Exploratory-Project 3

自杀是10-24奥尔兹的第二大死因，自杀率正在上升。最近 研究表明，在过去的30年里，黑人青年的自杀率令人不安地显著上升， 在黑人高中生中自我报告的自杀企图。黑人青年比白色青年 接受自杀意念或行为治疗，自杀后不太可能接受住院或门诊治疗 企图。黑人青年开始心理健康治疗的障碍包括缺乏感知需要，耻辱，不信任 提供者和治疗的困难，实际获得现有服务的困难，以及提供者缺乏文化 能力。患者导航提供了一种灵活的模型，可以解决许多这些障碍， 针对特定人群和需求，但没有很好地研究用于自杀青年。干预， 黑人青年可能需要适应，因为许多干预措施没有解决与文化有关的问题， 黑人病人这项探索性研究将调整和试点测试患者导航干预，自杀青少年 * 提高对10-18岁黑人青年的相关性和有效性 因自杀意念或行为到急诊室（艾德）就诊的年数，以增加其启动时间 精神健康治疗。我们将使用ADAPT-ITT模型系统地调整患者的要素 导航模型首先，我们将对青年和照顾者进行定性访谈。第二，我们将介绍 STA-ED提交给咨询小组，该小组将审查干预措施并就选择内容提供投入 需要调整的干预措施。适应将针对儿童和家庭文化因素，如文化 耻辱，对治疗效果的负面看法，以及问题的识别，通过提供文化上的 相关的心理教育和进行动机访谈，以解决治疗偏好， 感知。此外，干预措施将解决资源不足人群中常见的后勤障碍 黑人青年人数过多我们将在50名黑人的小型RCT中测试适应性干预 在艾德出现自杀意念或行为的青少年及其照顾者。参与者，随机分配至 将在基线时评估调整后的患者导航干预或常规增强治疗，2， 6个月我们将研究适应的实施结果（可行性，可接受性，保真度） 干预我们还将检查对主要结局（心理健康治疗开始率、时间 治疗次数）、次要结局（自杀意念）和潜在中介（心理健康 治疗动机）。这项探索性研究的信息将为心理健康提供新的知识 护理启动自杀黑人青年，并将通知NIMH应用程序，以测试患者导航干预， 一个全功能的RCT

Suicide is the second leading cause of death among 10-24 year olds and suicide rates are increasing. Recent research has shown disturbing and significant increases over the last 3 decades in suicides in Black youth and in self-reported suicide attempts among Black high school students. Black youth are less likely than White youth to be treated for suicidal ideation or behaviors, and less likely to receive inpatient or outpatient care after a suicide attempt. Barriers to Black youth starting mental health treatment include lack of perceived need, stigma, mistrust of providers and treatment, difficulties in physically accessing available services, and providers’ lack of cultural competence. Patient navigation offers a flexible model that can address many of these barriers, and can be tailored to specific populations and needs, but are not well studied for use with suicidal youth. An intervention for Black youth would likely require adaptation, as many interventions do not address culturally relevant issues for Black patients. This exploratory study will adapt and pilot test a patient navigation intervention, Suicidal Teens Accessing Treatment (STAT-ED), to increase its relevance to and effectiveness with Black youth ages 10-18 years presenting to the Emergency Department (ED) with suicidal ideation or behaviors to increase their initiation in mental health treatment. We will use the ADAPT-ITT model to systematically adapt elements of a patient navigation model. First, we will conduct qualitative interviews with youth and caregivers. Second, we will present STAT-ED to an advisory group, which will review the intervention and provide input on the selection components of the intervention to be adapted. The adaptation will target child and family cultural factors, such as cultural stigma, negative perceptions of treatment effectiveness, and problem identification, by providing culturally relevant psychoeducation and conducting motivational interviewing to address treatment preferences and perceptions. Additionally, the intervention will address logistical barriers common in under-resourced populations in which Black youth are overrepresented. We will test the adapted intervention in a small RCT with 50 Black youth presenting in the ED with suicidal ideation or behaviors and their caregivers. Participants, randomized to the adapted patient navigation intervention or enhanced treatment as usual, will be assessed at baseline, 2, and 6 months. We will examine implementation outcomes (feasibility, acceptability, fidelity) of the adapted intervention. We also will examine impact on primary outcome (rates of mental health treatment initiation, time to treatment, number of sessions), secondary outcome (suicidal ideation), and potential mediators (mental health treatment motivation). Information from this exploratory study will contribute new knowledge for mental health care initiation for suicidal Black youth and will inform a NIMH application to test patient navigation intervention in a fully-powered RCT.