Promoting Healthy Relationships among At-Risk Adolescents: A Feasibility Trial in the Emergency Department

促进高危青少年之间的健康关系：急诊科的可行性试验

• 批准号: 9891166
• 负责人: Kimberly Anne Randell
• 金额: $ 15.8万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-11 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9891166
• 关键词: Academic achievement; Accident and Emergency department; Address; Adolescent; Age; Behavior; Behavior Therapy; Behavioral Research; Clinical Research; Clinical Trials; Communities; Complement; Consensus; Counseling; Data; Development; Development Plans; Disclosure; Dropout; Eating Disorders; Education; Educational Intervention; Emergency Care; Emergency Department evaluation; Emergency Department-based Intervention; Emergency Medicine; Emergency department visit; Evaluation; Evidence based intervention; Feasibility Studies; Female Adolescents; Generations; Goals; Harm Reduction; Health; Health Services; Healthcare; Healthy People 2020; High Prevalence; Homicide; Hybrids; Individual; Intervention; K-Series Research Career Programs; Knowledge; Life Cycle Stages; Link; Male Adolescents; Manuals; Measures; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mission; Modeling; Modification; National Institute of Child Health and Human Development; Outcome; Parents; Participant; Patients; Performance; Physicians; Population; Populations at Risk; Pregnancy; Provider; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Ethics; Resources; Risk; Risk Factors; School Drop-Outs; Schools; Sexual Health; Sexually Transmitted Diseases; Societies; Speed; Structure; Suicide; Teenagers; Testing; Training; Training Activity; Translations; Treatment Efficacy; United States Dept. of Health and Human Services; United States National Institutes of Health; Victimization; Violence; Work; Youth; base; behavior change; brief intervention; care providers; care seeking; career; career development; clinical practice; community setting; condoms; control trial; cost; design; early childbearing; effective intervention; efficacy testing; emergency contraception; emotional abuse; experience; feasibility trial; follow-up; high-risk adolescents; implementation science; implementation trial; improved; motivational enhancement therapy; novel; patient oriented; pediatric emergency; point of care; prevent; primary outcome; programs; reproductive coercion; response; school health; skills; theories; treatment as usual; trial comparing

Adolescent relationship victimization (ARV), characterized by physical, sexual, cyber or psychological abuse, reproductive coercion, or sexual exploitation, remains highly prevalent despite implementation of evidence- based interventions in schools and community settings. Negative outcomes, including suboptimal academic achievement, pregnancy, sexually transmitted infections, disordered eating, suicidality, and homicide, result in significant costs to individuals and society. The emergency department (ED) offers unique opportunities to promote healthy relationships and mitigate negative impact of ARV among an at-risk adolescent population. However, current ED-based relationship interventions are limited by 1) disclosure-based delivery, 2) addressing limited forms of abuse, 3) limited efficacy, and 4) missed opportunities to provide point-of-care harm reduction resources. The Healthcare Education Assessment and Response for Adolescent Relationships (HEART) intervention may address these concerns through 1) universal delivery of education and counseling, and 2) comprehensively addressing the full range of ARV. Previous study by Dr. Miller (co-mentor) demonstrated efficacy of HEART to decrease ARV. However, HEART requires adaptation for the ED setting, given significant contextual differences between the ED and the originally intended setting, school health centers. Dr. Randell, a pediatric emergency medicine physician and candidate for this career development award, is committed to a patient oriented clinical research career targeting interventions to promote healthy adolescent relationships. Her five-year career development plan includes structured mentoring and formal didactics to address critical gaps in her training through acquisition of expertise in theories of behavior change, clinical trials for adolescent behavioral research, implementation science, and adolescent research ethics. The proposed study complements other training activities by enabling hands-on experience in intervention adaptation and a randomized control trial. Following identification of enhancements necessary for HEART in the ED setting, Dr. Randell will conduct a randomized controlled trial to enable evaluation of eight feasibility constructs. The hypothesis is that HEART in the ED will be feasible as defined by primary outcomes of acceptability and efficacy to decrease ARV. The rationale is that this study will produce the first ED-based intervention to utilize universal education to comprehensively address ARV in conjunction with provision of point-of-care harm reduction resources. Study findings will inform the development of a larger hybrid efficacy- implementation study, supported by an R01 submission during the K23 award period. This training and research plan are consistent with the mission of the National Institutes of Health and the National Institute of Child Health and Human Development, the Healthy People 2020 objectives from the United States Department of Health and Human Services, and the 2009 Academic Emergency Medicine consensus recommendations for addressing public health problems in the ED setting.

青少年关系受害（ARV），其特征是身体、性、网络或心理虐待， 尽管实施了证据，生殖胁迫或性剥削仍然非常普遍 基于学校和社区环境的干预措施。负面结果，包括学业成绩不佳 成就、怀孕、性传播感染、饮食失调、自杀和他杀，导致 给个人和社会带来巨大成本。急诊科 (ED) 提供独特的机会 促进健康的关系并减轻抗逆转录病毒药物对高危青少年人群的负面影响。 然而，当前基于 ED 的关系干预措施受到 1) 基于披露的交付的限制，2) 解决有限形式的滥用问题，3) 功效有限，以及 4) 错失提供护理点的机会 减少危害资源。青少年关系的医疗保健教育评估和应对 (HEART) 干预措施可以通过以下方式解决这些问题： 1) 普遍提供教育和咨询， 2）全面解决全系列抗逆转录病毒药物问题。米勒博士（共同导师）之前的研究 已证实 HEART 能够有效降低 ARV 水平。然而，HEART 需要适应 ED 设置， 鉴于教育部与最初的预期环境之间存在显着的背景差异，学校健康 中心。 Randell 博士，儿科急诊医学医师，也是该职业发展的候选人 奖项，致力于以患者为导向的临床研究事业，以干预措施促进健康 青少年关系。她的五年职业发展计划包括结构化指导和正式培训 通过获取行为改变理论的专业知识来解决培训中的关键差距的教学法， 青少年行为研究、实施科学和青少年研究伦理的临床试验。这 拟议的研究通过提供干预实践经验来补充其他培训活动 适应和随机对照试验。确定 HEART 所需的增强功能后 在急诊室，兰德尔博士将进行一项随机对照试验，以评估八项可行性 构造。假设根据主要结局的定义，急诊室中的 HEART 是可行的 减少 ARV 的可接受性和有效性。理由是这项研究将产生第一个基于 ED 的 采取干预措施，利用普及教育全面解决抗逆转录病毒问题，同时提供 减少护理点伤害资源。研究结果将为更大的混合功效的开发提供信息- 实施研究，得到 K23 奖励期间提交的 R01 的支持。此次培训和 研究计划与美国国立卫生研究院和美国国立卫生研究院的使命一致 儿童健康和人类发展，美国国务院的“健康人民 2020”目标 卫生与公共服务部，以及 2009 年学术急诊医学共识建议 解决急诊室环境中的公共卫生问题。