CA-LINC: A Culturally Adapted Care Coordination Suicide Detection and Intervention Model for Black Youth

ABSTRACT
Suicide is a leading cause of death for Black youth with rates of suicide ideation and behaviors (SIB) increasing
at alarming rates. Unfortunately, systemic, community, organizational, provider, family, and individual level
problems/barriers increase Black youth SIB risk and also block access to needed resources/services. Current
suicide prevention/intervention efforts are not sufficient to decrease SIB in Black youth and Black LGBTQ+SGL
youth. Linking Individuals Needing Care (LINC) is a consumer- and theory-driven care coordination intervention
designed to reduce SIB by improving service engagement and delivery standards. Culturally Adapted LINC (CA-
LINC) is a proposed adaptation of LINC to meet the specific needs of diverse Black youth/families, by
incorporating input from Black communities whose help-seeking behaviors are often facilitated through non-
behavioral health supports such as Black faith-based organizations (FBO). In fact, CA-LINC will be implemented
in mental health “hubs” located in Black FBOs to facilitate access to care. In the proposed mixed-methods
feasibility study, the CA-LINC intervention will be created and then pilot-tested relative to improving risk
detection, service referrals, treatment, continuity of care, and service engagement among 80 Black youth and
Black LGBTQ+SGL ages 14-17 in Charlotte, North Carolina. Phase I of this study will use community-based
participatory research strategies to adapt LINC to address the practical, systemic, linguistic, cultural, and
developmental needs of diverse Black youth/families. We will identify/assess stakeholder perceptions/needs to
enhance suicide risk detection, service referrals/linkages, and service engagement using qualitative interviews
(Aim 1a). Focus groups will obtain provider perceptions/feedback on clinical workflow processes and
implementation strategies (Aim 1b). We will adapt service delivery components and workflow/implementation
strategies using an iterative process (Aim 1c). In Phase II, a two-arm parallel-comparison single-blinded pilot
randomized controlled trial (RCT) will explore the “fit” (i.e., feasibility) of CA-LINC in Black communities, and
inform a scalable RCT for a future R01 study (Aim 2). We will assess stakeholder perceptions on
acceptability/appropriateness of CA-LINC (Aim 2a). We will assess provider and community stakeholder
perceptions on the practicality and integration of implementing and sustaining CA-LINC using existing community
resources/infrastructure (Aim 2b). We will evaluate the feasibility of study procedures for screening, recruitment,
and randomization (Aim 2c) and evaluate treatment adherence, fidelity, and study retention (Aim 2d). We will
examine effect size estimates for SIB among Black youth randomly assigned (CA-LINC vs. Treatment as Usual,
TAU, no follow-up care) to mental health hubs (Aim 2e). Lastly, we will examine differences in potential change
mechanisms (therapeutic alliance, service utilization, cultural humility, family relationships, engagement, and
barriers to participation) between CA-LINC and TAU (Aim 2f). This study has the potential for improving service
delivery standards, reducing suicide risk among Black youth, and supporting NIMH’s goal to reduce suicide rates.