Cognitive Behavioral Therapy for Treatment-Seeking to Improve Treatment Engagement and Reduce Suicide Risk Among Deaf Individuals

ABSTRACT Deaf individuals are one of the most understudied and underserved cultural populations in the field of mental health. While limited, data suggests significant mental health disparities among Deaf adults including higher rates of suicidal thoughts and behaviors; yet, they have low rates of mental health treatment engagement. The Candidate’s long-term goal is to develop and test evidence-based interventions for Deaf adults to promote mental health and reduce suicide risk. Reaching that goal requires mentored training in three domains of clinical research, and completion of a research project to produce foundational results (described below). First, the candidate needs to gain expertise in the design, execution, and analysis of randomized controlled trials (RCT) with Deaf individuals (Objective 1) to successfully conduct RCTs in a reliable, valid, and ethical manner, and test target engagement with an experimental therapeutics approach. Second, the candidate needs to gain knowledge and skills related to research with subjects at elevated risk for suicide (Objective 2) to safely and effectively conduct suicide prevention and treatment research. Third, the candidate needs to gain knowledge and skills to support ease of implementation of her interventions in varied contexts including deployment-ready and principle-driven intervention development, and implementation science (Objective 3). The principal objectives of the proposed research study are to use deployment-ready intervention development and implementation science methods to develop an interventionist training and monitoring program for Cognitive Behavioral Therapy for Treatment-Seeking for Deaf individuals (Deaf CBT-TS; Aim 1), and conduct an RCT using an experimental therapeutics approach to examine whether the intervention can modify beliefs about treatment (intervention principles) and increase treatment-seeking behaviors (target mechanism; Aim 2). Secondary objectives include exploring the intervention’s potential to increase hope and reduce indicators of suicide risk (mental health symptoms, alcohol use, suicide ideation; Aim 3), and identifying factors that may impact the efficacy of Deaf CBT-TS including acculturative stress and the availability of Deaf-accessible treatment resources to understand factors that may impact the implementation of the intervention in varied health service settings (Aim 4). One hundred Deaf sign language using adults with clinically significant symptoms of depression, anxiety, PTSD, insomnia, alcohol use disorder, and/or suicide ideation (oversample 50%), who are not engaged in treatment will be randomized to Deaf CBT-TS (2 sessions) or a waitlist control group. Half of the subjects will be from Rochester (Deaf-specialty treatment resources) and half will be from across the U.S. Subjects will complete baseline, 2- and 4-month follow-up assessments. Results of this K23 project will function as a basis for a larger R01 of a fully powered RCT examining clinical outcomes (i.e., reductions in indicators of suicide risk) and the mediation effect of treatment engagement.