Carolina Vélez-Grau. Photo by Caitlin Cunningham for BC Photography.
As director of the Home-Based Crisis Intervention Program at New York-Presbyterian Hospital, Carolina Vélez-Grau worked with young people experiencing suicidal behaviors in their homes and communities.
The program was designed to stabilize acute psychiatric symptoms and prevent inpatient hospitalization.
Vélez-Grau primarily served adolescents and families living in resource-constrained, inner-city neighborhoods with large Latinx populations. Many patients were at high risk of suicide, particularly Latinx girls, she recalled. But she found that the interventions she had been trained to use lacked a cultural component that reflected the experiences of the adolescents and families she worked with.
“It wasn’t only about ethnicity,” said Vélez-Grau, who worked at New York-Presbyterian Hospital from 2006 to 2015. “Their challenges were exacerbated when facing normal developmental growth as well as by structural issues that unfortunately made up their lives in the United States.”
Now an assistant professor at the Boston College School of Social Work, Vélez-Grau is drawing on those clinical experiences to develop and test culturally responsive approaches to preventing suicide among historically marginalized adolescents.
Her research so far has found a link between burdensomeness and suicidal ideation among depressed and non-depressed Latinx youth.
She was surprised to discover that burdensomeness can work in both directions, meaning that adolescents can feel that they’re a burden on their families, but they can also perceive their families as a burden on them.
“There’s this bidirectional feeling: I am not only a burden to others, but my family can be a burden to me,” said Vélez-Grau. “There are a lot of expectations that are placed on these adolescents in terms of education, how much they contribute at home, and whether they carry the values of origin.”
“ The question is, can we do this. Can we train non-mental health providers to provide that first aid for adolescents who might be at risk if they don't have an early intervention? ”
Her latest study, supported by a grant from the National Institute of Mental Health, is testing whether youth mentors can deliver an evidence-based intervention to Latinx youth in community settings.
The intervention, called Brief Interpersonal Psychotherapy for Adolescents LAZOS, trains participants to understand depression, develop problem-solving skills, and communicate complex emotions. The program also includes modules intended to build ethnic pride and help adolescents navigate discrimination and bullying.
Before adapting the intervention, Vélez-Grau conducted formative research to determine how it could best be delivered in community centers. Part of that research included giving adolescents cameras to document how they experienced mental health in their neighborhoods, a project that helped her identify key components of the adaptation.
Vélez-Grau plans to recruit 46 adolescents from two community centers in Boston’s South End to pilot the program. Half the participants will be paired with mentors trained in the intervention, while the other half will be matched with mentors who will provide usual services such as academic support, vocational training, and life skills.
The approach capitalizes on the fact that youth mentors may share adolescents’ language, neighborhood, culture, and experiences, potentially expanding suicide prevention beyond clinical settings and into more accessible community environments.
“The question is, can we do this?” said Vélez-Grau. “Can we train non-mental health providers to provide that first aid for adolescents who might be at risk if they don't have an early intervention?”
Her career goal is to be known as an expert in preventive approaches to suicide. “I want to show that investing in prevention works,” said Vélez-Grau, who recently helped create the first profession-wide National Standard of Care for Suicide Prevention as part of a task force for the National Association of Social Workers. “I may be starting with the Hispanic population, because it’s what I have known and studied the most, but I do see commonalities among other marginalized adolescents with similar issues at home and in their communities.”