CA-LINC: A Culturally Adapted Care Coordination Suicide Detection and Intervention Model for Black Youth

摘要 自杀是黑人青年死亡的主要原因，自杀意念和行为（SIB）的比率不断增加 以惊人的速度。不幸的是，系统，社区，组织，提供者，家庭和个人层面 问题/障碍增加了黑人青年SIB的风险，也阻碍了获得所需的资源/服务。电流 自杀预防/干预工作不足以减少黑人青年和黑人LGBTQ+SGL的SIB 青年链接个人需要护理（LINC）是一个消费者和理论驱动的护理协调干预 旨在通过提高服务参与度和交付标准来减少SIB。文化适应LINC（CA- LINC）是LINC的一个拟议的适应，以满足不同的黑人青年/家庭的具体需求， 纳入黑人社区的意见，他们的求助行为往往是通过非 行为健康支持，如黑人信仰组织（FBO）。事实上，CA-LINC将在 在黑人家庭组织的精神健康“中心”，以方便获得护理。在建议的混合方法中， 可行性研究，将创建CA-LINC干预措施，然后进行试点测试，以改善风险 检测，服务转介，治疗，护理的连续性和服务参与80黑人青年和 黑人LGBTQ+SGL年龄14-17在夏洛特，北卡罗来纳州。本研究的第一阶段将使用基于社区的 参与式研究战略，以适应LINC解决实际的，系统的，语言的，文化的， 不同的黑人青年/家庭的发展需求。我们将确定/评估利益相关者的看法/需求， 通过定性访谈，加强自杀风险检测、服务转介/联系和服务参与 (Aim 1a）。焦点小组将获得提供者对临床工作流程的看法/反馈， 实施战略（目标1b）。我们将调整服务交付组件和工作流程/实施 使用迭代过程的策略（目标1c）。在II期，一项双臂平行比较单盲试验性研究 随机对照试验（RCT）将探索“适合”（即，在黑人社区实施CA-LINC的可行性， 通知未来R 01研究的可扩展RCT（目标2）。我们将评估利益相关者的看法， CA-LINC的可接受性/适当性（目标2a）。我们将评估供应商和社区利益相关者 对利用现有社区实施和维持CA-LINC的实用性和整合性的看法 资源/基础设施（目标2b）。我们将评估筛选、招募、 和随机化（目标2c），并评价治疗依从性、保真度和研究保留率（目标2d）。我们将 检查随机分配的黑人青年中SIB的效应量估计值（CA-LINC vs.治疗为安慰剂， TAU，没有后续护理）到精神卫生中心（目标2 e）。最后，我们将研究潜在变化的差异 机制（治疗联盟，服务利用，文化谦逊，家庭关系，参与， CA-LINC和TAU之间的参与障碍（目标2f）。这项研究有可能改善服务 提供标准，降低黑人青年的自杀风险，并支持NIMH降低自杀率的目标。

ABSTRACT Suicide is a leading cause of death for Black youth with rates of suicide ideation and behaviors (SIB) increasing at alarming rates. Unfortunately, systemic, community, organizational, provider, family, and individual level problems/barriers increase Black youth SIB risk and also block access to needed resources/services. Current suicide prevention/intervention efforts are not sufficient to decrease SIB in Black youth and Black LGBTQ+SGL youth. Linking Individuals Needing Care (LINC) is a consumer- and theory-driven care coordination intervention designed to reduce SIB by improving service engagement and delivery standards. Culturally Adapted LINC (CA- LINC) is a proposed adaptation of LINC to meet the specific needs of diverse Black youth/families, by incorporating input from Black communities whose help-seeking behaviors are often facilitated through non- behavioral health supports such as Black faith-based organizations (FBO). In fact, CA-LINC will be implemented in mental health “hubs” located in Black FBOs to facilitate access to care. In the proposed mixed-methods feasibility study, the CA-LINC intervention will be created and then pilot-tested relative to improving risk detection, service referrals, treatment, continuity of care, and service engagement among 80 Black youth and Black LGBTQ+SGL ages 14-17 in Charlotte, North Carolina. Phase I of this study will use community-based participatory research strategies to adapt LINC to address the practical, systemic, linguistic, cultural, and developmental needs of diverse Black youth/families. We will identify/assess stakeholder perceptions/needs to enhance suicide risk detection, service referrals/linkages, and service engagement using qualitative interviews (Aim 1a). Focus groups will obtain provider perceptions/feedback on clinical workflow processes and implementation strategies (Aim 1b). We will adapt service delivery components and workflow/implementation strategies using an iterative process (Aim 1c). In Phase II, a two-arm parallel-comparison single-blinded pilot randomized controlled trial (RCT) will explore the “fit” (i.e., feasibility) of CA-LINC in Black communities, and inform a scalable RCT for a future R01 study (Aim 2). We will assess stakeholder perceptions on acceptability/appropriateness of CA-LINC (Aim 2a). We will assess provider and community stakeholder perceptions on the practicality and integration of implementing and sustaining CA-LINC using existing community resources/infrastructure (Aim 2b). We will evaluate the feasibility of study procedures for screening, recruitment, and randomization (Aim 2c) and evaluate treatment adherence, fidelity, and study retention (Aim 2d). We will examine effect size estimates for SIB among Black youth randomly assigned (CA-LINC vs. Treatment as Usual, TAU, no follow-up care) to mental health hubs (Aim 2e). Lastly, we will examine differences in potential change mechanisms (therapeutic alliance, service utilization, cultural humility, family relationships, engagement, and barriers to participation) between CA-LINC and TAU (Aim 2f). This study has the potential for improving service delivery standards, reducing suicide risk among Black youth, and supporting NIMH’s goal to reduce suicide rates.