Intensive Crisis Intervention

强化危机干预

基本信息

批准号：
10676111
负责人：
Mary A. Fristad
金额：
$ 20.28万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-01 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10676111
关键词：
Acceleration Accident and Emergency department Acute Address Adherence Admission activity Adolescent Age Ambulatory Care Beds Behavioral Caring Case Series Catchment Area Cause of Death Child Childhood Clinical Clinical Management Cognitive Cognitive Therapy Communities Consumer Satisfaction Crisis Intervention Data Collection Effectiveness Eligibility Determination Enrollment Evaluation Evidence based treatment Family Family psychotherapy Feeling hopeless Feeling suicidal Goals Health Services Accessibility Hospitalization Inpatients Intervention Interview Knowledge Length of Stay Manuals Measures Mental disorders Methods Modeling National Institute of Mental Health Outcome Outcome Assessment Parents Patients Pediatric Hospitals Practical Robust Implementation and Sustainability Model Practice based research Procedures Process Protocols documentation Provider Psychiatric Hospitals Psychiatric therapeutic procedure Randomized Randomized, Controlled Trials Recommendation Research Risk Safety Secure Self-Injurious Behavior Services Suicide Suicide attempt Suicide prevention Supervision Surveys Symptoms Testing Therapeutic Time Training Treatment outcome Work Youth acceptability and feasibility alternative treatment base behavioral health clinical material effectiveness evaluation evidence base experience follow-up functional improvement high risk hospital readmission hybrid type 1 design implementation facilitators implementation intervention improved innovation inpatient psychiatric treatment inpatient service intervention refinement intrinsic motivation motivational enhancement therapy novel novel strategies pilot test pilot trial primary outcome readmission rates recruit reducing suicide response secondary outcome skills suicidal adolescent suicidal behavior suicidal risk suicide rate treatment effect trial comparing

项目摘要

Suicide is the second leading cause of death for US adolescents. Youth at highest risk of suicide are often ad- mitted to inpatient psychiatric units when safety in the community is unable to be maintained. However, access to these services has decreased over the last several decades as availability of adolescent inpatient psychiat- ric beds has steadily declined. Against this backdrop, inpatient admissions for suicidal behavior and intentional self-injury among youth have more than doubled from 2006 to 2015. Limited access to, and demand for these services has created the need for additional options to provide short-term crisis intervention and stabilization services in a secure setting. In direct response to PAR-20-286, this proposal examines high-impact practice- based research with near-term potential to address NIMH suicide prevention priorities. We previously devel- oped Intensive Crisis Intervention (ICI), a brief, evidence-based treatment that incorporates Family Therapy/ Parent Training, Cognitive Behavioral Therapy and Motivational Interviewing to target family functioning in re- ducing adolescent suicidal behavior. An open pilot trial on our Youth Crisis Stabilization Unit (YCSU) demon- strated that ICI is feasible, acceptable, and associated with improved clinical outcomes over a 3-month follow- up period. In addition, average length of stay for adolescents receiving ICI was 5.8 days briefer than those re- ceiving traditional psychiatric inpatient care. There were no significant differences in readmission rates or time to readmission across the two settings. We now propose to further develop and test ICI. We will recruit 80 ado- lescents presenting to Nationwide Children’s Hospital (NCH) Psychiatric Crisis Department with suicidal idea- tion and behavior that are eligible for admission to both the NCH YCSU and Adolescent Psychiatric Inpatient Unit. During Year 1, 20 adolescents and one of their parents/guardians will be enrolled in a nonrandomized case series. In-depth qualitative interviews with patients, parents, and providers will be used to further refine the ICI manual, training and supervision protocols, and fidelity/adherence measures, and identify barriers to, and facilitators of implementation and sustainability. In Years 2 and 3, 60 adolescents will be enrolled in a ran- domized controlled trial (RCT) comparing ICI with traditional inpatient psychiatric treatment. The project’s main goal is to examine feasibility, acceptability, research implementation procedures, and preliminary effectiveness of ICI using a mixed-methods approach. We hypothesize that ICI will be acceptable to families and show greater improvements in our proposed mechanism of change, family functioning, compared with traditional in- patient treatment at discharge, 30 days, and 3-month follow-up. Secondary aims will assess preliminary treat- ment effects of ICI on suicidal ideation, attempts, ED/hospital admission, hopelessness and therapeutic alli- ance. This application builds directly from our initial promising findings as the next step in strengthening the research evidence base and pragmatic clinical materials for ICI as an effective model of care for adolescent suicidal behavior that can be implemented and sustained across diverse pediatric settings to help save lives.

自杀是美国青少年的第二大死因，自杀风险最高的青少年往往是自杀者。当社区安全无法维持时，可转入住院精神病科。在过去的几十年里，由于青少年住院精神病患者的可获得性，这些服务的数量有所减少。在此背景下，因自杀行为和故意而入院的病人数量稳步下降。从 2006 年到 2015 年，青少年自伤的数量增加了一倍多。获得这些服务的机会和需求有限服务需要额外的选择来提供短期危机干预和稳定在安全环境中提供服务作为对 PAR-20-286 的直接回应，该提案审查了高影响力的实践 - 我们之前开发了具有近期潜力解决 NIMH 自杀预防优先事项的研究。强化危机干预（ICI），一种简短的、基于证据的治疗，结合了家庭治疗/ 家长培训、认知行为治疗和动机访谈，以重新定位家庭功能减少青少年自杀行为。我们的青年危机稳定部门（YCSU）恶魔的公开试点试验分层认为 ICI 是可行的、可接受的，并且与 3 个月随访期间临床结果的改善相关此外，接受 ICI 的青少年平均住院时间比接受 ICI 的青少年短 5.8 天。接受传统精神科住院治疗的患者的再入院率或时间没有显着差异。我们现在建议进一步开发和测试 ICI，我们将招募 80 名 ado-。到全国儿童医院 (NCH) 精神危机科就诊并有自杀念头的儿童 - 符合入住 NCH YCSU 和青少年精神病院的条件和行为第一年期间，20 名青少年及其一名家长/监护人将参加非随机分组。将利用对患者、家长和提供者的深入定性访谈来进一步完善。 ICI 手册、培训和监督协议以及忠诚/遵守措施，并找出障碍，在第二年和第三年，60 名青少年将参加一项随机项目。比较 ICI 与传统住院精神科治疗的随机对照试验 (RCT) 该项目的主要内容。目标是检查可行性、可接受性、实施研究程序和初步有效性我们勇敢地相信 ICI 将被家庭接受并表明。与传统的家庭功能相比，我们提出的变革机制、家庭功能得到了更大的改进。患者出院时的治疗、30 天和 3 个月的随访将评估初步治疗。 ICI 对自杀意念、企图、急诊室/入院、绝望和治疗等的影响该应用程序直接基于我们最初有希望的发现构建，作为加强的下一步。 ICI 作为青少年护理的有效模式的研究证据基础和实用临床材料可以在不同的儿科环境中实施和维持自杀行为，以帮助拯救生命。