Development and Pilot Testing of an Integrated Suicide Assessment and Safety Plan Digital Tool for Adolescent Outpatients

针对青少年门诊患者的综合自杀评估和安全计划数字工具的开发和试点测试

基本信息

批准号：
10575212
负责人：
LAURA P RICHARDSON
金额：
$ 27.34万
依托单位：
UNIVERSITY OF WASHINGTON
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：
2023-02-17 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10575212
关键词：
Address Adolescent Adolescent Risk Behavior Adolescent and Young Adult Age Algorithms Ambulatory Care Facilities Attention Behavior Caring Child Childhood Clinic Clinical Pathways Counseling Detection Development Electronics Emergency department visit Environment Feeling suicidal Future Goals Health Personnel High School Student Intervention Medical Mental Health Monitor Outcome Outpatients Parents Pathway interactions Pilot Projects Practice Guidelines Prevention Research Procedures Process Provider Qualitative Research Recommendation Registries Reporting Research Risk Management Safety Screening Result Screening procedure Self Efficacy Self Management Specialist Suicide Suicide attempt Suicide prevention Surveys System Technology Testing Time Training Work acceptability and feasibility age group clinical care coping design digital platform digital tool efficacy testing empowerment follow-up human centered design implementation design improved improved outcome mortality pilot test primary outcome prototype risk stratification safety assessment safety net screening shared decision making suicide rate therapy development timeline tool treatment as usual usability

项目摘要

ABSTRACT Suicide is the second leading cause of mortality among adolescents and young adults (AYA) and rates of suicide and emergency department visits for suicide attempts have been increasing in this age group over the past decade.1-3 Outpatient medical settings may serve as a safety net to improve the detection, management, and outcomes for AYA with suicidal ideation.4-8 Improving outcomes requires interventions and tools that are designed for implementation in the fast-paced outpatient medical setting. Practice guidelines and toolkits recommend that a positive suicide screening be followed by a full assessment and safety planning.9-11 However, healthcare providers in outpatient medical settings have few supports to complete this work. In this R34 application, we propose to use Human-Centered Design strategies12 with AYA, parents, and healthcare providers to build and optimize an Integrated Screening and Safety Planning (ISSP) tool for AYA who screen positive for suicidal ideation in pediatric outpatient medical settings. The tool will include: 1) safety assessment, 2) algorithms for risk stratification and decision support for HCPs to guide next steps of care, 3) integrated tools for collaborative safety plan completion with means restriction counseling, and 4) creation of a registry to improve tracking and follow-up. We then conduct a pilot study with 100 AYA (ages 13-21) in three outpatient clinics, comparing use of the ISSP tool to the usual care Seattle Children's clinical pathway on the primary outcomes of AYA Suicide-Related Coping, Parent Suicide Prevention Self-Efficacy, and Provider Suicide Management Self-Efficacy using a pre-post design. Parents and AYA will complete surveys at baseline, and 1- and 2-month follow ups, and healthcare providers will complete surveys at three time points: prior to the control period, after the control period, and after the intervention period. ISSP provides the opportunity to engage stakeholders and co-design technology that addresses a key challenge in the assessment of suicidal ideation in medical settings: moving beyond screening to a focus on improving the completion of screening in a way that empowers AYA, HCPs and parents. If successful, this tool has the potential for future broad dissemination including adaptations to other medical settings and for use with other age groups. A key strength of our proposal is the focus on implementation needs alongside intervention development which will shorten the timeline for tests of efficacy in an R01 trial as well as future dissemination efforts.

抽象的自杀是青少年和年轻人死亡的第二大原因（aya），率为自杀和急诊科进行自杀未遂的企图一直在增加过去十年。1-3门诊医疗环境可能是改善检测，管理，以及具有自杀意念的AYA的结果。4-8改善结果需要干预措施和工具专为在快节奏的门诊医疗环境中实施而设计。练习指南和工具包建议进行积极的自杀筛查，然后进行全面评估和安全计划。9-11 但是，门诊医疗环境中的医疗保健提供者几乎没有支持完成这项工作。在此R34应用程序中，我们建议使用以人为本的设计策略112与Aya，父母和医疗保健提供商将为AYA建立和优化综合筛选和安全计划（ISSP）工具谁筛选了儿科门诊医疗环境中自杀念头的阳性。该工具将包括：1）安全评估，2）HCP的风险分层和决策支持算法指导下一步的护理，3）通过限制咨询完成协作安全计划的整合工具，4）创建注册表以改善跟踪和随访。然后，我们在三个门诊诊所，将ISSP工具的使用与通常的护理西雅图儿童的临床途径进行比较与AYA自杀相关应对，父母预防自杀自我效能和提供者的主要结果使用前设计的自杀管理自杀自我效能。父母和Aya将完成调查基线以及1个月和2个月的随访，医疗保健提供者将在三个时间点完成调查：在控制期之前，在控制期之后和干预期之后。 ISSP提供了吸引利益相关者和共同设计技术的机会，以解决关键在评估医学环境中自杀念头的挑战：超越筛查的重点改善筛选的完成方式，以使AYA，HCP和父母能力。如果成功，此工具有可能将来进行广泛的传播，包括适应其他医疗环境以及与其他年龄段。我们建议的关键优势是专注于实施需求以及干预开发将缩短R01试验和未来传播的疗效测试时间表努力。