Optimizing Suicide Prevention Strategies for Pediatric Primary Care

优化儿科初级保健的自杀预防策略

基本信息

批准号：
10649853
负责人：
STEPHANIE D STEPP
金额：
$ 25.61万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-19 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10649853
关键词：
Academy Accident and Emergency department Address Adolescent American Attitude Behavior Behavioral Belief Cellular Phone Child Childhood Clinical Cognitive Collaborations Communication Comprehension Data Depressed mood Depression screen Development Distress Effectiveness Emergency Situation Feedback Feeling suicidal Focus Groups Future Goals Health Personnel Health Services Human Individual Intervention Intervention Studies Interview Medical Mental Depression Mental Health Methods Modality National Institute of Mental Health Online Systems Outcome Parents Pediatric Research Pediatrics Prevention strategy Primary Care Provider Randomized Recommendation Research Research Support Resources Risk Rural Safety Severities Site Suicide Suicide prevention Survey Methodology Surveys Technology Teenagers Testing Visit Work Youth adolescent suicide aged animation automated text message behavioral health computer human interaction computerized coping cost depressive symptoms design digital distress tolerance effectiveness testing effectiveness/implementation trial emotion regulation follow-up future implementation high risk implementation strategy integrated care intervention delivery parental involvement pediatrician pilot trial practice setting practice-based research network preference preventive intervention primary care practice primary care provider primary care setting prototype psychoeducation psychoeducational randomized trial recruit routine provider screening service delivery skills suburb suicidal adolescent suicidal behavior suicidal risk suicide rate text messaging intervention treatment as usual usability

项目摘要

PROJECT SUMMARY/ABSTRACT This proposal responds to the youth suicide crisis by optimizing a suicide prevention intervention delivery strategy that is feasible, acceptable, and scalable in pediatric primary care (PPC). Although PPC providers routinely identify at-risk youth, no suicide prevention intervention is suited for the immediate, in-office delivery that this clinical situation demands. In our prior work, we developed and tested the effectiveness of an integrated adolescent suicide prevention intervention, iCHART (integrated Care to Help At-Risk Teens), in a controlled, academic PPC setting that relied on behavioral health (BH) providers. iCHART consists of: 1) Screening Wizard, a web-based enhanced screener to aid PPC providers in treatment decisions; 2) BRITE, an app-supported intervention that guides youth in developing a personalized, smartphone-based safety plan; and 3) Text2Connect, an automated texting intervention that motivates youth to follow providers’ recommendations. The original version of iCHART components showed feasibility, usability, and acceptability across youth, parents, and providers and preliminary effectiveness in enhancing BH referral, referral follow-through, and decreasing depression. However, a critical gap remains in equipping front line pediatricians, who generally lack access to onsite BH providers, with suicide prevention intervention strategies that are feasible, usable, and acceptable for their workflows and in their setting. This proposal aims to address this gap through the development of a computerized version of As Safe As Possible (cASAP) to deliver aspects of the iCHART intervention that required BH support (i.e., psychoeducation about safety planning, cognitive-behavioral skills to cope with distress, and facilitate collaboration with parents). In the proposed study, we will partner with the American Academy of Pediatrics (AAP) national PPC practice-based research network, Pediatric Research in Office Settings (PROS) to develop and test a version of iCHART that can be provided in the PPC setting without onsite BH providers, termed iCHART-cASAP. In this proposal, we will draw upon our extensive expertise in human-computer interaction (HCI) methods and user studies with youth, parents, and PPC providers, to inform the technology design of a computerized version of ASAP (cASAP) to provide youth and parents information about safety planning, cognitive behavioral skills to cope with distress, and parent communication with youth about their mental health. We will then conduct a stepped wedge pilot randomized trial with 60 youth aged 12-17 at risk for suicide (past month suicide ideation/attempt) identified in PPC. We will compare iCHART-cASAP to usual care and the impact on depression and suicide risk at 1-, 3-, and 6-month follow-up. Following the pilot trial, we will conduct a mixed methods study with PPC providers to develop an accompanying implementation strategy. Our findings will inform a future, fully powered R01 effectiveness-implementation trial in the PROS network and in partnership with the AAP to test iCHART-cASAP’s impact on identification, treatment engagement, safety planning, and ultimately, suicidal behavior.

项目概要/摘要该提案通过优化自杀预防干预措施来应对青少年自杀危机尽管 PPC 提供者认为该策略在儿科初级保健 (PPC) 中是可行的、可接受的且可扩展的。常规识别高危青少年，没有自杀预防干预措施适合立即在办公室分娩在我们之前的工作中，我们开发并测试了集成的有效性。青少年自杀预防干预，iCHART（帮助高危青少年的综合护理），在受控的、依赖于行为健康 (BH) iCHART 提供者的学术 PPC 设置包括：1) 筛选向导，基于网络的增强筛选器，可帮助 PPC 提供者做出治疗决策 2) BRITE，一款由应用程序支持的应用程序；指导青少年制定基于智能手机的个性化安全计划的干预措施；以及 3) Text2Connect，一种自动短信干预措施，可激励年轻人遵循提供商的建议。 iCHART 组件的原始版本显示了青少年、家长和社区的可行性、可用性和可接受性。和提供者以及在增强 BH 转诊、转诊跟进和减少然而，在为一线儿科医生提供装备方面仍然存在严重差距，他们通常缺乏获得治疗的机会。现场 BH 提供者提供可行、可用且可接受的自杀预防干预策略他们的工作流程和设置旨在通过开发解决这一差距。尽可能安全 (cASAP) 的计算机化版本，用于提供 iCHART 干预所需的各个方面 BH 支持（即有关安全计划的心理教育、应对痛苦的认知行为技能以及促进与家长的合作）。在拟议的研究中，我们将与美国科学院合作。儿科 (AAP) 国家 PPC 基于实践的研究网络、办公室环境中的儿科研究 (PROS) 开发和测试可在 PPC 设置中提供的 iCHART 版本，无需现场 BH 提供商，在此提案中，我们将利用我们在人机方面的丰富专业知识。与青少年、家长和 PPC 提供商的互动 (HCI) 方法和用户研究，为技术提供信息设计计算机化版本的 ASAP (cASAP)，为青少年和家长提供有关安全的信息计划、应对困扰的认知行为技能以及家长与青少年就他们的问题进行沟通然后，我们将对 60 名 12-17 岁有心理健康风险的青少年进行阶梯式楔形试点随机试验。 PPC 中发现的自杀（过去一个月的自杀意念/企图）我们将比较 iCHART-cASAP 与常规护理。以及在试点试验后 1、3 和 6 个月的随访中对抑郁和自杀风险的影响。与 PPC 提供商进行混合方法研究，以制定相应的实施策略。研究结果将为未来在 PROS 网络和中进行全面支持的 R01 有效性实施试验提供信息与 AAP 合作测试 iCHART-cASAP 对识别、治疗参与度、安全性的影响计划，并最终导致自杀行为。