E-CONNECT: A SERVICE SYSTEM INTERVENTION FOR JUSTICE YOUTH AT RISK FOR SUICIDE

虽然在所有少年司法（JJ）处理点的青少年自杀行为（SB）的风险增加， 相关的行为健康（BH）问题，那些在社区环境中受到监督的问题（例如，试用期），可能在 最大风险：（a）身份识别和服务转介协议在安全环境中更为常见，（B） 国家政策越来越倾向于社区监督/转送，而不是监禁，（c） 社区比安全环境中的社区有更多的手段和机会，以及（d） 社区JJ青少年获得BH护理的多系统协调挑战远远大于 这些安全的照顾。我们建议调整和测试多层次服务交付模型的实用性， 增加对性健康问题和相关性健康问题的识别，指导有针对性的转诊，培训工作人员和结构 机构间合作，以增加缓刑青年对BH服务的吸收;并记录 在少年缓刑和社区中广泛实施这一模式所需的组织要素 治疗设置。该模型是基于我们早期的，基于证据的连接协议从项目连接， 并利用Connect 2007年开发中无法获得的技术进步， 早期的执行问题。在纽约州9个县工作，项目的具体目标是（1）制定一个 技术先进的跨系统识别/链接服务模式，培训工作人员， 机构间协作和转诊决策，并使用移动的应用程序无缝地将联合收割机 (a)SB和相关BH问题的筛查，（B）临床需求分类和（c）特定国家 简化BH服务的转介计划;（2）检查与基线相比， Connect改善了（a）中介PO实践成果（服务需求识别、跨系统转介） 和增加（B）青年BH服务使用（访问，参与）;和（3）阐明多层次因素（例如， 工作人员、组织、青年/家庭、社区）影响执行（可行性、可接受性 可持续性）的电子连接跨各种缓刑部门处理类别（如身份罪犯， 转移案件），以便为全面扩大规模提供信息。基于理论的机制（例如，变化 工作人员的知识和自我效能;机构的结构特征），PO实践的变化影响BH 服务使用情况亦会一并研究。在GPM和CFIR框架的指导下，这项为期5年的研究将包括4个 项目阶段：（1）开发，（2）基线数据收集，（3）实施，（4）维持。后 开发，各县被随机分配到4个波之一，以便在4个月时开始实施电子连接 阶梯楔形设计中的间隔。实施活动持续18个月，研究中心使用e-Connect 18个月后的协议将是可持续性的指标。这一举措是解决SB问题的首批举措之一， 提前JJ青年入组BH治疗。因为我们建议解决风险和急性SB，本研究 有可能查明经常被忽视的高风险、高需求青年并将其与服务联系起来。

While youth at all juvenile justice (JJ) processing points are at increased risk for suicidal behavior (SB) and associated behavioral health (BH) issues, those supervised in community settings (e.g., probation), may be at greatest risk: (a) protocols for identification and service referral are far more common in secure settings, (b) national policy increasingly favors community supervision/diversion over incarceration, (c) youth supervised in the community have far more access to means and opportunity than do those in secure settings, and (d) the multi- system coordination challenges to accessing BH care for community JJ youth are far greater than for those secure care. We propose to adapt and test the utility of a multi-level service delivery model that increases identification of SB and related BH problems, guides targeted referral, trains staff and structures interagency collaboration to increase uptake of BH services by youth on probation; and document the organizational elements required to widely-implement this model in juvenile probation and community treatment settings. The model is based on our earlier, evidence-based linkage protocols from Project Connect, and capitalizes on technological advances unavailable at Connect’s 2007 development, so as to address earlier implementation issues. Working in 9 NYS counties, project specific aims are (1) to develop a technologically advanced cross-system identification/linkage service model that trains staff, formalizes interagency collaboration and referral decision-making and uses a mobile application to seamlessly combine (a) screening for SB and related BH problems, (b) classification of clinical need and (c) county-specific streamlined referral plans for BH services; (2) to examine the degree to which, compared to Baseline, e- Connect improves (a) intermediary PO practice outcomes (service need identification, cross-system referral) and increasing (b) youth BH service use (access, engagement); and (3) to elucidate multi-level factors (e.g., staff, organizational, youth/family, community,) that influence implementation (feasibility, acceptability, sustainability) of e-Connect across various probation department processing categories (e.g. status offenders, diversion cases) to inform comprehensive scale-up. The theoretically based mechanisms (e.g., changes in staff knowledge and self-efficacy; agency structural characteristics) by which PO practice change affects BH service use will also be examined. Guided by the GPM and CFIR framework, this 5-year study will comprise 4 project phases: (1) Development, (2) Baseline data collection, (3) Implementation, and (4) Sustainment. After development, counties are randomized to one of 4 Waves to begin implementation of e-Connect at 4-month intervals in a stepped-wedge design. Implementation activities continue for 18m and sites’ use of e-Connect protocols after 18m will be an indication of sustainability. This initiative is one of the first to address SB and advance JJ youth enrollment in BH treatment. Because we propose addressing risk and acute SB, this study has the likelihood of identifying and linking to services high-risk, high need youth that are often overlooked.