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: 10570213
• 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/10570213
• 关键词: Academic achievement; Accident and Emergency department; Address; Adolescent; Age; Behavior; Behavior Therapy; Behavioral Research; Clinical Research; Clinical Trials; Complement; Consensus; Counseling; Data; Development; Development Plans; Disclosure; Dropout; Drops; Eating Disorders; Education; Educational Assessment; Educational Intervention; Emergency Care; Emergency Department evaluation; Emergency Department-based Intervention; Emergency Medicine; Emergency department visit; Evaluation; Evidence based intervention; Feasibility Studies; Female Adolescents; 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, Controlled Trials; Recommendation; Reporting; Research; Research Ethics; Resources; Risk; Risk Factors; Schools; Sexual Health; Sexually Transmitted Diseases; Societies; Speed; Structure; 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; behavior change; brief intervention; care seeking; career; career development; clinical practice; community engagement; community setting; comparison control; condoms; cost; design; early childbearing; effective intervention; efficacy testing; efficacy/implementation trial; emergency contraception; emotional abuse; experience; feasibility trial; follow-up; high-risk adolescents; implementation science; implementation study; improved; motivational enhancement therapy; novel; patient oriented; pediatric emergency; point of care; prevent; primary care provider; primary outcome; programs; reproductive coercion; response; school based health center; skills; suicidal; 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，但生殖胁迫或性剥削仍然很普遍 基于学校和社区环境的干预措施。负面结果，包括次优学术 成就，怀孕，性传播感染，饮食失调，自杀性和杀人罪，导致 对个人和社会的巨大成本。急诊室（ED）提供了独特的机会 促进健康的关系并减轻ARV在高危青少年人群中的负面影响。 但是，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形式，3）有限的效力，4）错过提供护理点的机会 损害减少资源。青少年关系的医疗教育评估和回应 （心脏）干预可以通过1）普遍提供教育和咨询，解决这些问题， 2）全面解决了ARV的全部范围。 Miller博士先前的研究 表现出心脏降低ARV的功效。但是，心脏需要适应ED设置， 鉴于ED与最初预期的环境之间的明显上下文差异，学校健康 中心。 Randell博士，儿科急诊医学医师和此职业发展的候选人 奖励，致力于以患者为导向的临床研究职业，以促进健康 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 通过获得行为改变理论的专业知识，可以解决她在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 拟议的研究通过实现干预方面的实践经验来补充其他培训活动 适应和随机对照试验。识别心脏所需的增强功能 ED设置Randell博士将进行一项随机对照试验，以评估八个可行性 构造。假设是ED中的心脏将是可行的，如由 可接受性和功效可降低ARV。理由是这项研究将产生第一个基于ED的 干预以利用普遍教育来全面解决ARV，并提供 减少危害的危害资源。研究结果将为较大的混合功效的发展提供信息 - 实施研究，在K23奖励期间由R01提交的支持。这个训练和 研究计划与美国国立卫生研究院和国家研究所的使命一致 儿童健康和人类发展，健康的人民2020年的目标 卫生和公共服务以及2009年的学术急诊医学共识建议 在ED环境中解决公共卫生问题。