Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults

青少年和年轻人预防自杀的阶梯式护理的随机试验

基本信息

批准号：
9750801
负责人：
Joan Rosenbaum Asarnow
金额：
$ 105.04万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9750801
关键词：
Accidents Accounting Acute Adolescence Adolescent and Young Adult Adopted Adoption Age Algorithms Applied Research Behavior Caring Case Manager Cause of Death Cessation of life Clinical Computerized Medical Record Continuity of Patient Care Cost Effectiveness Analysis Data Decision Making Development Direct Costs Economic Policy Elderly Emergency Care Emergency Situation Emergency department visit Emergency medical service Enrollment Evaluation Event Facilities and Administrative Costs Feedback Feeling suicidal Gender Goals Health Health Information System Health Sciences Health Services Health system Healthcare Healthcare Systems Homicide Hospitalization Hospitals Hour Income Individual Infrastructure Internet Intervention Intervention Studies Measures Medical Mental Depression Outcome Pathway interactions Patient Monitoring Patient-Focused Outcomes Patients Persons Population Preventive Intervention Preventive care Primary Health Care Process Quality of life Quality-Adjusted Life Years Randomized Randomized Controlled Trials Research Risk Risk Assessment Risk Factors Savings Science Self-Injurious Behavior Services Suicide Suicide attempt Suicide prevention System Teenagers Testing Therapeutic Time Training Support Triage Violence Visit Youth age group base behavioral health behavioral health intervention collaborative care cost cost effectiveness cost-effectiveness evaluation depressive symptoms effective intervention evidence base health care quality high risk improved innovation inpatient service intervention effect member mortality non-suicidal self injury premature primary care services primary outcome programs randomized trial reducing suicide research data dissemination screening secondary outcome skills skills training suicidal suicidal behavior suicidal morbidity suicidal risk suicide rate young adult

项目摘要

Abstract We propose a rigorous randomized trial to evaluate an innovative stepped care for suicide prevention intervention for adolescents and young adults, compared to a ZS program initiated by a health system. An effective ZS strategy for this age group is critically needed because this is a developmental period when: 1) suicide is the second leading cause of death, accounting for more deaths than any medical illness; 2) suicidal tendencies and behaviors often first occur in this age span; 3) rates of suicide and suicide attempts (SAs) increase dramatically; and 4) effective intervention can reduce risk, suffering, and costs over lifetimes. The project combines a partnership with a health system that has strong infrastructure and commitment to quality improvement for ZS with a research team that has successfully implemented collaborative stepped care interventions in health systems and has expertise in clinical, health services, economics, and policy research and dissemination. We will identify and enroll 300 youths ages 12-24 with elevated suicide and SA risk using a multi-stage screening process. Eligible youths will be randomized to: 1) zero suicide best practices, which emphasizes health system quality improvement using the zero suicide toolkit (ZSBP, www.sprc.org); or 2) ZSBP+ stepped care for suicide prevention, which integrates evidence-based suicide prevention with primary care and emergency services. Prior research demonstrates the value of similar integrated medical- behavioral health interventions for improving patient outcomes, rates of care, and continuity of care- a critical issue for ZS efforts, as many youths discontinue care prematurely despite continuing risk. The ZSBP+ approach uses: 1) risk assessments to triage youths to appropriate care levels; 2) Care Managers to deliver CBT and DBT skills training and support primary care and emergency clinicians with patient evaluation and treatment; 3) internet eCBT and therapeutic DBT skills video plus access to coaching support (24/7) for lower risk youths, with stepped up in-person group and/or individual treatment added for higher risk youths; and 4) regular monitoring of patient outcomes, with real-time feedback to clinicians to facilitate decision-making and use of the stepped care algorithms. The intervention period is 12 months: 6 months of acute treatment; and 6 months of continuation treatment. Outcomes are assessed at baseline and at 3, 6 and 12-month follow-ups. We hypothesize that, compared to youths in ZSBP, youths randomized to ZSBP+ will have significantly lower rates of fatal and nonfatal SAs over time (primary outcome) and will show improvements on secondary outcomes (suicide events over time, self-harm episodes, depressive symptoms). We will also conduct cost effectiveness analyses. Results will provide critical information for health systems and science regarding the potential to achieve ZS goals by integrating state of the art science with practice quality improvement. ZSBP+ stepped care for suicide prevention has potential for broader sustained adoption within the health system and national dissemination, enhancing our capacity to meet the ZS challenge.

抽象的我们提出一项严格的随机试验来评估预防自杀的创新阶梯式护理与卫生系统发起的 ZS 计划相比，针对青少年和年轻人的干预。一个该年龄段迫切需要有效的 ZS 策略，因为这是一个发展时期：1) 自杀是第二大死因，其死亡人数比任何疾病都多； 2）有自杀倾向倾向和行为通常首先出现在这个年龄段； 3）自杀率和自杀未遂率（SA）急剧增加； 4) 有效的干预可以减少一生的风险、痛苦和成本。该项目结合了与拥有强大基础设施和承诺的卫生系统的合作伙伴关系与已成功实施协作步骤的研究团队一起提高 ZS 的质量卫生系统的护理干预措施，并拥有临床、卫生服务、经济和政策方面的专业知识研究和传播。我们将识别并招募 300 名 12-24 岁自杀率和 SA 较高的青少年使用多阶段筛选过程来风险。符合条件的青少年将被随机分配到：1）零自杀最佳实践，强调使用零自杀工具包提高卫生系统质量（ZSBP，www.sprc.org）；或者 2) ZSBP+自杀预防分级护理，将循证自杀预防与初级保健和紧急服务。先前的研究证明了类似的综合医疗的价值改善患者治疗效果、护理率和护理连续性的行为健康干预措施——至关重要 ZS 工作面临的问题是，尽管风险持续存在，但许多青少年过早停止护理。 ZSBP+ 方法用途： 1) 进行风险评估，将青少年分类到适当的护理级别； 2) 护理经理提供 CBT 和 DBT 技能培训并支持初级保健和急诊临床医生进行患者评估和治疗； 3）互联网 eCBT 和治疗 DBT 技能视频以及为低风险青少年提供辅导支持 (24/7)，对高危青少年增加面对面的团体和/或个人治疗； 4）常规监测患者结果，并向临床医生提供实时反馈，以促进决策和使用逐步护理算法。干预期12个月：急性期治疗6个月；和6个月的继续治疗。结果在基线以及 3、6 和 12 个月的随访时进行评估。我们假设与 ZSBP 中的青少年相比，随机分配到 ZSBP+ 的青少年的比率会显着降低随着时间的推移，致命性和非致命性 SA 的数量（主要结果）并将显示次要结果的改善（随着时间的推移自杀事件、自残事件、抑郁症状）。我们还将进行成本效益分析。结果将为卫生系统和科学提供有关潜力的关键信息通过将最先进的科学与实践质量改进相结合来实现 ZS 目标。 ZSBP+阶梯式护理预防自杀有可能在卫生系统和国家范围内得到更广泛、持续的采用传播，增强我们应对 ZS 挑战的能力。