A New Clinical Model for the Engagement of Latinx Youth with Suicidal Behavior and their Families in a Culturally Centered CBT Treatment

The objective of this proposal is to test a New Clinical Model to engage Latinx/Hispanic (L/H) youth and their caregivers in a culturally centered, evidence-based treatment for suicidal behaviors (SB). The Socio-Cognitive Behavioral Therapy for Suicidal Behavior (SCBT-SB) is an affirmative and culturally relevant treatment with empirical evidence supporting its use for L/H youth with suicidality. The New Clinical Model consists of the addition of community health workers (CHWs) to the SCBT-SB. CHWs are trusted members of their communities who provide education and connection to resources to L/H families in their native language. A community based participatory research approach is proposed and the Socio-Cultural Framework for Health Service Disparities will be the theoretical model used. The target population (n=150) will be L/H youth ages 12 to 18 living at home experiencing depressive symptoms with suicidal ideation (SI), SI, and those having made a suicide attempt or seen in the Emergency Department because they were suicidal within the three months prior to enrollment. Adolescents and their families will be randomized to SCBT-SB, with or without a CHW. We will not only test the effects of an intervention on clinical outcomes but also interview families and consult with stakeholders about the usefulness of having CHWs as providers. The following aims are proposed: Aim 1: To compare the effectiveness of the SCBT-SB + CHW condition (New Clinical Model) versus SCBT-SB only on clinical outcomes in a sample of adolescents at suicidal risk. Hypothesis 1. SCBT+CHW condition will show better treatment effects on suicidal ideation compared to the SCBT-SB only condition at 6- and 9-months follow-up. Hypothesis 2. SCBT+CHW condition will show better treatment effects on depressive symptoms compared to the SCBT-SB only condition at 6- and 9-months follow-up. Hypothesis 3. SCBT+CHW condition will show better treatment effects on suicide attempts and Emergency Department visits for suicidality compared to the SCBT-SB only condition at 6- and 9-months follow-up. Aim 2: Evaluate motivation for treatment and treatment engagement as the means by which we see improvement in clinical outcomes. The CHW intervention will address some of the social determinants of mental health in L/H youth families. By addressing social determinants of mental health, it is expected that motivation for and engagement in treatment will improve and influence clinical outcomes. Hypothesis 4. Change in motivation for treatment and treatment engagement will be directly related to treatment outcomes, regardless of condition, but stronger in the SCBT-SB+CHW condition. Aim 3: Assess the acceptability, appropriateness, and feasibility of the New Clinical Model as well as its potential for more wide scale implementation in the future. A qualitative approach will be used to address this aim. Qualitative data will be gathered at three different levels: patients, providers, and stakeholders. The successful completion of this study has the potential of reducing service disparities among L/H youth with suicidality. The next step would be to implement the New Model in other community organizations. As such, it addresses the AFSP goal to, "Accelerate translation of research findings into real world suicide prevention solutions."