WeCare: A System of Care for Black Youth (WeCare)

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

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). The proposed strategy, WeCare, combines combines three components: (1) universal screening using the Computerized Adaptive Screen for Suicidal Youth (CASSY), (2) a brief intervention designed for Black youth with elevated suicide risk in for ED settings, Connections for Safety (CFS), that combines safety planning and strategies to support linkage to outpatient mental health services, and (3) supportive text messages to youth and parent/caregivers for six weeks following the youth's ED visit. Study objectives are (1) to integrate input from multiple stakeholders to inform and facilitate WeCare implementation, and (2) to use a hybrid one effectiveness-implementation design to evaluate its effectiveness.

Study Overview

• Status: Not yet recruiting
• Conditions: Suicidal Ideation
• Intervention / Treatment: Behavioral: WeCare

Detailed Description

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 Act. These all highlight the urgent need to improve suicide risk detection, treatment, and prevention among Black youth.

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 EDs. WeCare combines (1) CASSY, a universal screening; (2) CFS, an intervention with elements from SAFETY-Acute (SAFETY-A), an evidence-based, family-centered intervention to safety planning for children and adolescents; (3) Safety Planning Intervention (SPI), a brief ED-based intervention of a written list prioritizing coping strategies and sources of support to alleviate a suicidal crisis; (3) Making Connections Intervention (MCI), a mental health engagement intervention for Black adolescents and their parents; and (4) a follow-up text messaging support system for youth and parents will be introduced for enhanced feasibility.

This study is a randomized clinical effectiveness trial with 2,200 Black youth at risk for suicide to examine the effectiveness of WeCare. Youth, ages 12 to 19 years, enrolled from two hospital EDs in New York City, will be assessed on enrollment for risks associated with suicide. 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 to examine the effectiveness of WeCare and mediators of WeCare effects. The objective is to increase risk identification, treatment referral and engagement, and, in turn, reduce suicidal ideation and behavior among Black youth.

• Study Type: Interventional
• Enrollment (Estimated): 2200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Damali Wilson, PhD; Phone Number: (212) 992-9726; Email: damali.wilson@nyu.edu
• Study Contact Backup: Name: Michael A Lindsey, PhD; Phone Number: (212) 998-5959; Email: michael.lindsey@nyu.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 17 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion criteria adolescent and parent/guardians:

• Adolescents aged 12-17 years and their parents or guardians, and adolescents 18-19 years who have the option for their parent or guardian to participate
• Having a parent/caregiver present in the ED to consent (12-17 year olds, only)
• Having a cellular phone with text messaging capacity
• Adolescent able to speak English, and understand study questions
• Parents able to consent in English, Spanish, French or Creole
• Meet screening 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, French or Creole (12-17 year olds, only)
• Adolescent does not have access to cellular phone
• Adolescents active in mental health treatment (e.g., seen a therapist, social worker, or mental health provider in the last week)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: WeCare; WeCare system of care - universal screening, ED-based intervention, text message follow-up.	Behavioral: WeCare; 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.
No Intervention: Usual Services; Usual care for youth presenting to the ED will be the control condition.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mental Health Outpatient Visits (Electronic Medical Record)	This measure assesses mental health service utilization from 50 patient care locations in New York City via electronic medical records.	Baseline, Months 3 and 6
Columbia-Suicide Severity Rating Scale	This measure is a semi structured interview to assess suicidal ideation and attempt This measure is a semi structured interview to assess suicidal ideation and attempt behavior (actual, interrupted, aborted suicide attempts; preparatory behavior).	Baseline, Months 3 and 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Attitudes Toward Psychological Help Scale	This measure assesses psychological factors, including stigma, perceived relevance of treatment, etc. that impact one's perceptions and attitudes about using formal mental health treatment services.	Baseline, Months 3 and 6
Barriers	This measure captures barriers to MH treatment participation identified in PI Lindsey's prior work with Black youth and families.	Baseline, Months 3 and 6
Caregiver Knowledge of Mental Health Services (Therapy Survey)	This measures expectations about treatment at a children's psychiatric clinic (caregiver).	Baseline, Months 3 and 6
ED STARS Mental Health Service Use	This measure assesses mental health service utilization, efforts to link to services, linkage, and engagement with outpatient MH services (caregiver).	Baseline, Months 3 and 6
Hopelessness	This measure targets recent feelings of hopelessness and hope.	Baseline, Months 3 and 6
Parent-Family Connectedness Scale	This measure assesses familial connectedness.	Baseline, Months 3 and 6
How I Feel about Friends	This measure assesses peer connectedness.	Baseline, Months 3 and 6
Peer Victimization and Perpetration	This measure assesses bullying.	Baseline, Months 3 and 6
Urgency Premeditated Perseverance Sensation Seeking Subscale	This measure assesses impulsivity.	Baseline, Months 3 and 6
Mental Health Service Use	This measure assesses lifetime mental health service use (caregiver).	Baseline, Months 3 and 6
Stages of Change	This measure assesses adolescents' willingness to change.	Baseline, Months 3 and 6
Barriers to Treatment Participation Scale	This measure assesses barriers to treatment (caregiver).	Baseline, Months 3 and 6

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-Efficacy	This measure assesses adolescents' confidence in use of different coping behaviors (commonly incorporated in safety plans) when experiencing suicidal thoughts.	Baseline, Months 3 and 6
YRBS-Alcohol	This measure assesses alcohol use.	Baseline, Months 3 and 6
Drug Use Scale	This measure assesses adolescents' behaviors related to drug use.	Baseline, Months 3 and 6
YRBS-Physical Fights	This item measures frequency of physical fighting.	Baseline, Months 3 and 6
Lethal Means Restriction	This measure assesses adolescents' access to lethal means (caregiver).	Baseline, Months 3 and 6
Perceived Effectiveness of Treatment	This measure assesses perceived treatment effectiveness.	Baseline, Month 3
Purpose in Life	This measure assesses adolescents' sense of purpose	Baseline, Months 3 and 6
Thoughts about Mortality	This measure assesses beliefs and attitudes towards death.	Baseline, Month 6
Suicidal Thoughts	This instruments measures the frequency of suicidal thoughts (only if participant responds YES to CSSRS 1 or 2).	Baseline, Months 3 and 6
Exposure to Suicide	This measure assesses if adolescents had exposure to someone who attempted or died by suicide.	Baseline, Months 3 and 6
Acquired Capability for Suicide	This measure assesses fearlessness of death.	Baseline, Months 3 and 6
Demographics	This survey queries background characteristics (youth and caregiver versions).	Baseline, Months 3 and 6
Gender Identity and Sexual Orientation	This survey queries adolescents' gender identity and sexual orientation.	Baseline, Months 3 and 6
Purpose in Life (Expanded)	Expanded version of baseline purpose of life measure.	Baseline, Months 3 and 6
Regard of Identity	The measure assesses regard for racial identity.	Baseline, Months 3 and 6
Social Competencies	This measure assesses social skills.	Baseline, Months 3 and 6
Religious Identity	This survey queries religious identity (caregiver).	Baseline, Months 3 and 6
Acculturation	This survey asks about acculturation to the United States (caregiver).	Baseline, Months 3 and 6
Medical Mistrust	This measure assesses medical mistrust (caregiver).	Baseline, Months 3 and 6
PedsQL	This measure assesses caregiver-reported issues youth face.	Baseline, Months 3 and 6
ED-s Risk Survey (from ED-STARS)	This survey measure assesses the duration of suicidal thoughts, family and social connectedness, peer victimization and bullying, impulsive-aggression, physical fighting, and overall adaptive functioning.	Baseline, Months 3 and 6
Work and Social Adjustment Scale - Youth (Parent version)	This measure assesses the impact of youth's problem to do certain day-to-day tasks (caregiver).	Months 3 and 6
iBelong	This measure assesses adolescents' sense of belongingness.	Baseline, Month 6
Joy	This measure assesses adolescents' sense of joy in their life.	Months 3 and 6
Data Archive Collection Items	These items are shared data with the wider scientific community to assess mental and physical health concerns and wellbeing.	Baseline, Months 3 and 6

Collaborators and Investigators

• Sponsor: New York University
• Collaborators: University of Michigan
• Investigators: Principal Investigator: Michael A Lindsey, PhD, New York University

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2024
• Primary Completion (Estimated): March 31, 2027
• Study Completion (Estimated): March 31, 2027

Study Registration Dates

• First Submitted: November 30, 2022
• First Submitted That Met QC Criteria: December 8, 2022
• First Posted (Actual): December 16, 2022

Study Record Updates

• Last Update Posted (Estimated): February 26, 2024
• Last Update Submitted That Met QC Criteria: February 21, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: depression; suicide; Black youth; ideation
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide; Suicidal Ideation
• Other Study ID Numbers: R01MH129786-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Submit data in compliance with NIMH Data Archive data submission agreement.
• IPD Sharing Time Frame: By the end of data collection, March 2027.
• IPD Sharing Access Criteria: In accordance with the NIMH Data Archive requirements.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No