IntERact: Preventing Risky Firearm Behaviors Among Urban Youth Seeking Emergency Department Care

Interact：预防寻求急诊科护理的城市青少年的危险枪支行为

• 批准号: 10438200
• 负责人: Patrick M. Carter
• 金额: $ 65万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10438200
• 关键词: IntERact; Preventing; Risky; Firearm; Behaviors

Firearms are the leading cause of death for U.S. youth. National organizations have highlighted the need for prevention programs focused on decreasing interpersonal firearm violence. Urban EDs are an underutilized setting for such programs, as they provide access to at-risk youth engaged in risky firearm behaviors (RFBs). Intervening early with youth in this setting may decrease subsequent firearm violence and related consequences. Despite the importance of this problem, evidence-based interventions to decrease RFBs are lacking. Given our prior work showing that single session ED interventions (i.e., SafERteens) integrating motivational interviewing (MI) and cognitive behavioral therapy (CBT) are efficacious reducing violence among lower risk youth, the application of this behavioral therapy, expanded to address greater problem severity over multiple sessions and enhanced by adding care management (CM), represents a potentially efficacious approach for decreasing RFBs. Our pilot of this integrated approach was found to be feasible among high-risk youth engaged in violence. Utilizing centralized remote therapy to address identified in-person therapy barriers (e.g., transportation) and supporting the intervention with an APP may be a promising way of enhancing session attendance, intervention dose, and engagement, while considering future implementation issues. This proposal addresses Objective Two (Funding Option B) of the CDC NOFO as it focuses on collecting new data on strategies to decrease firearm violence. We propose a 2-arm randomized control trial (RCT) enrolling ED youth (age 16-24) reporting past 3-month firearm carriage and smartphone ownership, randomizing them to either: (1) IntERact; or, (2) an enhanced usual care + assessment (EUC+A) condition where they will receive a resource brochure and daily assessments. The IntERact condition will receive: (1) 6 remotely delivered behavioral therapy sessions integrating MI, CBT, and CM; and, (2) an smartphone APP supporting the therapy by facilitating therapist contact, conducting automated daily assessments, delivering between session tailored MI/CBT content, delivering just-in-time GPS-triggered notifications upon entry into high-risk locations, and aiding with CM resources. Specific aims are: (1) To conduct an RCT enrolling 400 eligible youth (200/group) to examine IntERact efficacy; and, (2) To conduct a cost evaluation, comparing resource costs for intervention delivery to costs for outcomes averted. As a secondary aim, we will examine mediators/moderators of efficacy. Outcomes will be assessed at 3- and 6-months. Primary outcomes include: (1) risky firearm behaviors (RFBs); (2) firearm carriage; and, (3) violence (i.e., aggression; victimization; consequences). Secondary Outcomes include: (1) ED visits for violent injury (e.g., firearm injuries); (2) substance use; (3) mental health symptoms (i.e., anxiety, depression, PTSD); and, (4) criminal justice involvement (i.e., arrests). Given elevated rates of RFBs among socio-disadvantaged youth with disparities in access to services, the proposed IntERact intervention, if found to be efficacious, has the potential for significant public health impact.

枪支是美国青年死亡的主要原因。国家组织强调了需要 预防计划的重点是减少人际枪支暴力。 Urban Eds是未充分利用的 为此类计划设置，因为它们提供了从事风险枪支行为（RFB）的高危青年的访问权限。 在这种情况下与青年早期介入可能会减少随后的枪支暴力和相关性 结果。尽管这个问题很重要，但基于证据的干预措施减少了RFB 缺乏。鉴于我们先前的工作表明单个会话ED干预措施（即Saferteens）集成 动机访谈（MI）和认知行为疗法（CBT）有效地减少了暴力 降低风险青年，这种行为疗法的应用，扩展了以解决更大的问题严重性 多次会议，并通过添加护理管理（CM）增强，代表了潜在的有效性 减少RFB的方法。我们发现，在高风险中，我们的这种综合方法的飞行员是可行的 青年从事暴力。利用集中式远程疗法来解决已确定的面对面治疗障碍 （例如，运输）并使用应用程序支持干预可能是一种有希望的增强方式 会议上课，干预剂量和参与度，同时考虑未来的实施问题。这 提案解决了CDC NOFO的目标两个（资金选项B），因为它着重于收集新 有关减少枪支暴力的策略的数据。我们提出了一项2臂随机对照试验（RCT） Ed Youth（16-24岁）报告了过去3个月的枪支马车和智能手机所有权，然后将其随机化 两者：（1）互动；或（2）增强的常规护理 +评估（EUC + a）条件将在其中收到 资源小册子和日常评估。互动条件将接收：（1）6远程交付 整合MI，CBT和CM的行为疗法课程； （2）支持该疗法的智能手机应用程序 通过促进治疗师的联系，进行自动每日评估，在量身定制的会议之间进行 MI/CBT内容，进入高风险位置时，会在及时的GPS触发通知中提供 协助CM资源。具体目的是：（1）进行400名合格青年的RCT（200/组） 检查相互作用的功效； （2）进行成本评估，比较干预的资源成本 交付避免结果的成本。作为次要目的，我们将研究 功效。结果将在3个月和6个月进行评估。主要结果包括：（1）风险枪支 行为（RFB）； （2）枪支马车；和（3）暴力（即侵略；受害；后果）。 次要结果包括：（1）ED访问暴力伤害（例如，枪支伤害）； （2）使用物质； （3） 心理健康症状（即焦虑，抑郁，PTSD）； （4）刑事司法参与（即逮捕）。 鉴于在获得服务方面差异的社会待遇年轻人中，RFB的率升高， 拟议的互动干预措施，如果发现有效，则有可能产生重大的公共卫生影响。