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

The overall goal of this study is to respond to the urgent need for an effective suicide prevention strategy for Black youth by examining the effectiveness of a systems-level strategy to recognize and respond to suicide risk among Black adolescents who present to emergency departments (EDs). This strategy, WeCare, combines two evidence-based strategies -- universal screening using the Computerized Adaptive Screen for Suicidal Youth and an adapted version of the SAFETY-ACUTE, which incorporates PI Lindsey's extensive work with Black youth, their families, and community stakeholders to develop culturally tailored strategies for addressing treatment barriers (MCI, Lindsey et al., 2009). Study objectives are to integrate input from multiple stakeholders to inform and facilitate WeCare implementation, and to use a hybrid one effectiveness-implementation design to evaluate its effectiveness.

From 1991 through 2017, suicide attempts increased by 73% among Black high school-aged youth, and suicide attempts requiring hospitalization increased by 122% for Black high school-aged boys. These alarming findings, in part, led to the creation of the Emergency Taskforce on Black Youth Suicide and Mental Health and their subsequent report, Ring the Alarm: The Crisis of Black Youth Suicide in America, and passage of the Pursuing Equity in Mental Health Act. These all highlight the urgent need to improve suicide risk detection, treatment, and prevention among Black youth. The challenges of suicide prevention among Black youth are manifold. 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. We propose to respond to these challenges and the urgent need for an effective suicide prevention strategy for Black youth by examining the effectiveness of an "easily implementable," "systems-level" strategy to recognize and respond to suicide risk among Black youth who present to emergency departments (EDs). Our strategy, WeCare, combines two evidence-based strategies -- universal screening using the Computerized Adaptive Screen for Suicidal Youth (CASSY) and an adapted version of the SAFETYACUTE that incorporates PI Lindsey's extensive work with Black youth, their families, and community stakeholders to develop culturally tailored strategies for addressing treatment barriers, with a technological adaptation for increased feasibility (i.e., follow-up text messaging). Implementation theory and research emphasizes the importance of obtaining input from multiple levels of stakeholders, including consumers (youth and their parents), providers (ED clinicians), medical directors and program administrators, and policy makers across the phases of intervention adaptation and implementation prior to an effectiveness trial of WeCare. Although we are not revising the core components of SAFETY-A, this framework will enable us to culturally tailor SAFETY-A for Black youth and technologically update it to use text messages (instead of telephone calls). The ED is an optimal setting to test this strategy because ED visits for youth suicide risk have more than doubled in recent years, EDs are a common point of access for mental health services, and parents and youth view suicide risk screening in the ED favorably. Our goal is to increase risk identification, treatment referral and engagement, and, in turn, reduce suicidal ideation and behavior among Black youth.

WeCare is a system of care that combines two evidence-based strategies -- universal screening using the Computerized Adaptive Screen for Suicidal Youth (CASSY) and an adapted version of the SAFETY ACUTE that incorporates PI Lindsey's extensive work with Black youth, their families, and community stakeholders to develop culturally tailored strategies for addressing treatment barriers, with a technological adaptation for increased feasibility (i.e., follow-up text messaging).

WeCare combines two evidence-based strategies -- universal screening using the Computerized Adaptive Screen for Suicidal Youth and an adapted version of the SAFETY-ACUTE, which incorporates PI Lindsey's extensive work with Black youth, their families, and community stakeholders to develop culturally tailored strategies for addressing treatment barriers.

This measure assesses mental health service utilization from 50 patient care locations in New York City via electronic medical records.

This measure is a 5-item semi-structured interview to assess suicidal behavior (actual, interrupted, aborted suicide attempts; preparatory behavior).

Inclusion Criteria: Inclusion criteria adolescent and parent/guardians: Adolescents aged 12-17 years and their parents or guardians Having a parent/caregiver present in the emergency department to consent Having a cellular phone Adolescent able to speak English, and understand study questions Parents able to consent in English, Spanish, or Creole Meet screening criteria Inclusion criteria for ED clinical providers and administrative stakeholders: Currently employed at Kings or Harlem Hospital and working in the hospital ED on at least a half-time basis Age 18 or above Exclusion Criteria: Exclusion criteria adolescent and parent/guardians: Adolescent is medically unstable Adolescent present with severe cognitive impairment Parents are not present in the ED and available to give consent in either English, Spanish, or Creole Adolescent does not have access to cellular phone Exclusion criteria for ED clinical providers and administrative stakeholders: 1. Not currently employed at least part-time in the hospital ED