABSTRACT The research component of the Southwest Hub will identify effective, feasible and sustainable interventions to prevent suicide and promote resilience among American Indian (AI) youth building on 20+ years of partnership between the Johns Hopkins Center for American Indian Health (CAIH), the White Mountain Apache Tribe (WMAT) and Navajo Nation (NN). The foundation of these partnerships is tribally-mandated surveillance for early identification, and follow-up and case management to connect at-risk youth to treatment after a recent suicide attempt, ideation or binge substance use episode. In addition, we have been designing and piloting brief interventions informed by local tribal data. Two such interventions were selected to be evaluated in sequence by our Suicide Prevention Study. Both employ Native paraprofessionals as a means of task-shifting much-needed psychoeducation and promoting continuity of care in under-resourced communities. The first intervention, New Hope (NH), is an evidence-based first-stage strategy delivered by paraprofessional community mental health workers (CMHWs) focused on reducing immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections. The second, the Elder’s Resilience (ER) intervention, is a longer-term strategy delivered by Elders with support from CMHWs to promote resilience by increasing youth’s connectedness, self-esteem and cultural identity and values. Our Primary Aim is: to use a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate which of four sequences of New Hope (NH), Elders Resilience (ER) and Case Management (CM) has the greater effect on immediate and longer-term suicidal ideation (primary outcome) and resilience (secondary outcome) among AI adolescents ages 10-24 identified at risk for suicide. We hypothesize that: a) New Hope vs. Case Management alone will significantly reduce participant suicidal ideation; b) Elders Resilience vs. Case Management alone will significantly improve participant resilience; c) New Hope followed by Elders Resilience will have the strongest effects on suicidal ideation and resilience; and d) Case Management alone will have the weakest effects of all combinations. Our Secondary Aims are: 1) to examine mediators and moderators of treatment effectiveness and sequencing in order to determine which types and sequence of interventions is best suited for which youth; and 2) to assess the acceptability, feasibility and capacity for sustainability of the Hub’s key intervention components with core and satellite partners, the Navajo, San Carlos Apache, Hualapai, and Cherokee nations. Due to heterogeneity of suicide risk factors generally and among AIAN youth, not all youth require the same type of interventions. Generating evidence for what works, when it works and for whom is even more paramount to AI suicide prevention efforts, where rates are currently high and resources are limited.