STAT-ED Suicidal Teens Accessing Treatment after an Emergency Department Visit

STAT-ED 自杀青少年在急诊科就诊后接受治疗

• 批准号: 8454654
• 负责人: JEFFREY A BRIDGE
• 金额: $ 39.97万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8454654
• 关键词: STAT; ED; Suicidal; Teens; Accessing

DESCRIPTION (provided by applicant): While many young patients at risk for suicide present to the emergency department (ED) following suicide attempts or in situations of extreme suicidal crises, other patients at risk for suicide go unrecognized, and therefore untreated, in the ED. Once discharged, 30% of suicidal adolescents return to the ED with another crisis within six months of the sentinel event. Currently, no evidence-based standards exist for appropriate screening and post-screening interventions in order to improve outcomes for patients presenting in EDs who are at elevated risk for suicidal behavior. This two-site R01 application tests the effectiveness of a brief treatment engagement intervention termed Suicidal Teens Accessing Treatment after an ED Visit (STAT-ED) for adolescents seeking treatment in the ED for non-psychiatric concerns but identified via systematic screening as being at risk for suicide. In this unique 3-year proposal, investigators from two institutions (Cincinnati Children's Hospital Medical Center [CCHMC] and Nationwide Children's Hospital [NCH]) will recruit and randomize 160 adolescents (80 per site) to (a) the STAT-ED intervention or (b) enhanced usual care (EUC) as a comparison condition. EUC consists of a brief consultation and a mental health referral. The STAT-ED intervention targets family engagement, problem solving, assistance with referral and limited case management during the transition from the ED to outpatient care with the goal of maximizing the initiation of mental health treatment and aftercare among youth screening positive for previously unrecognized suicide risk. The application builds on a pilot study in which STAT-ED was well- accepted by patients, families, and clinicians and was more effective than EUC. We now propose to test the STAT-ED intervention against EUC in a larger, more diverse sample from two geographically separate, urban pediatric EDs serving broad populations (Cincinnati and Columbus, Ohio). A second aim is to compare the effectiveness of STAT-ED and EUC in reducing suicidal ideation and depression symptoms after ED discharge. The rationale is that by using the pediatric ED to identify and treat unrecognized suicide risk, adolescents will be less likely to overuse ED services in the future, have a better quality of life and ultimately have a reduced risk of morbidity and mortality. If successful, it will provide a brif and sustainable intervention that can be implemented across diverse pediatric ED settings. This study will contribute to the mission of the CDC by improving our capacity to identify "best practices" for screening, assessing, and implementing practical suicide prevention interventions in the pediatric ED setting. PUBLIC HEALTH RELEVANCE: Public Health Relevance. By providing a brief treatment engagement intervention to youth identified by ED staff as being at elevated risk for suicide, the study will be the first to test whether outpatient mental health care uptake and treatment attendance can be improved without undue burden on the work flow and resources of the pediatric ED setting.

描述（由申请人提供）：虽然在自杀企图或极端自杀危机的情况下，许多有自杀率的年轻患者出现在急诊室（ED），而其他有自杀危险的患者则在ED中未被认可，因此未经治疗。一旦出院后，有30％的自杀青少年在哨兵事件发生后的六个月内返回急诊室。目前，尚无基于证据的标准来进行适当的筛查和筛查后干预措施，以改善在自杀行为风险较高的ED中的患者的预后。此两次R01申请测试了短暂的治疗干预措施的有效性，称为自杀青少年在ED访问（Stat-Ed）中为寻求ED治疗的非精神病学关注的青少年提供治疗，但通过系统筛查被确定为处于自杀风险中。在这个独特的3年提案中，来自两个机构（辛辛那提儿童医院医疗中心[CCHMC]和全国儿童医院[NCH]）的调查人员将招募和随机将160名青少年（每个站点80）随机分为（a）统计-ED干预措施或（b）增强的常规护理（EUC）作为比较条件。 EUC由简短的咨询和心理健康转诊组成。在从急诊室过渡到门诊护理期间，该统计局干预措施针对家庭参与，解决问题，在转诊和有限的病例管理方面，目的是最大程度地提高心理健康治疗的启动以及对以前未被认可的自杀风险呈阳性的青少年筛查效果。该应用程序建立在一项试点研究的基础上 Stat-Ed被患者，家庭和临床医生所接受，并且比EUC更有效。现在，我们建议在两个地理独立的城市儿科EDS（辛辛那提和俄亥俄州哥伦布）的两个地理独立的城市儿科ED中测试针对EUC的统计干预措施。第二个目的是比较Stat-Ed和EUC在减少ED出院后自杀意念和抑郁症状的有效性。理由是，通过使用儿科ED来识别和治疗未识别的自杀风险，青少年将来不太可能过度使用ED服务，具有更好的生活质量，并最终降低了发病率和死亡率的风险。如果成功的话，它将提供一种可以在各种儿科环境中实施的BRIF和可持续干预措施。这项研究将通过提高我们确定筛查，评估和实施儿科环境中筛查，评估和实施实际自杀预防干预的“最佳实践”的能力来促进CDC的使命。 公共卫生相关性：公共卫生相关性。通过为ED员工确定的年轻人提供自杀风险较高的青年的简短治疗干预措施，该研究将是第一个测试门诊精神卫生保健的吸收和治疗出勤率是否可以改善，而没有对儿科ED环境的工作流量和资源负担不足。