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.

抽象的我们提出了一项严格的随机试验，以评估预防自杀的创新阶梯护理与卫生系统发起的ZS计划相比，青少年和年轻人的干预措施。一个迫切需要该年龄段的有效ZS策略，因为这是一个发展时期：1）自杀是死亡的第二大原因，其死亡人数比任何医疗疾病都要多； 2）自杀趋势和行为通常首先发生在这个年龄段。 3）自杀和自杀企图（SAS）急剧增加； 4）有效干预可以减少一生中的风险，痛苦和成本。该项目与具有强大基础设施和承诺的卫生系统结合了合作伙伴关系通过研究团队成功实施协作的研究团队为ZS的质量提高卫生系统的护理干预措施，并具有临床，卫生服务，经济学和政策方面的专业知识研究与传播。我们将确定并注册300名12-24岁的年轻人，自杀和SA 使用多阶段筛选过程冒险。符合条件的年轻人将被随机分配到：1）零自杀最佳做法，使用零自杀工具包（ZSBP，www.sprc.org）强调卫生系统质量的改进；或者 2）ZSBP+对预防自杀的护理，该护理将循证自杀的预防与初级保健和紧急服务。先前的研究证明了类似综合医学的价值行为健康干预措施，以改善患者的预后，护理率和护理连续性 - 至关重要 ZS努力的问题是，尽管持续存在风险，但许多年轻人过早地停止护理。 ZSBP+方法用途：1）分类年轻人达到适当的护理水平的风险评估； 2）护理经理交付CBT和DBT 通过患者评估和治疗，技能培训和支持初级保健和紧急临床医生； 3） Internet ECBT和治疗性DBT技能视频以及较低风险年轻人的教练支持（24/7）的访问权限，加强了面对面的小组和/或为更高风险年轻人增加的个人治疗； 4）常规监测患者的结果，并对临床医生进行实时反馈，以促进决策和使用阶梯护理算法。干预期为12个月：急性治疗6个月；和6个月继续处理。在基线和3、6和12个月的随访中评估结果。我们假设，与ZSBP的年轻人相比，随机与ZSBP+的年轻人的速度明显降低随着时间的推移（主要结果）的致命和非致命SA，并将显示次要结果的改善（随着时间的推移自杀事件，自我损害发作，抑郁症状）。我们还将发挥成本效益分析。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艺术科学状态与实践质量改进整合到实践中来实现ZS目标。 ZSBP+步进护理为了自杀，预防有可能在卫生系统和国家内部更广泛的持续采用传播，增强我们满足ZS挑战的能力。