Integrating the Youth Nominated Support Team (YST) with CBT for Black Youth with Acute Suicide Risk

项目摘要 最近的数据显示，黑人青年的自杀死亡率惊人地增加， 在获得和参与门诊精神卫生保健方面的差距。尽管有这一迫切需要， 没有成熟的心理社会治疗自杀风险与证明在黑人青年的有效性。 常用的方法（例如，CBT）倾向于关注与自杀相关的内在因素 痛苦，如认知扭曲和情绪失调，对人际因素的关注有限 (e.g.,联系，社会支持），这是建议作为一种自杀预防策略，并可能是 专门保护黑人青年。青年提名支持团队（YST）旨在 在急性自杀危机后拒绝治疗，特别关注人际关系， 并被SAMHSA指定为“有希望的干预措施”。YST创建了一个青年队提名 接受教育和指导的成年人，每周为高危青年提供支持性联系， 鼓励青少年参与治疗。YST是美国唯一的个人自杀预防策略。 美国有证据表明与减少自伤死亡率有关;参加YST也与 提高治疗利用率。为了满足这一迫切需要和RFA-MH-22-125，拟议项目将 使用基于社区的参与式研究（CBPR）策略，反复开发和试点测试两个- 组成部分的心理社会干预，认知行为治疗预防自杀加上青年， 指定支持团队（CBT-SP+YST），适用于12-17岁的青少年，在艾德因急性 自杀风险鉴于对黑人青年进行的干预发展研究很少， 黑人青年自杀死亡率的增加，以及社会支持干预可能 特别是对黑人青年的保护，CBT-SP+YST的初步发展将侧重于文化定制， 底特律/韦恩县公共精神卫生系统服务的黑人青年。嵌入在一个混合体中 有效实施框架，我们将1）整合一个创新的可扩展的计算机辅助版本 YST（E-YST）与CBT-SP，根据社区利益相关者的投入调整干预内容， 2)开展可行性试点; 3）开展试点RCT，以检查理论化的行动机制，青年 结果，干预的可行性/可接受性，以及在这一人群中实施的障碍 黑人青年保险完成拟议的研究是取得更大规模成效的第一步 这项试验将由创新的计算机辅助E-YST平台提供便利。融合 这两项战略的调整有可能解决紧迫的公共卫生问题，同时利用 在黑人青年周围的家庭、学校和社区机构中发现的固有优势。

Project Abstract Recent data show alarming increases in suicide mortality among Black youth combined with concerning disparities in access to and engagement in outpatient mental health care. Despite this urgent need, there are no well-established psychosocial treatments for suicide risk with demonstrated effectiveness in Black youth. Commonly used approaches (e.g., CBT) tend to focus on intrapersonal factors associated with suicide-related distress, such as cognitive distortions and emotion dysregulation, with limited focus on interpersonal factors (e.g., connectedness, social support), which are recommended as a suicide prevention strategy, and may be specifically protective for Black youth. The Youth Nominated Support Team (YST) was designed to be adjunctive to treatment following an acute suicide crisis, is specifically focused on intrapersonal connections, and has been designated a “promising intervention” by SAMHSA. YST creates a team of youth- nominated adults who receive education and guidance, provide weekly supportive contacts for high-risk youth, and encourage youth participation in treatment. YST is the only individual-level suicide prevention strategy in the U.S. with evidence of association with reduced self-injury mortality; participation in YST is also linked to increased treatment utilization. In response to this urgent need and RFA-MH-22-125, the proposed project will use a community-based participatory research (CBPR) strategy to iteratively develop and pilot test a two- component psychosocial intervention, Cognitive-Behavioral Therapy for Suicide Prevention plus the Youth- Nominated Support Team (CBT-SP+YST) for adolescents, ages 12-17 years, following an ED visit for acute suicide risk. Given the paucity of intervention development research conducted with Black youth, the alarming increases in suicide mortality among Black youth, and the possibility that social support interventions may be particularly protective for Black youth, this initial development of CBT-SP+YST will focus on cultural tailoring for Black youth served by Detroit/Wayne County’s public mental health system. Embedded within a hybrid one effectiveness-implementation framework, we will 1) integrate an innovative scalable computer assisted version of YST (E-YST) with CBT-SP, tailoring intervention components based on input from community stakeholders, 2) conduct a feasibility pilot and 3) conduct a pilot RCT to examine theorized mechanisms of action, youth outcomes, intervention feasibility/acceptability, and barriers to implementation in this population of publicly insured Black youth. Completion of the proposed study is the first step towards a larger-scale effectiveness trial, which will be facilitated by the innovative computer-assisted E -YST platform. The integration and tailoring of these two strategies has the potential to address an urgent public health concern while capitalizing on the inherent strengths found in the families, schools, and community institutions that surround Black youth.