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.

枪支是美国青少年死亡的主要原因。国家组织强调需要 预防方案的重点是减少人际枪支暴力。城市急诊室未得到充分利用 此类计划的设置，因为它们为从事危险枪支行为 (RFB) 的高危青少年提供了机会。 在这种情况下对青少年进行早期干预可能会减少随后的枪支暴力和相关事件 结果。尽管这个问题很重要，但减少 RFB 的基于证据的干预措施仍然存在 缺乏。鉴于我们之前的工作表明，单次 ED 干预措施（即 SafERteens）整合了 动机访谈（MI）和认知行为疗法（CBT）可有效减少暴力 风险较低的青少年，这种行为疗法的应用范围扩大到解决更严重的问题 多次治疗并通过添加护理管理 (CM) 进行增强，代表了一种潜在有效的方法 减少 RFB 的方法。我们发现这种综合方法的试点在高风险人群中是可行的 青少年参与暴力。利用集中式远程治疗来解决已确定的面对面治疗障碍 （例如交通）并通过 APP 支持干预可能是一种有希望的增强方法 会议出席率、干预剂量和参与度，同时考虑未来的实施问题。这 提案涉及 CDC NOFO 的目标二（资助选项 B），因为它的重点是收集新的 有关减少枪支暴力战略的数据。我们建议开展一项 2 组随机对照试验 (RCT) 教育部青少年（16-24 岁）报告过去 3 个月的枪支携带和智能手机拥有情况，并将其随机化 可以： (1) Interact；或者，(2) 增强的常规护理 + 评估 (EUC+A) 条件，他们将接受 资源手册和每日评估。 InterERact 条件将收到： (1) 6 远程传送 整合 MI、CBT 和 CM 的行为治疗课程； (2) 支持治疗的智能手机应用程序 通过促进治疗师的联系、进行自动化的日常评估、在疗程之间进行定制 MI/CBT 内容，在进入高风险地点时提供及时的 GPS 触发通知，以及 协助 CM 资源。具体目标是： (1) 开展随机对照试验，招募 400 名符合条件的青少年（200 人/组） 检查 InterERact 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。作为次要目标，我们将检查调解者/主持人 功效。结果将在 3 个月和 6 个月时进行评估。主要结果包括：(1) 危险枪支 行为（RFB）； (2) 携带枪支； (3) 暴力（即侵略、受害、后果）。 次要结果包括： (1) 因暴力伤害（例如枪伤）而前往急诊室就诊； (2) 物质使用； (3) 心理健康症状（即焦虑、抑郁、创伤后应激障碍）； (4) 刑事司法参与（即逮捕）。 鉴于在获得服务方面存在差异的社会弱势青年中，RFB 比例较高， 拟议的 Interact 干预措施如果被发现有效，将有可能对公共卫生产生重大影响。