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The goal of this research is to test a systems-level suicide prevention strategy, Native-RISE (Risk Identification for Suicide and Enhanced care), that combines predictive analytics and brief contact interventions (BCIs) to reduce suicide in health systems serving Native Americans (NAs). This project aims to prove the effectiveness and scalability of Native-RISE within three Indian Health Service (IHS) health care clinics (Whiteriver, Chinle and Shiprock) already implementing suicide prevention programs and serving the White Mountain Apache Tribe (WMAT) and Navajo Nation (NN).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Case Managers WITH algorithm AND with provider risk notification (SI/SA/Binge/NSSI) | Experimental | Case Managers who see the algorithm classification + IHS provider risk notification & resource card distribution. These participants present with suicide ideation (SI), suicide attempt (SA), binge substance use (Binge), or non-suicidal self injury (NSSI). |
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| Case Managers withOUT algorithm AND with provider risk notification (SI/SA/Binge/NSSI) | Active Comparator | Case Managers who do NOT see the algorithm classification + IHS provider risk notification & resource card distribution. These participants present with suicide ideation (SI), suicide attempt (SA), binge substance use (Binge), or non-suicidal self injury (NSSI). |
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| Case Managers WITH algorithm AND provider risk notification (high risk history, no SI/SA/Binge/NSSI | Experimental | Case Managers who see the algorithm classification + provider risk notification; participants get resource card distribution. High risk participants based on algorithm classification. |
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| Provider risk notification alone (high risk history, without SI/SA/Binge/NSSI) | Active Comparator | Provider risk notification alone; participants get resource card distribution. High risk participants based on algorithm classification. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| System of Care - combination of algorithm and Brief Contact Intervention | Device | Case managers see the Native-RISE algorithm classification and Clinical Providers receive a risk notification. A resource card is provided to the participant. |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of suicide attempts among individuals flagged at elevated risk | Rate of suicide attempts among individuals flagged at elevated risk is tracked through International Classification of Diseases (ICD) codes and chief complaints as recorded in the participating health system. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Number of contacts with Case Managers (Reach of Brief Contact Interventions (BCI)) | Reach of BCI is defined as at least three or more contacts with Case Managers within the first year following identification of elevated risk. | 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Emily Haroz, PhD | Johns Hopkins University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chinle Navajo Nation Center for Indigenous Health | Chinle | Arizona | 86503 | United States | ||
| Whiteriver Center for Indigenous Health |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39401036 | Background | Haroz EE, Rebman P, Goklish N, Garcia M, Suttle R, Maggio D, Clattenburg E, Mega J, Adams R. Performance of Machine Learning Suicide Risk Models in an American Indian Population. JAMA Netw Open. 2024 Oct 1;7(10):e2439269. doi: 10.1001/jamanetworkopen.2024.39269. | |
| 39414996 | Background | Adams R, Haroz EE, Rebman P, Suttle R, Grosvenor L, Bajaj M, Dayal RR, Maggio D, Kettering CL, Goklish N. Developing a suicide risk model for use in the Indian Health Service. Npj Ment Health Res. 2024 Oct 16;3(1):47. doi: 10.1038/s44184-024-00088-5. |
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Native-RISE Model is a predictive algorithm for suicide risk in Native American populations. The algorithm was developed based on analysis of over 330,000 visits and designed to identify people at risk of a suicide attempt or death within 90 days of the last visit. The evaluation of the model initial results have been published with the model having an area under the ROC (AUROC) 0.83 [0.80-0.86]) and performing better than existing care (AUROC 0.64 [0.61-0.67]).
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| Active Comparator - Provider notification of risk status | Behavioral | Clinical Providers receive a risk notification and a resource card is provided to the participant. |
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| Whiteriver |
| Arizona |
| 85941 |
| United States |
| Shiprock Center for Indigenous Health | Shiprock | New Mexico | 87420 | United States |
| ID | Term |
|---|---|
| D000092864 | Suicide Prevention |
| ID | Term |
|---|---|
| D013405 | Suicide |
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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