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

PROJECT SUMMARY Suicide attempts increased by 73% among Black adolescents, and suicide attempts requiring hospitalization increased by 122% for Black adolescent boys between the years 1991-2017. 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. Our goal is to increase risk identification, treatment referral and engagement, and, in turn, reduce suicidal ideation and behavior among Black youth, addressing NIMH goals for this RFA and, more broadly, the National Action Alliance goals for youth suicide. The study's aims are to: 1) Inform and facilitate implementation of a system of care for Black youth at risk for suicide who present to the ED by assessing multiple stakeholders' (youth, parents, clinicians, support staff, administrators) perspectives regarding the WeCare system of care. We will use established implementation science frameworks to: a) determine barriers, facilitators, and recommended adaptations to WeCare before, during, and after the trial; b) ascertain WeCare acceptability and feasibility; and c) produce a WeCare implementation package that trains existing clinicians in the WeCare system of care through a user-friendly manual, training protocol, and fidelity assessment, and 2) Conduct a randomized clinical effectiveness trial with 2,200 Black Youth at risk for suicide to examine the effectiveness of WeCare. Approximately 4,257 youth, ages 12 to 17 years, enrolled from two hospital EDs in New York City, will be assessed on enrollment for risks associated with suicide, and moderate/high risk youth will be randomly assigned to WeCare vs. usual services. Survey assessments will be conducted at 3-, and 6-month follow-up, with medical record review through 12 months. As exploratory aims, we will a) examine whether impacts of WeCare are moderated by youth sex, sexual minority status, age (12-14, 15-17 years), and baseline risk for suicidality; b) conduct a cost effectiveness analysis to inform implementation, and c) understand how level of suicide risk (assessed via the CASSY) is associated with treatment engagement among those youth assigned to WeCare.