From Court to the Community: Improving Access to Evidence-Based Treatment for Underserved Justice-Involved Youth At-Risk for Suicide

项目总结 生活在社区的涉及正义的青年(Jiy)经历了不成比例的高自杀念头 与一般人群中的青少年相比，青少年的性行为(STB)和非自杀性自伤(NSSI)的发生率更高。许多 Jiy无法获得专门为治疗NNSI和STB而设计的循证治疗，从而增加了 这一人群中自杀的总体风险。此外，即使Jiy确实可以获得循证治疗， 这一人群的治疗启动率很低。目前的建议旨在降低Jiy之间的机顶盒和NSSI，以及 从而减少这一弱势和未得到充分服务的青年群体的心理健康差距。我们的主要目标是 实施旨在增加循证治疗策略可获得性的系统级干预 专为治疗Jiy的STB和NSSI行为而设计的Rhode Island提到的门诊护理 家事法庭。我们将进行一项整群随机阶梯楔形试验，在这项试验中，9个不同的社区心理 在罗德岛州为Jiy提供服务的卫生机构(CMHA)将随机接受标准化的 培训计划。选定数量的CHMA管理员和提供者将完成半结构化 实施前的定性访谈，以评估机构/系统级别和提供商级别的因素，这些因素可能 促进或阻碍妇幼保健机构对STB和NSSI循证治疗策略的接受 住在社区里。量化数据将评估组织、提供商和年轻人的特征和意愿 通过问卷方式收集CMHA提供者填写的电子病历前 实施、立即实施和9个月的维持。据推测，在 系统层面，培训计划将由CMHA持续至少一年至最多三年 管理员。在提供者一级，假定使用循证治疗的培训 STB和NSSI的战略将显著提高这些战略的使用和质量 在一年的随访期内交付。在患者层面上，我们假设培训计划将有所改善 父母坚持门诊治疗，降低青少年STB和NSSI患病率 我们医疗保健系统中的紧急医疗/精神护理。我们的次要目标是检查 影响居住在社区的济阳居民的治疗积极性。我们将招募180名智联青年的照顾者 对最近的NSSI/STB筛查呈阳性，以检验以下假设：Jiy的照顾者被随机分配到 心理教育/行动计划的条件，与教育视频相比，更有可能 在CMHA开始治疗。照顾者将在基线后3个月和6个月完成后续评估 评估他们的青少年是否开始治疗，以及青少年参加了多少次治疗。这 应用程序与NIMH的战略目标3.3紧密一致：“测试干预措施的有效性 社区实践环境，以及RFA-MH-21-187测试有效的系统级策略的目标 发现和预防SIB和/或NSSI，特别是在服务不足的儿童和青少年中。

PROJECT SUMMARY Justice-involved youth (JIY) living in the community experience disproportionately high rates of suicidal thoughts and behavior (STB) and non-suicidal self-injury (NSSI) compared to adolescents in the general population. Many JIY lack access to evidence-based treatment specifically designed to treat NNSI and STB, thereby increasing the overall risk of suicide in this population. Further, even when JIY do have access to evidence-based treatment, treatment initiation in this population is low. The current proposal aims to reduce STB and NSSI among JIY, and thus reduce mental health disparities in this vulnerable and underserved youth population. Our primary aim is to implement a systems-level intervention designed to increase access to evidence-based treatment strategies specifically designed to treat STB and NSSI behaviors for JIY referred to outpatient care by the Rhode Island Family Court. We will conduct a cluster randomized stepped wedge trial in which 9 distinct community mental health agencies (CMHA) who serve JIY in the state of Rhode Island will be randomized to receive a standardized training program. A select number of CHMA administrators and providers will complete semi-structured qualitative interviews pre-implementation to assess agency/system-level and provider-level factors that may promote or hinder the uptake of evidenced-based treatment strategies for STB and NSSI in CMHAs serving JIY living in the community. Quantitative data will assess organizational, provider, and youth characteristics and will be collected through questionnaires CMHA providers complete and from the electronic medical record pre- implementation, immediately post-implementation, and 9-months into sustainment. It is hypothesized that at the systems level, the training program will be sustained for at least one year and up to 3 years by CMHA administrators. At the provider level, it is hypothesized that training in the use of evidence-based treatment strategies for STB and NSSI will significantly increase both the use of these strategies and the quality of their delivery over a year’s follow-up period. At the patient level, we hypothesize that the training program will improve parental adherence to outpatient treatment and reduce rates of adolescent STB and NSSI that require emergency medical/psychiatric care in our healthcare system. Our secondary aim is to examine factors that influence treatment initiation among JIY living in the community. We will enroll 180 caregivers of JIY youth who screen positive for recent NSSI/STB to test the hypothesis that JIY whose caregivers are randomized to the psychoeducation/action plan condition, compared to an educational video, will be significantly more likely to initiate treatment at a CMHA. Caregivers will complete follow-up assessments at 3- and 6-months post-baseline to assess whether their adolescent initiated treatment and how many sessions the adolescent attended. This application has strongly aligns with NIMH’s Strategic Objective 3.3: “Test interventions for effectiveness in community practice settings,” and the goals of the RFA-MH-21-187 to test effective “systems-level strategies for the detection and prevention of SIB and/or NSSI specifically among underserved children and adolescents.”