Improving screening and follow-up for suicidal ideation and behaviors among Latinx youth in primary care

项目总结/摘要 该提案的目的是制定和试行儿科系统级战略， 初级保健，以加强识别和管理自杀意念和行为， 拉丁裔青年，特别是那些父母英语水平有限的移民家庭 熟练程度（LEP）。我们将重点使用经过培训的社区卫生工作者， 提高诊所自杀风险筛查和早期干预的能力和质量，重点是 安全规划、家长心理教育和护理协调。我们的具体目标是1： 为将CHW纳入SIB筛查制定针对具体地点的实施方案 为拉丁裔青年及其家庭制定安全规划; 2：试点实施 该计划在四个儿科初级保健实践中进行了为期六个月的开放试验，代表了一系列 3：让利益攸关方网络参与探讨障碍， 促进者，包括成本和计费策略，以在整个 广泛的儿科初级保健设置。在目标1中，我们将使用实现映射， 结合用户观点的系统过程（例如，家庭），实施者（例如， 诊所工作人员）、采用者（如诊所管理人员）和维持者（如医疗保健服务提供 专家和付款人），指导制定战略， 在四个参与儿科实践的循证干预。在目标2中，我们将评估 可行性、可接受性和对组织的影响（例如，增加筛查和CHW 转诊，参与后续心理健康访问）和患者水平的结果（例如， 改善家庭功能、育儿自我效能）。定量数据（例如，率变动 筛选）将使用中断时间序列分析进行检查。在目标3中，我们将 与利益相关者进行半结构化访谈，并召集利益相关者网络， 更大规模试验的实施计划然后，我们将整合试点试验和定性数据 使用混合方法分析来评估组织的可行性和可接受性， 提供者和患者级别，并召集会议制定更大规模试验的实施计划。 成功完成这项以部署为重点的试点研究将为我们做好准备， 一项未来的多中心随机对照试验，评估 社区卫生工作者在医疗机构实施自杀预防干预措施， 在儿科初级保健中，拉丁裔青年的自杀意念和行为率， 解决心理健康服务差距和预防青少年自杀的长期目标。

Project Summary/Abstract The objective of this proposal is to develop and pilot a systems-level strategy in pediatric primary care to enhance identification and management of suicidal ideation and behavior in Latinx youth, particularly those in immigrant families with parents who have limited English proficiency (LEP). We will focus on the use of trained community health workers (CHWs) to increase clinic capacity and quality of suicide risk screening and early intervention, with a focus on safety planning, parent psychoeducation and care coordination. Our specific aims are 1: To develop site-specific implementation protocols for the integration of CHWs into SIB screening and safety planning for Latinx youth and their families; 2: To pilot the implementation of the program in a six-month open trial in four pediatric primary care practices representing a range of usual practice settings; and 3: To engage a stakeholder network to explore barriers and facilitators, including costs and billing strategies, to implementation of this approach across a broad range of pediatric primary care settings. In Aim 1, we will use Implementation Mapping, a systematic process incorporating the perspectives of users (e.g., families), implementers (e.g., clinic staff), adopters (e.g. clinic administrators) and sustainers (e.g. healthcare service delivery experts and payors) to guide development of strategies to adopt, implement and maintain an evidence-based intervention in the four participating pediatric practices. In Aim 2, we will assess feasibility, acceptability, and impact on organizational (e.g., increase in screening and CHW referral, engagement in follow-up mental health visits) and patient-level outcomes (e.g., improved family functioning, parenting self-efficacy). Quantitative data (e.g., changes in rates of screening) will be examined using an interrupted time series analysis. In Aim 3, we will conduct semi-structured interviews with stakeholders and convene the stakeholder network to develop an implementation plan for a larger trial. We will then integrate pilot trial and qualitative data using mixed methods analysis to assess feasibility and acceptability at the organizational, provider, and patient levels and convene to develop an implementation plan for a larger trial. Successful completion of this deployment-focused pilot study would prepare us for a future multi-site cluster randomized controlled trial assessing the effectiveness of the implementation of suicide prevention interventions delivered by CHWs in health care settings on rates of suicidal ideation and behavior for Latinx youth in pediatric primary care, with the long- term goal of addressing mental health service disparities and preventing youth suicide.