Southwest Hub for American Indian Youth Suicide Prevention Research

项目摘要-研究 西南枢纽的研究部分将确定有效，可行和可持续的 干预措施，以防止自杀和促进美洲印第安人（AI）青年的复原力， 约翰霍普金斯美国印第安人健康中心（CAIH）， 白色山地阿帕奇部落（WMAT）和纳瓦霍族（NN）。这些伙伴关系的基础是 部落授权的监测，以早期识别，并采取后续行动和案件管理， 在最近的自杀企图，意念或狂欢物质使用事件后，高危青年接受治疗。在 此外，我们一直在根据当地部落数据设计和试行简短的干预措施。两个这样 我们的自杀预防研究选择了一系列干预措施进行评估。都采用 本土辅助专业人员作为任务转移急需的心理教育和促进的一种手段 在资源不足的社区继续提供护理。第一个干预，新希望（NH），是一个 由准专业社区精神卫生工作者提供的基于证据的第一阶段战略 （CMHWs）的重点是通过安全规划，情绪调节技能， 并促进了护理联系。第二，老年人的韧性（ER）干预，是一个长期的， 长者在社区保健工作者的支持下推行策略，透过增加青少年的 连通性、自尊以及文化认同和价值观。我们的主要目标是：使用顺序 多分配随机试验（SMART）设计，以评估新的四种序列中的哪一种 希望（NH），老年人复原力（ER）和案例管理（CM）对即时和 AI中的长期自杀意念（主要结局）和恢复力（次要结局） 10-24岁的青少年有自杀风险。我们假设：a）新希望与案例 单独管理将显著减少参与者的自杀意念; B）老年人的复原力与病例 管理本身将大大提高参与者的复原力; c）新希望，其次是长者 复原力对自杀意念和复原力的影响最大;及d）个案管理 在所有组合中，单独使用的效果最弱。我们的第二个目标是：1）检查 治疗效果和排序的中介者和调节者，以确定 干预措施的类型和顺序最适合哪些青年; 2）评估可接受性， 中心的核心干预组成部分的可持续性的可行性和能力， 卫星伙伴纳瓦霍、圣卡洛斯阿帕奇、华拉派和切罗基民族。由于异质性 自杀风险因素的一般和AIAN青年，并不是所有的青年都需要相同类型的 干预措施。为什么有效、什么时候有效以及对谁有效提供证据， 这对预防AI自杀工作至关重要，目前AI自杀率很高，资源有限。

Project Summary - Research The research component of the Southwest Hub will identify effective, feasible and sustainable interventions to prevent suicide and promote resilience among American Indian (AI) youth building on 20+ years of partnership between the Johns Hopkins Center for American Indian Health (CAIH), the White Mountain Apache Tribe (WMAT) and Navajo Nation (NN). The foundation of these partnerships is tribally-mandated surveillance for early identification, and follow-up and case management to connect at-risk youth to treatment after a recent suicide attempt, ideation or binge substance use episode. In addition, we have been designing and piloting brief interventions informed by local tribal data. Two such interventions were selected to be evaluated in sequence by our Suicide Prevention Study. Both employ Native paraprofessionals as a means of task-shifting much-needed psychoeducation and promoting continuity of care in underresourced communities. The first intervention, New Hope (NH), is an evidence-based first-stage strategy delivered by paraprofessional community mental health workers (CMHWs) focused on reducing immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections. The second, the Elder’s Resilience (ER) intervention, is a longer-term strategy delivered by Elders with support from CMHWs to promote resilience by increasing youth’s connectedness, self-esteem and cultural identity and values. Our Primary Aim is: to use a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate which of four sequences of New Hope (NH), Elders Resilience (ER) and Case Management (CM) has the greater effect on immediate and longer-term suicidal ideation (primary outcome) and resilience (secondary outcome) among AI adolescents ages 10-24 identified at risk for suicide. We hypothesize that: a) New Hope vs. Case Management alone will significantly reduce participant suicidal ideation; b) Elders Resilience vs. Case Management alone will significantly improve participant resilience; c) New Hope followed by Elders Resilience will have the strongest effects on suicidal ideation and resilience; and d) Case Management alone will have the weakest effects of all combinations. Our Secondary Aims are: 1) to examine mediators and moderators of treatment effectiveness and sequencing in order to determine which types and sequence of interventions is best suited for which youth; and 2) to assess the acceptability, feasibility and capacity for sustainability of the Hub’s key intervention components with core and satellite partners, the Navajo, San Carlos Apache, Hualapai, and Cherokee nations. Due to heterogeneity of suicide risk factors generally and among AIAN youth, not all youth require the same type of interventions. Generating evidence for what works, when it works and for whom is even more paramount to AI suicide prevention efforts, where rates are currently high and resources are limited.