Improving screening and follow-up for suicidal ideation and behaviors among Latinx youth in primary care

项目摘要/摘要 这项提议目标是在儿科制定和试行一项系统级别的战略 初级保健，以加强对自杀意念和行为的识别和管理 拉丁裔青年，特别是父母英语水平不高的移民家庭的青年 熟练程度(LEP)。我们将重点使用训练有素的社区卫生工作者(CHW)来 提高自杀风险筛查和早期干预的临床能力和质量，重点 关于安全规划、家长心理教育和护理协调。我们的具体目标是： 制定现场特定实施方案，将CHW整合到SIB筛选中 为拉丁裔青年及其家人制定安全规划；2：试行 计划在四个儿科初级保健实践中进行为期六个月的公开试验，代表了一系列 通常做法设置；以及3：与利益攸关方网络接触，以探索障碍和 促进者，包括成本和计费策略，以跨 广泛的儿科初级保健环境。在目标1中，我们将使用实现映射，一个 结合了用户(例如，家庭)、实施者(例如， 诊所工作人员)、采用者(例如诊所管理员)和持续者(例如提供医疗保健服务 专家和付款人)，以指导制定战略，以通过、实施和维护 四个参与的儿科实践中的循证干预。在目标2中，我们将评估 可行性、可接受性和对组织的影响(例如，筛查和CHW的增加 转诊、参与后续心理健康访问)和患者级别的结果(例如， 改善家庭功能、养育自我效能)。量化数据(例如， 筛选)将使用中断的时间序列分析进行检查。在目标3中，我们将进行 与利益相关者进行半结构化访谈，并召集利益相关者网络，以制定 更大规模试验的实施计划。然后，我们将整合试点试验和定性数据 使用混合方法分析来评估组织的可行性和可接受性， 提供者和患者层面，并召开会议，为更大规模的试验制定实施计划。 成功完成这项以部署为重点的试点研究将使我们为 一项未来的多站点整群随机对照试验，评估 卫生福利院在医疗机构推行预防自杀措施的情况 在儿科初级保健中，拉丁裔青年的自杀意念和行为的比率，与长期- 解决精神卫生服务差距和防止青少年自杀的长期目标。

Project Summary/Abstract The objective of this proposal is to develop and pilot a systems-level strategy in pediatric primary care to enhance identification and management of suicidal ideation and behavior in Latinx youth, particularly those in immigrant families with parents who have limited English proficiency (LEP). We will focus on the use of trained community health workers (CHWs) to increase clinic capacity and quality of suicide risk screening and early intervention, with a focus on safety planning, parent psychoeducation and care coordination. Our specific aims are 1: To develop site-specific implementation protocols for the integration of CHWs into SIB screening and safety planning for Latinx youth and their families; 2: To pilot the implementation of the program in a six-month open trial in four pediatric primary care practices representing a range of usual practice settings; and 3: To engage a stakeholder network to explore barriers and facilitators, including costs and billing strategies, to implementation of this approach across a broad range of pediatric primary care settings. In Aim 1, we will use Implementation Mapping, a systematic process incorporating the perspectives of users (e.g., families), implementers (e.g., clinic staff), adopters (e.g. clinic administrators) and sustainers (e.g. healthcare service delivery experts and payors) to guide development of strategies to adopt, implement and maintain an evidence-based intervention in the four participating pediatric practices. In Aim 2, we will assess feasibility, acceptability, and impact on organizational (e.g., increase in screening and CHW referral, engagement in follow-up mental health visits) and patient-level outcomes (e.g., improved family functioning, parenting self-efficacy). Quantitative data (e.g., changes in rates of screening) will be examined using an interrupted time series analysis. In Aim 3, we will conduct semi-structured interviews with stakeholders and convene the stakeholder network to develop an implementation plan for a larger trial. We will then integrate pilot trial and qualitative data using mixed methods analysis to assess feasibility and acceptability at the organizational, provider, and patient levels and convene to develop an implementation plan for a larger trial. Successful completion of this deployment-focused pilot study would prepare us for a future multi-site cluster randomized controlled trial assessing the effectiveness of the implementation of suicide prevention interventions delivered by CHWs in health care settings on rates of suicidal ideation and behavior for Latinx youth in pediatric primary care, with the long- term goal of addressing mental health service disparities and preventing youth suicide.