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

摘要 自杀是黑人青年的主要死亡原因，自杀意念和行为(SIB)的比率不断上升 以惊人的速度。不幸的是，系统、社区、组织、提供者、家庭和个人级别 问题/障碍增加了黑人青年SIB的风险，还阻碍了获得所需资源/服务的机会。当前 自杀预防/干预努力不足以降低黑人青年和黑人LGBTQ+SGL的SIB 青春年华。连接需要护理的个人(LINC)是一种由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。适应文化的LINC(CA- LINC)是LINC的拟议改编，以满足不同黑人青年/家庭的特定需求，由 纳入黑人社区的意见，这些社区的求助行为通常是通过非 行为健康支持，如基于黑人信仰的组织(FBO)。事实上，CA-LINC将被实施 在精神健康方面，“中心”设在黑人福利机构，以便利获得护理。在建议的混合方法中 可行性研究，将创建CA-LINC干预措施，然后针对改善风险进行试点测试 在80名黑人青年中进行检测、服务转介、治疗、连续性护理和服务参与 北卡罗来纳州夏洛特市14-17岁的黑人LGBTQ+SGL。这项研究的第一阶段将使用基于社区的 参与式研究战略，使LINC适应实用、系统、语言、文化和 不同黑人青年/家庭的发展需求。我们将确定/评估利益相关者的看法/需求 通过定性访谈增强自杀风险检测、服务转介/链接和服务参与度 (目标1a)。焦点小组将获得提供者对临床工作流程的看法/反馈，以及 执行战略(目标1b)。我们将调整服务交付组件和工作流程/实施 使用迭代过程的战略(目标1c)。在第二阶段，双臂平行比较单盲飞行员 随机对照试验(RCT)将探索CA-LINC在黑人社区中的“适合性”(即可行性)，以及 为未来的R01研究通知可扩展的随机对照试验(目标2)。我们将评估利益相关者对 CA-LINC的可接受性/适当性(目标2a)。我们将评估提供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认识 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)，并评估治疗依从性、保真度和研究保留(目标2d)。我们会 检查随机分配的黑人青年中SIB的效果大小估计(CA-LINC与通常治疗相比， Tau，没有后续护理)到精神健康中心(目标2e)。最后，我们将检查潜在变化的差异 机制(治疗联盟、服务利用、文化谦逊、家庭关系、参与度和 参与障碍)(目标2f)。这项研究有改进服务的潜力。 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.