Answering the Alarm: A System of Care for Black Youth at Risk for Suicide

项目总结 黑人青少年的自杀企图增加了73%，自杀企图 需要住院的黑人青少年男孩在1991年间增加了122%- 2017年。许多自杀的黑人青年身份不明，只有不到一半的人被转介接受治疗 急诊科就诊后，许多转诊青年不坚持治疗。 然而，之前的研究还没有检查过照顾黑人青年的系统的有效性 将自杀风险筛查与干预相结合，以加强与高质量心理健康的联系 服务。我们的目标是增加风险识别、治疗转介和参与，并在 反过来，减少黑人青年中的自杀念头和行为，解决NIMH为此的目标 RFA，以及更广泛地说，国家行动联盟的青年自杀目标。这项研究的目的 目的是：1)告知和促进实施关爱处于危险中的黑人青年的制度 通过评估多个利益相关者(青少年、父母、临床医生、 支持人员、管理员)对WeCare护理系统的看法。我们将使用 建立实施科学框架，以：a)确定障碍、促进者和 试验前、试验中和试验后对WeCare的建议适应；b)确定WeCare 可接受性和可行性；以及c)制定一套WeCare实施方案，培训 现有临床医生在WeCare系统中通过用户友好的手册、培训 协议和保真度评估，以及2)进行随机临床疗效试验 2200名有自杀危险的黑人青年来检查WeCare的有效性。大致 4,257名12岁至17岁的年轻人将从纽约市的两家医院急诊室登记 根据与自杀相关的风险登记进行评估，中高风险青年将 随机分配给WeCare和常规服务。调查评估将在3：00进行， 随访6个月，复查病历12个月。作为探索的目标，我们 将a)审查WeCare的影响是否受到青年性别、性或性别的影响 少数族裔身份、年龄(12-14岁、15-17岁)和自杀风险基线；b)执行费用 为实施提供信息的有效性分析，以及c)了解自杀风险水平 (通过Cassy评估)与这些青年中的治疗参与度有关 分配给WeCare。

PROJECT SUMMARY Suicide attempts increased by 73% among Black adolescents, and suicide attempts requiring hospitalization increased by 122% for Black adolescent boys between the years 1991- 2017. Many suicidal Black youth are unidentified, fewer than half are referred to treatment following an emergency department visit, and many referred youth do not adhere to treatment. Yet, prior research has not examined the effectiveness of a system of care for Black youth that combines suicide risk screening with an intervention to enhance linkage to quality mental health services. Our goal is to increase risk identification, treatment referral and engagement, and, in turn, reduce suicidal ideation and behavior among Black youth, addressing NIMH goals for this RFA and, more broadly, the National Action Alliance goals for youth suicide. The study’s aims are to: 1) Inform and facilitate implementation of a system of care for Black youth at risk for suicide who present to the ED by assessing multiple stakeholders’ (youth, parents, clinicians, support staff, administrators) perspectives regarding the WeCare system of care. We will use established implementation science frameworks to: a) determine barriers, facilitators, and recommended adaptations to WeCare before, during, and after the trial; b) ascertain WeCare acceptability and feasibility; and c) produce a WeCare implementation package that trains existing clinicians in the WeCare system of care through a user-friendly manual, training protocol, and fidelity assessment, and 2) Conduct a randomized clinical effectiveness trial with 2,200 Black Youth at risk for suicide to examine the effectiveness of WeCare. Approximately 4,257 youth, ages 12 to 17 years, enrolled from two hospital EDs in New York City, will be assessed on enrollment for risks associated with suicide, and moderate/high risk youth will be randomly assigned to WeCare vs. usual services. Survey assessments will be conducted at 3-, and 6-month follow-up, with medical record review through 12 months. As exploratory aims, we will a) examine whether impacts of WeCare are moderated by youth sex, sexual or gender minority status, age (12-14, 15-17 years), and baseline risk for suicidality; b) conduct a cost effectiveness analysis to inform implementation, and c) understand how level of suicide risk (assessed via the CASSY) is associated with treatment engagement among those youth assigned to WeCare.