Social Ecology and the Prevention of Suicide and Aggression in African American Youth 

Principal Investigator: LaVome Robinson, Ph.D.

Co-Investigator: Leonard A. Jason, Ph.D.

A grant that was funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development

Abstract

This indicated prevention intervention trial employs a randomized controlled design to examine the efficacy of a 15-session, culturally tailored, cognitive-behavioral group prevention intervention for urban, low income African American adolescents. The PI successfully adapted the Coping with Stress Course (Clarke et al., 1995) to be culturally sensitive and appropriate for use with urban, low-income African American adolescents. This culturally-adapted intervention (i.e., the Adapted-Coping with Stress Course [Robinson & Case, 2003]) will be significantly revised to enhance individual competencies believed to mitigate the risk for self-directed (i.e., suicidality) and inter-personal aggression. In addition, the proposed study aims to examine how neighborhood and family ecological characteristics moderate the effects of a culturally-adapted, cognitive-behavioral coping with stress prevention intervention on African American adolescents’ self-directed and interpersonal aggression. This study is expected to have broad public health implications toward the reduction of African American youth health disparities and inform practice and policy on the development of effective violence prevention interventions for African American youth. It is expected that this study will inform a future large scale effectiveness study that will embed an evidence-based, culturally sensitive violence prevention intervention within a large urban school system.

Preventing Suicide in African American Adolescents

Principal Investigator: W LaVome Robinson, Ph.D.

Co-Investigators: Leonard A. Jason, Ph.D., Kate Keenan, Ph.D., Sally Lemke, Ph.D., Donald Hedeker, Ph.D.

Funder: National Institute of Mental Health

Abstract:

Suicide is among the most prevalent and harmful health disparities for African American youth. The rate of suicide among African American children, ages 5-11, nearly doubled from 1993-2012, while rates declined among European American children during the same period (Bridge et al., 2015). Suicide is the third-leading cause of death for African American males, ages 10–24, and females, ages 15-19 (Centers for Disease Control and Prevention [CDC], 2016). documented suicide rates for African American adolescents are extremely high, these rates are likely underestimates due to cultural stigma and norms that perpetuate the underreporting or misclassifications of suicide within the African American community (Bridge et al., 2015; Goldston et al., 2008; Huguet, Kaplan, & McFarland, 2012). Consequently, African American youth suicide may be far greater than documented, adding a heightened sense of urgency for the advancement of effective prevention strategies. Several studies indicate that 9^th grade students, in particular, are at higher risk for engaging in self-harm and suicide attempts, relative to older high school peers (e,g., Jiang, Perry, & Hesser, 2010; Kann et al., 2018; Swahn et al., 2012), and suicide attempt rates are higher for African American 9^th graders than white 9^th graders (CDC, 2017). Given the heightened risk status of 9^th grade African American adolescents, there is a vital need for effective prevention efforts specifically targeting these adolescents.  Suicide is a major, preventable public health problem (NIMH, 2018). PI Robinson culturally adapted and modified Gregory Clarke and colleagues (Clarke et al., 1995) prevention intervention, the Coping with Stress Course (CWSC), to be relevant for low-resourced, urban African American adolescents who are at high risk for suicide. Participatory methods, giving considerable voice to the adolescent peers, were used to adapt the intervention; key informants for intervention adaptation were low-resourced, urban African American youth and their school personnel. Robinson’s culturally adapted version of Clarke’s curriculum (i.e., the Adapted-Coping with Stress [A-CWS] intervention) has demonstrated feasibility, acceptability, and efficacy (see Preliminary Studies section) for helping African American adolescents adaptively cope (Robinson, Droege, Case, & Jason, 2015) and reduce their risk for suicide (Robinson et al., 2016). We aim to move from intervention efficacy to effectiveness and sustainability. School-based health center (SBHC) social workers are indigenous service providers within schools and ideal agents of change to sustain school-based interventions. This study will train indigenous SBHC social workers to implement the A-CWS intervention and test the effectiveness of their service delivery on key outcomes of interest. This is a very achievable next step; other studies report good success in training school personnel to implement, with fidelity, school-based mental health interventions within predominantly minority schools within the Chicago area (Atkins, Graczyk, Frazier & Abdul-Adil, 2003), as well as other large urban cities (Capella et al., 2012; Kellam et al., 2008).  This effectiveness trial will inform procedures for scaling up efficacious, high quality, and culturally-grounded suicide prevention programs for low-resourced, urban African American youth; as such, this study is practice relevant and expected to inform best practices for the prevention of suicide among African American adolescents.